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Research ArticleNeurointervention

Predictors and Outcomes of Periprocedural Intracranial Hemorrhage after Stenting for Symptomatic Intracranial Atherosclerotic Stenosis

Kaijiang Kang, Peipei Gong, Feng Gao, Dapeng Mo, Xingquan Zhao, Zhongrong Miao and Ning Ma
American Journal of Neuroradiology November 2024, 45 (11) 1716-1722; DOI: https://doi.org/10.3174/ajnr.A8379
Kaijiang Kang
aFrom the Department of Neurology (K.K., X.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
dCenter of Stroke (K.K., F.G., D.M., X.Z., Z.M, N.M.), Beijing Institute for Brain Disorders, Beijing, China
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Peipei Gong
eAffiliated Hospital of Nantong University (P.G.), Medical School of Nantong University, Nantong, China
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Feng Gao
bDepartment of Interventional Neuroradiology (F.G., D.M., Z.M., N.M.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
cChina National Clinical Research Center for Neurological Diseases (F.G., D.M., X.Z., Z.M., N.M.), Beijing, China
dCenter of Stroke (K.K., F.G., D.M., X.Z., Z.M, N.M.), Beijing Institute for Brain Disorders, Beijing, China
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Dapeng Mo
bDepartment of Interventional Neuroradiology (F.G., D.M., Z.M., N.M.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
cChina National Clinical Research Center for Neurological Diseases (F.G., D.M., X.Z., Z.M., N.M.), Beijing, China
dCenter of Stroke (K.K., F.G., D.M., X.Z., Z.M, N.M.), Beijing Institute for Brain Disorders, Beijing, China
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Xingquan Zhao
aFrom the Department of Neurology (K.K., X.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
cChina National Clinical Research Center for Neurological Diseases (F.G., D.M., X.Z., Z.M., N.M.), Beijing, China
dCenter of Stroke (K.K., F.G., D.M., X.Z., Z.M, N.M.), Beijing Institute for Brain Disorders, Beijing, China
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Zhongrong Miao
bDepartment of Interventional Neuroradiology (F.G., D.M., Z.M., N.M.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
cChina National Clinical Research Center for Neurological Diseases (F.G., D.M., X.Z., Z.M., N.M.), Beijing, China
dCenter of Stroke (K.K., F.G., D.M., X.Z., Z.M, N.M.), Beijing Institute for Brain Disorders, Beijing, China
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Ning Ma
bDepartment of Interventional Neuroradiology (F.G., D.M., Z.M., N.M.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
cChina National Clinical Research Center for Neurological Diseases (F.G., D.M., X.Z., Z.M., N.M.), Beijing, China
dCenter of Stroke (K.K., F.G., D.M., X.Z., Z.M, N.M.), Beijing Institute for Brain Disorders, Beijing, China
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Abstract

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.

ABBREVIATIONS:

CASSISS
China Angioplasty & Stenting for Symptomatic Intracranial Severe Stenosis Study
ICAS
intracranial atherosclerotic stenosis
NPRH
non-procedure-related hemorrhage
PRH
procedure-related hemorrhage
SAMMPRIS
Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis
VISSIT
Vitesse Intracranial Stent Study for Ischemic Therapy
  • © 2024 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 45 (11)
American Journal of Neuroradiology
Vol. 45, Issue 11
1 Nov 2024
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Cite this article
Kaijiang Kang, Peipei Gong, Feng Gao, Dapeng Mo, Xingquan Zhao, Zhongrong Miao, Ning Ma
Predictors and Outcomes of Periprocedural Intracranial Hemorrhage after Stenting for Symptomatic Intracranial Atherosclerotic Stenosis
American Journal of Neuroradiology Nov 2024, 45 (11) 1716-1722; DOI: 10.3174/ajnr.A8379

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Intracranial Hemorrhage Post-Stenting Outcomes
Kaijiang Kang, Peipei Gong, Feng Gao, Dapeng Mo, Xingquan Zhao, Zhongrong Miao, Ning Ma
American Journal of Neuroradiology Nov 2024, 45 (11) 1716-1722; DOI: 10.3174/ajnr.A8379
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