Symptomatic intracranial stenosis: cerebrovascular complications from elective stent placement.
OBJECTIVE
To retrospectively evaluate the cerebrovascular complications from elective stent placement for symptomatic intracranial stenosis and to explore preliminarily which factors are associated with complications.


METHODS
Institutional ethics committee approval was obtained, with waiver of informed consent. Records were reviewed of 181 consecutive elective stent placement procedures in 169 patients (mean age, 51.8 years; 142 male and 27 female patients) with symptomatic intracranial stenosis of more than 50% diameter reduction. Complications were evaluated. Fisher exact or chi(2) tests were used to assess statistical differences between rates for discrete variables. Stratification analysis was used to assess the significant relationship (P < .05) between a potential risk factor and a complication.


RESULTS
Complications occurred in 20 patients (11.8%) of 169 patients: Ten patients (5.9%) had stroke (four patients had symptomatic intracranial hemorrhages [ICHs], and two of these patients died; six patients had ischemic strokes). Six patients had target-lesion thrombosis for which intrathrombus thrombolysis resulted in early complete patency without sequelae, two had asymptomatic ICHs, one had transient ischemic attack, and one had asymptomatic dissection. Perioperative noncompliance with antiplatelet therapy was found to be significantly associated with target-lesion thrombosis (two of eight patients [noncompliance] vs four of 161 patients [compliance], P = .027). Stratification analysis revealed a significant correlation between the use of double stents for a lesion and ICH (P = .005).


CONCLUSIONS
Cerebrovascular complications from elective stent placement for intracranial stenosis are diverse. The use of double stents for a lesion is an independent risk factor for ICH. Perioperative noncompliance with antiplatelet therapy is associated with a higher frequency of target-lesion thrombosis.
Jiang
Wei-Jian
WJ
Department of Neurology and Neuroradiology, Beijing Tiantan Hospital, Capital University of Medical Sciences, 6 Tiantan Xili, 100050 Beijing, China. cjr.jiangweijian@vip.163.com
Du
Bin
B
Leung
Thomas W
TW
Xu
Xiao-Tong
XT
Jin
Min
M
Dong
Ke-Hui
KH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects; D002543:Cerebral Hemorrhage / Q000209:etiology*; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000188:drug therapy / Q000628:therapy*; D020767:Intracranial Thrombosis / Q000209:etiology / Q000628:therapy; D002546:Ischemic Attack, Transient / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009553:Nimodipine / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000145:classification / Q000209:etiology*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000517:prevention & control
D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D009553:Nimodipine