Intracranial hemorrhage secondary to carotid artery stenting angioplasty: clinical analysis / 介入放射学杂志

ABSTRACT

Objective To investigate the clinical features,pathogenesis and treatment of intracranial hemorrhage occurring after carotid artery stenting (CAS) angioplasty.Methods The clinical data and imaging materials of 5 patients with carotid artery stenosis,who were admitted to authors' hospital during the period from January 2008 to January 2017 to receive CAS and developed intracranial hemorrhage after CAS,were retrospectively analyzed.Results Of the 513 patients with carotid artery stenosis who received CAS angioplasty,5 patients (0.97％) developed intracranial hemorrhage,which was confirmed by postoperative cranial CT and/or DSA.The 5 patients included 3 males and 2 females,with an average age of (71.4±5.0) years.The stenosis rate of carotid artery ranged from 90％ to 99％.The intracranial hemorrhage occurred during CAS procedure or within 10 days after CAS.DSA examination demonstrated moyamoya vessels at ipsilateral basal ganglia region in one patient and perforating artery bleeding in another patient.Conservative medication was employed in 3 patients,one of them recovered well and the other two died.Two patients received hematoma puncture drainage and developed hemiplegia.Conclusion The incidence of intracranial hemorrhage after CAS is very low,but intracranial hemorrhage carries higher mortality and morbidity.Clinically,there are a lot of causes that can induce intracranial hemorrhage.Sufficient preoperative assessing and screening of the risk factors are helpful for reducing the occurrence of intracranial hemorrhage.Once intracranial hemorrhage after CAS occurs,active measures,including control of blood pressure,drug sedation,discontinuation of anticoagulant,reduction or discontinuation of antiplatelet drugs and surgical intervention,can improve the survival rate of patients.