Treatment and Outcome of Intracranial Hemorrhage after Carotid Artery Stenting

Intracranial hemorrhage following carotid artery stenting (CAS) is a rare but potentially devastating complication. The present study reviewed intracranial hemorrhage cases from patients undergoing CAS in ten years to find the methods to rescue patients from this fatal complication. Patients with postoperative intracranial hemorrhage following CAS were retrospectively selected, and clinical features, treatments and outcomes were studied. Ten patients with intracranial hemorrhage were identified. The mean onset time of hemorrhage was 6.1 ± 7.1 h. Intracerebral hemorrhage occurred in eight patients and SAH in two patients. The patients were treated by stopping anti-platelet and anticoagulant for at least three days, and surgical drainage of the hematoma/ventricle drainage or conservative treatment. Six patients survived, two had left moderate paralysis, four had a good recovery at four week follow-up, and four patients died. No patients underwent thrombosis in stent after withdrawing of antiplatelet and anticoagulant. Intracranial hemorrhage after CAS occurs usually in a few hours and leads to catastrophic results. Once patients have intracranial hemorrhage, good neurocritical care may help to save them. Stopping antiplatelet and anticoagulant for at least three days may avoid thrombosis in the stenting site.

Download Full-text

Fatal intracranial hemorrhage after carotid artery stenting: Three case reports and a literature review

Journal of International Medical Research ◽

10.1177/0300060520937576 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052093757

Author(s):

Yumiao Zhou ◽

Chaobo Zheng ◽

Liang Chen ◽

Yuanyuan Lin

Keyword(s):

Carotid Artery ◽

Intracranial Hemorrhage ◽

Carotid Artery Stenting ◽

Case Reports ◽

Case Presentation ◽

Risk Patients ◽

Basal Ganglia Hemorrhage ◽

The Mean ◽

Mean Time ◽

Careful Screening

Introduction We herein describe three patients who developed fatal intracranial hemorrhage (ICH) after carotid artery stenting (CAS). Case Presentation: We retrospectively reviewed 126 patients who underwent CAS from January 2016 to December 2018 and identified 3 patients (2.4%) (all male, mean age of 59 years) who developed ICH after CAS. Two of them developed left basal ganglia hemorrhage with extension into the ventricle and subarachnoid space, and the third patient developed primary ventricular bleeding. One hemorrhage occurred immediately after CAS, whereas the other two occurred 3 hours and 8 hours after the procedure, respectively. The mean stenosis of the treated carotid arteries was 91%. All three hemorrhages were fatal, and the mean time from hemorrhage to death was 50 hours. Conclusion ICH is a potentially fatal complication of CAS and often occurs several hours after the procedure. Headache, vomiting, and consciousness disorders are the most common symptoms of ICH. Careful screening to identify high-risk patients and strict management of perioperative blood pressure are important to prevent this complication.

Download Full-text

Carotid Artery Stenting for Stenosis following Revascularization or Cervical Irradiation

Journal of Endovascular Therapy ◽

10.1177/152660280200900103 ◽

2002 ◽

Vol 9 (1) ◽

pp. 14-19 ◽

Cited By ~ 24

Author(s):

Pierre Alric ◽

Pascal Branchereau ◽

Jean-Philippe Berthet ◽

Henri Mary ◽

Charles Marty-Ané

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Balloon Dilation ◽

Safe Alternative ◽

Carotid Revascularization ◽

Elapsed Time ◽

Carotid Stenoses ◽

Radiation Induced ◽

The Mean

Purpose: To assess the safety and efficacy of carotid artery stenting (CAS) for stenosis following revascularization or cervical irradiation. Methods: Twenty-two CAS procedures performed on 21 patients (20 men; mean age 69.3 years, range 58–87) from June 1997 to June 2000 were retrospectively reviewed. There were 5 radiation-induced carotid stenoses in 4 patients and 17 postsurgical restenoses. The mean interval between carotid revascularization and CAS was 48.1 months (range 6–264), while the elapsed time from irradiation to CAS was always >8 years (range 8–28). Seven patients screened during this period were excluded from CAS because of a duplex-defined >50% hypoechoic lesion and/or angiographic documentation of an irregular ulcerated stenosis. Results: Four Palmaz and 16 Wallstents were successfully deployed in 20 arteries; 1 access failure prompted conversion to surgery and a stent delivery failure resulted in 1 patient receiving balloon dilation only (technical success 91%). No complications were encountered in the periprocedural period, and no neurological events were observed during a mean follow-up of 16.6 months (range 3–36). One patient died at 20 months from an unrelated cause. One (4.8%) restenosis was detected after 1 year in the patient who did not receive a stent. Conclusions: CAS is a safe alternative to conventional surgery in patients with carotid artery stenosis following surgical revascularization or cervical irradiation provided preoperative testing excludes stenoses at risk for embolism.

