Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis

BACKGROUND AND PURPOSE: The transluminal angioplasty and stenting procedure has been recently advocated as a potential alternative to surgical endarte rectomy for the treatment of severe extracranial carotid stenosis, This stu dy assesses the incidence and significance of intracranial hemorrhage occur ring 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; r ange, 48-88 years) who underwent primary stenting and angioplasty by use of Wallstents (103/104) at three centers between January 1996 and January 199 9. Seventy-five (83%) patients were referred by neurosurgery departments, S eventy-one (68%) arteries were symptomatic; the mean stenosis percentage wa s 85% (range, 40-99%), RESULTS: Four intraparenchymal hemorrhages occurred, representing 4.4% of p atients and 3.8% of vessels, after angioplasty and stent placement. The mea n preoperative stenosis percentage was 95% (range, 90-99%), One hemorrhage occurred immediately after stent placement, whereas the three other hemorrh ages 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. T hree hemorrhages were fatal; the fourth experienced two seizures only. No a cute neurologic symptoms were present prior to hemorrhages, and there was n o postprocedural hypertension in these patients. All had been receiving ant iplatelet 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 sixfo ld 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 tre nd may reflect patient selection, different anticoagulation protocols, and/ or study population size, Additional data are needed to determine the safet y and efficiency of carotid stenting as a treatment for carotid stenosis.