RT Journal Article
SR Electronic
T1 Predictors and Outcomes of Periprocedural Intracranial Hemorrhage after Stenting for Symptomatic Intracranial Atherosclerotic Stenosis
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A8379
A1 Kang, Kaijiang
A1 Gong, Peipei
A1 Gao, Feng
A1 Mo, Dapeng
A1 Zhao, Xingquan
A1 Miao, Zhongrong
A1 Ma, Ning
YR 2024
UL http://www.ajnr.org/content/early/2024/10/10/ajnr.A8379.abstract
AB BACKGROUND AND PURPOSE: Periprocedural intracranial hemorrhage is one of common complications after stent placement for symptomatic intracranial atherosclerotic stenosis. This study was conducted to demonstrate predictors and long-term outcomes of periprocedural intracranial hemorrhage after stent placement for symptomatic intracranial atherosclerotic stenosis.MATERIALS AND METHODS: We retrospectively analyzed patients with symptomatic intracranial atherosclerotic stenosis stent placement in a prospective cohort at a high-volume stroke center. Clinical, radiologic, and periprocedural characteristics and long-term outcomes were reviewed. Periprocedural intracranial hemorrhage was classified as procedure-related hemorrhage (PRH) and non-procedure-related hemorrhage (NPRH). The long-term outcomes were compared between patients with PRH and NPRH, and the predictors of NPRH were explored.RESULTS: Among 1849 patients, 24 (1.3%) had periprocedural intracranial hemorrhage, including PRH (4) and NPRH (20). The postprocedural 30-day mRS was 0−2 in 9 (37.5%) cases, 3−5 in 5 (20.8%) cases, and 6 in 10 (41.7%) cases. For the 14 survivors, the long-term (median of 78 months) mRS were 0−2 in 10 (76.9%) cases and 3−5 in 3 (23.1%) cases. The proportion of poor long-term outcomes (mRS ≥3) in patients with NPRH was significantly higher than those with PRH (68.4% versus 0%, P = .024). Anterior circulation (P = .002), high preprocedural stenosis rate (P < .001), and cerebral infarction within 30 days (P = .006) were independent predictors of NPRH after stent placement.CONCLUSIONS: Patients with NPRH had worse outcomes than those with PRH after stent placement for symptomatic ICAS. Anterior circulation, severe preprocedural stenosis, and recent infarction are independent predictors of NPRH.CASSISSChina Angioplasty & Stenting for Symptomatic Intracranial Severe Stenosis StudyICASintracranial atherosclerotic stenosisNPRHnon-procedure-related hemorrhagePRHprocedure-related hemorrhageSAMMPRISStenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial StenosisVISSITVitesse Intracranial Stent Study for Ischemic Therapy