Neurointervention.  2019 Sep;14(2):107-115. 10.5469/neuroint.2019.00108.

Clinical Impact of Intracerebral Hemorrhage after Hyperacute Extracranial Stenting in Patients with Ischemic Stroke

Affiliations
  • 1Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea. jinsoo22@gmail.com
  • 2Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.
  • 3Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.
  • 4Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea.
  • 5Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea.
  • 6Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
  • 7Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea.

Abstract

PURPOSE
Emergent intracranial occlusions causing acute ischemic stroke are often related to extracranial atherosclerotic stenosis. This study aimed to investigate the association between post-procedure intracerebral hemorrhage (ICH) and emergent extracranial artery stenting and assess their effects on clinical outcomes in patients with acute ischemic stroke.
MATERIALS AND METHODS
We retrospectively analyzed patients undergoing hyperacute endovascular treatment for cervicocephalic vascular occlusion in three Korean hospitals between January 2011 and February 2016. Patients who had extracranial artery involvement and were treated from 24 hours of symptom onset to puncture were included in this study, and they were divided into the extracranial stenting (ES) and non-ES groups. Any type of petechial hemorrhages and parenchymal hematoma was defined as ICH for the current study.
RESULTS
In total, 76 patients were included in this study. Among them, 56 patients underwent ES, and 20 patients did not. Baseline characteristics, risk factors, laboratory data, treatment methods, successful reperfusion rates, and baseline stenotic degrees of extracranial internal carotid artery did not differ between these two groups. However, atrial fibrillation was more frequent in patients without than with ES (P=0.002), and post-procedure ICH was more frequent in patients with than without ES (P=0.035). Logistic regression models revealed that ES was independently associated with post-procedure ICH (odds ratio [OR], 7.807; 95% confidence interval [CI], 1.213-50.248; P=0.031), and ICH was independently associated with poor clinical outcomes (OR, 0.202; 95% CI, 0.054-0.759; P=0.018); however, ES itself was not associated with clinical outcomes (OR, 0.530; 95% CI, 0.117-2.395; P=0.409). Notably, ICH and ES had interaction for predicting good outcomes (P=0.041).
CONCLUSION
Post-procedure ICH was associated with ES and poor clinical outcomes. Therefore, ES should be cautiously considered in patients with hyperacute stroke.

Keyword

Carotid stenosis; Stents; Cerebral infarction; Endovascular procedures; Cerebral hemorrhage

MeSH Terms

Arteries
Atrial Fibrillation
Carotid Artery, Internal
Carotid Stenosis
Cerebral Hemorrhage*
Cerebral Infarction
Constriction, Pathologic
Endovascular Procedures
Hematoma
Hemorrhage
Humans
Logistic Models
Punctures
Reperfusion
Retrospective Studies
Risk Factors
Stents*
Stroke*
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