Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis

W. F. Morrish, S. Grahovac, A. Douen, G. Cheung, W. Hu, R. Farb, P. Kalapos, R. Wee, M. Hudon, C. Agbi, M. Richard

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND PURPOSE: The transluminal angioplasty and stenting procedure has been recently advocated as a potential alternative to surgical endarterectomy for the treatment of severe extracranial carotid stenosis. This study assesses the incidence and significance of intracranial hemorrhage occurring after this procedure. METHODS: We retrospectively reviewed 104 carotid arteries (96 internal, two external, and six common) in 90 patients (63 male; mean age, 69.4 years; range, 48-88 years) who underwent primary stenting and angioplasty by use of Wallstents (103/104) at three centers between January 1996 and January 1999. Seventy-five (83%) patients were referred by neurosurgery departments. Seventy-one (68%) arteries were symptomatic; the mean stenosis percentage was 85% (range, 40-99%). RESULTS: Four intraparenchymal hemorrhages occurred, representing 4.4% of patients and 3.8% of vessels, after angioplasty and stent placement. The mean preoperative stenosis percentage was 95% (range, 90-99%). One hemorrhage occurred immediately after stent placement, whereas the three other hemorrhages occurred in a delayed fashion (mean, 2.8 days). The mean hematoma size was 4.8 cm (range, 2-8 cm). Three patients had associated subarachnoid or intraventricular bleeding; the fourth had associated subdural hemorrhage. Three hemorrhages were fatal; the fourth experienced two seizures only. No acute neurologic symptoms were present prior to hemorrhages, and there was no postprocedural hypertension in these patients. All had been receiving antiplatelet agents as well as intraprocedural IV heparin. CONCLUSION: Intracranial hemorrhage can occur after carotid angioplasty and stenting. We speculate that this represents cerebral hyperperfusion injury. The 3.8% incidence of cerebral hemorrhage observed is approximately sixfold greater than that reported post endarterectomy (0.6%) (95% CI, 0.2-8.7%). This is not statistically significant in this small study group. This trend may reflect patient selection, different anticoagulation protocols, and/or study population size. Additional data are needed to determine the safety and efficiency of carotid stenting as a treatment for carotid stenosis.

Original languageEnglish (US)
Pages (from-to)1911-1916
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume21
Issue number10
StatePublished - Nov 29 2000

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Intracranial Hemorrhages
Carotid Stenosis
Angioplasty
Hemorrhage
Endarterectomy
Stents
Pathologic Constriction
Subdural Hematoma
Platelet Aggregation Inhibitors
Cerebral Hemorrhage
Neurosurgery
Internal Carotid Artery
Neurologic Manifestations
Population Density
Hematoma
Patient Selection
Heparin
Seizures
Cohort Studies
Arteries

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Morrish, W. F., Grahovac, S., Douen, A., Cheung, G., Hu, W., Farb, R., ... Richard, M. (2000). Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis. American Journal of Neuroradiology, 21(10), 1911-1916.
Morrish, W. F. ; Grahovac, S. ; Douen, A. ; Cheung, G. ; Hu, W. ; Farb, R. ; Kalapos, P. ; Wee, R. ; Hudon, M. ; Agbi, C. ; Richard, M. / Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis. In: American Journal of Neuroradiology. 2000 ; Vol. 21, No. 10. pp. 1911-1916.
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title = "Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis",
abstract = "BACKGROUND AND PURPOSE: The transluminal angioplasty and stenting procedure has been recently advocated as a potential alternative to surgical endarterectomy for the treatment of severe extracranial carotid stenosis. This study assesses the incidence and significance of intracranial hemorrhage occurring after this procedure. METHODS: We retrospectively reviewed 104 carotid arteries (96 internal, two external, and six common) in 90 patients (63 male; mean age, 69.4 years; range, 48-88 years) who underwent primary stenting and angioplasty by use of Wallstents (103/104) at three centers between January 1996 and January 1999. Seventy-five (83{\%}) patients were referred by neurosurgery departments. Seventy-one (68{\%}) arteries were symptomatic; the mean stenosis percentage was 85{\%} (range, 40-99{\%}). RESULTS: Four intraparenchymal hemorrhages occurred, representing 4.4{\%} of patients and 3.8{\%} of vessels, after angioplasty and stent placement. The mean preoperative stenosis percentage was 95{\%} (range, 90-99{\%}). One hemorrhage occurred immediately after stent placement, whereas the three other hemorrhages occurred in a delayed fashion (mean, 2.8 days). The mean hematoma size was 4.8 cm (range, 2-8 cm). Three patients had associated subarachnoid or intraventricular bleeding; the fourth had associated subdural hemorrhage. Three hemorrhages were fatal; the fourth experienced two seizures only. No acute neurologic symptoms were present prior to hemorrhages, and there was no postprocedural hypertension in these patients. All had been receiving antiplatelet agents as well as intraprocedural IV heparin. CONCLUSION: Intracranial hemorrhage can occur after carotid angioplasty and stenting. We speculate that this represents cerebral hyperperfusion injury. The 3.8{\%} incidence of cerebral hemorrhage observed is approximately sixfold greater than that reported post endarterectomy (0.6{\%}) (95{\%} CI, 0.2-8.7{\%}). This is not statistically significant in this small study group. This trend may reflect patient selection, different anticoagulation protocols, and/or study population size. Additional data are needed to determine the safety and efficiency of carotid stenting as a treatment for carotid stenosis.",
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Morrish, WF, Grahovac, S, Douen, A, Cheung, G, Hu, W, Farb, R, Kalapos, P, Wee, R, Hudon, M, Agbi, C & Richard, M 2000, 'Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis', American Journal of Neuroradiology, vol. 21, no. 10, pp. 1911-1916.

Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis. / Morrish, W. F.; Grahovac, S.; Douen, A.; Cheung, G.; Hu, W.; Farb, R.; Kalapos, P.; Wee, R.; Hudon, M.; Agbi, C.; Richard, M.

In: American Journal of Neuroradiology, Vol. 21, No. 10, 29.11.2000, p. 1911-1916.

Research output: Contribution to journalArticle

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T1 - Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis

AU - Morrish, W. F.

AU - Grahovac, S.

AU - Douen, A.

AU - Cheung, G.

AU - Hu, W.

AU - Farb, R.

AU - Kalapos, P.

AU - Wee, R.

AU - Hudon, M.

AU - Agbi, C.

AU - Richard, M.

PY - 2000/11/29

Y1 - 2000/11/29

N2 - BACKGROUND AND PURPOSE: The transluminal angioplasty and stenting procedure has been recently advocated as a potential alternative to surgical endarterectomy for the treatment of severe extracranial carotid stenosis. This study assesses the incidence and significance of intracranial hemorrhage occurring after this procedure. METHODS: We retrospectively reviewed 104 carotid arteries (96 internal, two external, and six common) in 90 patients (63 male; mean age, 69.4 years; range, 48-88 years) who underwent primary stenting and angioplasty by use of Wallstents (103/104) at three centers between January 1996 and January 1999. Seventy-five (83%) patients were referred by neurosurgery departments. Seventy-one (68%) arteries were symptomatic; the mean stenosis percentage was 85% (range, 40-99%). RESULTS: Four intraparenchymal hemorrhages occurred, representing 4.4% of patients and 3.8% of vessels, after angioplasty and stent placement. The mean preoperative stenosis percentage was 95% (range, 90-99%). One hemorrhage occurred immediately after stent placement, whereas the three other hemorrhages occurred in a delayed fashion (mean, 2.8 days). The mean hematoma size was 4.8 cm (range, 2-8 cm). Three patients had associated subarachnoid or intraventricular bleeding; the fourth had associated subdural hemorrhage. Three hemorrhages were fatal; the fourth experienced two seizures only. No acute neurologic symptoms were present prior to hemorrhages, and there was no postprocedural hypertension in these patients. All had been receiving antiplatelet agents as well as intraprocedural IV heparin. CONCLUSION: Intracranial hemorrhage can occur after carotid angioplasty and stenting. We speculate that this represents cerebral hyperperfusion injury. The 3.8% incidence of cerebral hemorrhage observed is approximately sixfold greater than that reported post endarterectomy (0.6%) (95% CI, 0.2-8.7%). This is not statistically significant in this small study group. This trend may reflect patient selection, different anticoagulation protocols, and/or study population size. Additional data are needed to determine the safety and efficiency of carotid stenting as a treatment for carotid stenosis.

AB - BACKGROUND AND PURPOSE: The transluminal angioplasty and stenting procedure has been recently advocated as a potential alternative to surgical endarterectomy for the treatment of severe extracranial carotid stenosis. This study assesses the incidence and significance of intracranial hemorrhage occurring after this procedure. METHODS: We retrospectively reviewed 104 carotid arteries (96 internal, two external, and six common) in 90 patients (63 male; mean age, 69.4 years; range, 48-88 years) who underwent primary stenting and angioplasty by use of Wallstents (103/104) at three centers between January 1996 and January 1999. Seventy-five (83%) patients were referred by neurosurgery departments. Seventy-one (68%) arteries were symptomatic; the mean stenosis percentage was 85% (range, 40-99%). RESULTS: Four intraparenchymal hemorrhages occurred, representing 4.4% of patients and 3.8% of vessels, after angioplasty and stent placement. The mean preoperative stenosis percentage was 95% (range, 90-99%). One hemorrhage occurred immediately after stent placement, whereas the three other hemorrhages occurred in a delayed fashion (mean, 2.8 days). The mean hematoma size was 4.8 cm (range, 2-8 cm). Three patients had associated subarachnoid or intraventricular bleeding; the fourth had associated subdural hemorrhage. Three hemorrhages were fatal; the fourth experienced two seizures only. No acute neurologic symptoms were present prior to hemorrhages, and there was no postprocedural hypertension in these patients. All had been receiving antiplatelet agents as well as intraprocedural IV heparin. CONCLUSION: Intracranial hemorrhage can occur after carotid angioplasty and stenting. We speculate that this represents cerebral hyperperfusion injury. The 3.8% incidence of cerebral hemorrhage observed is approximately sixfold greater than that reported post endarterectomy (0.6%) (95% CI, 0.2-8.7%). This is not statistically significant in this small study group. This trend may reflect patient selection, different anticoagulation protocols, and/or study population size. Additional data are needed to determine the safety and efficiency of carotid stenting as a treatment for carotid stenosis.

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Morrish WF, Grahovac S, Douen A, Cheung G, Hu W, Farb R et al. Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis. American Journal of Neuroradiology. 2000 Nov 29;21(10):1911-1916.