Download Full-text

External carotid artery stenting in patients with ipsilateral internal carotid artery occlusion: Peri‐operative and 12‐month follow‐up

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.29563 ◽

2021 ◽

Author(s):

Hui Dong ◽

Xiongjing Jiang ◽

Yubao Zou ◽

Yang Chen ◽

Jining He ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Artery Stenting ◽

Internal Carotid ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

External Carotid Artery ◽

Internal Carotid Artery Occlusion ◽

External Carotid

Download Full-text

Carotid artery stenting and follow-up: Value of 64-MSCT angiography as complementary imaging method to color-coded duplex sonography

European Journal of Radiology ◽

10.1016/j.ejrad.2010.12.007 ◽

2012 ◽

Vol 81 (1) ◽

pp. 89-94 ◽

Cited By ~ 11

Author(s):

Richard Nolz ◽

Andreas Wibmer ◽

Dietrich Beitzke ◽

Stephan Gentzsch ◽

Andrea Willfort-Ehringer ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Duplex Sonography ◽

Imaging Method ◽

Color Coded Duplex Sonography ◽

Msct Angiography

Download Full-text

Changes on Cognitive Function after Carotid Artery Stenting in Patients with Severe Carotid Artery Stenosis: A Prospective, 3 Months Follow-up Study

Journal of the Korean Geriatrics Society ◽

10.4235/jkgs.2012.16.1.12 ◽

2012 ◽

Vol 16 (1) ◽

pp. 12-20 ◽

Cited By ~ 1

Author(s):

Ji Yoon Kang ◽

Hye Suk Kim ◽

Myung-Jin Kang ◽

Dae-Hyun Kim ◽

Jae-Kwan Cha ◽

...

Keyword(s):

Cognitive Function ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Artery Stenosis ◽

Follow Up Study

Download Full-text

Risk factors for hyperperfusion-induced intracranial hemorrhage after carotid artery stenting in patients with symptomatic severe carotid stenosis evaluation

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-013998 ◽

2018 ◽

Vol 11 (5) ◽

pp. 474-478 ◽

Cited By ~ 5

Author(s):

Lei Zhang ◽

Dongwei Dai ◽

Zifu Li ◽

Guoli Duan ◽

Yong-wei Zhang ◽

...

Keyword(s):

Risk Factors ◽

Carotid Artery ◽

Carotid Stenosis ◽

Intracranial Hemorrhage ◽

Carotid Artery Stenting ◽

Ct Perfusion ◽

Treatment Strategies ◽

Imaging Features ◽

Anterior Circulation ◽

Total Occlusion

BackgroundAnalyzing risk factors for hyperperfusion-induced intracranial hemorrhage (HICH) after carotid artery stenting (CAS) in patients with symptomatic severe carotid stenosis.MethodsThis study retrospectively analyzed clinical data of 210 patients, who had symptomatic severe carotid stenosis (70–99%) and received CAS treatment between June 2009 and June 2015, and evaluated the relationship of HICH with patients’ clinical baseline data, imaging features, and treatment strategies.ResultsSeven patients (3.3%) developed HICH after CAS. The incidence of HICH among patients with near total occlusion was significantly higher than among those without (10.1% vs 0%, P<0.001). Out of the seven, five had no development of either anterior or posterior circulations, and two had no development of anterior circulation and poor development of posterior circulation. Results showed that patients with poor compensation of Willis’ Circle were more likely to develop HICH compared with other patients (P<0.001). All patients received preoperative CT perfusion. TTP index was defined as the TTP ratio between the affected and contralateral side. The results showed that the TTP index was significantly different between the HICH group and non-HICH group (1.15±0.10 vs 1.30±0.15, P<0.001). An analysis of the ROC curve indicated that patients with TTP index >1.22 were more likely to develop HICH compared with other patients (sensitivity 100%, specificity 75.9%).ConclusionsPatients with severe unilateral carotid stenosis, the presence of near total occlusion, poor compensation of Willis’ Circle, and preoperative TTP index>1.22, have a higher risk of developing HICH after CAS.

Download Full-text

Pipeline embolization device treatment of internal carotid artery terminus aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014312 ◽

2018 ◽

Vol 11 (5) ◽

pp. 485-488 ◽

Cited By ~ 5

Author(s):

Amit Pujari ◽

Brian Matthew Howard ◽

Thomas P Madaelil ◽

Susana Libhaber Skukalek ◽

Anil K Roy ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Treatment Strategies ◽

Maximum Diameter ◽

Class Iii ◽

Pipeline Embolization Device ◽

Proximal Internal Carotid Artery ◽

The Mean

BackgroundThe pipeline embolization device (PED) is approved for the treatment of large aneurysms of the proximal internal carotid artery (ICA). Its off-label application in treating aneurysms located specifically at the ICA terminus (ICA-T) has not been studied.MethodsWe conducted a retrospective chart review of patients from 2011 to 7 treated with PEDs. Out of 365 patients, 10 patients with ICA-T aneurysms were included. Patient demographics, procedural information, follow-up imaging, and clinical assessments were recorded.ResultsMean age was 46.9 years (± 8.8), and 6 (60%) patients were women. The mean maximum diameter of the aneurysms treated was 14.7 mm (± 10.7) and the mean neck diameter was 9.3 mm (± 6.6). Reasons for presentation included six incidental findings, one acute subarachnoid hemorrhage (SAH), and three patients with prior SAH. Kamran–Byrne Occlusion Scale scores for the treated aneurysms were as follows: three class IV (complete obliteration), four class III (<50% filling in both height and width for fusiform aneurysms or residual neck for saccular aneurysms), one class II fusiform aneurysm, 1 class 0 saccular aneurysm (residual aneurysm body), and one not classified due to pipeline thrombosis. Two clinically asymptomatic complications were noted: one patient who had a small distal cortical SAH post PED and one patient whose stent was found to be thrombosed on follow-up angiogram. All patients were seen in follow-up, and no patients were found to have worsening of their pre-procedure modified Rankin Scale score.ConclusionThe PED has potential for treating ICA-T aneurysms not amenable to conventional treatment strategies. Further studies are warranted to confirm the long term outcomes.

Download Full-text

Long-term Follow-up of Blister Aneurysms of the Internal Carotid Artery

Neurosurgery ◽

10.1227/neu.0000000000000147 ◽

2013 ◽

Vol 73 (6) ◽

pp. 1026-1033 ◽

Cited By ~ 42

Author(s):

M. Yashar S. Kalani ◽

Joseph M. Zabramski ◽

Louis J. Kim ◽

Shakeel A. Chowdhry ◽

George A. C. Mendes ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Scale Score ◽

Glasgow Outcome Scale ◽

Internal Carotid ◽

Radiology Reports ◽

The Mean ◽

Operative Notes

Abstract BACKGROUND: Blister aneurysms of the internal carotid artery (ICA) are uncommon. There is a paucity of data on the long-term outcomes of patients. OBJECTIVE: To review our experience with the treatment of these lesions. METHODS: We retrospectively reviewed all aneurysms treated at our institution between 1994 and 2005. Relevant operative notes, radiology reports, and inpatient/outpatient records were reviewed. RESULTS: Seventeen patients (3 male, 14 female) with 18 blister aneurysms of the ICA were identified. The mean age was 44.6 years (range, 17–72; median, 42 years). Twelve patients (70.6%) presented with aneurysmal subarachnoid hemorrhage. The mean admission Glasgow Outcome Scale score was 4.3 (range, 2–5; median, 5). All patients were initially treated using microsurgical technique with direct clipping (n = 15; 83.3%) or clip-wrapping with Gore-Tex (n = 3, 16.7%). There were 4 cases of intraoperative rupture, all associated with attempted direct clipping; all 4 cases were successfully clipped. Two cases rebled post-treatment. Both rebleeding episodes were managed with endovascular stenting. Follow-up angiography was available for 14 patients and revealed a new aneurysm adjacent to the site of clipping in 1 patient and in-stent stenosis in 2. At the mean follow-up of 74.5 months (median, 73; range, 7–165), the mean Glasgow Outcome Scale score was 4.6 (range, 2–5; median, 5). CONCLUSION: Microsurgical treatment of blister aneurysms of the ICA results in excellent outcome. In the evolution of treating these friable aneurysms, we have modified our clip-wrapping technique and use this technique when direct clipping is not feasible.

Download Full-text