title: Mechanisms of stroke after intracranial angioplasty and stenting in the SAMMPRIS trial.
abstract: BACKGROUND
  Enrollment in the stenting and aggressive medical management for the prevention of stroke in intracranial stenosis (SAMMPRIS) trial was halted owing to higher-than-expected 30-day stroke rates in the stenting arm. Improvement in periprocedural stroke rates from angioplasty and stenting for intracranial atherosclerotic disease (ICAD) requires an understanding of the mechanisms of these events.
  
  
  OBJECTIVE
  To identify the types and mechanisms of periprocedural stroke after angioplasty and stenting for ICAD.
  
  
  METHODS
  Patients who experienced a hemorrhagic or ischemic stroke or a cerebral infarct with temporary signs within 30 days of attempted angioplasty and stenting in SAMMPRIS were identified. Study records, including case report forms, procedure notes, and imaging were reviewed. Strokes were categorized as ischemic or hemorrhagic. Ischemic strokes were categorized as perforator territory, distal embolic, or delayed stent thrombosis. Hemorrhagic strokes were categorized as subarachnoid or intraparenchymal. Causes of hemorrhage (wire perforation, vessel rupture) were recorded.
  
  
  RESULTS
  Three patients had an ischemic stroke after diagnostic angiography. Two of these strokes were unrelated to the procedure. Twenty-one patients had an ischemic stroke (n = 19) or cerebral infarct with temporary signs (n = 2) within 30 days of angioplasty and stenting. Most (n = 15) were perforator territory and many of these occurred after angiographically successful angioplasty and stenting of the basilar artery (n = 8). Six patients experienced a subarachnoid hemorrhage (3 from wire perforation) and 7 had a delayed intraparenchymal hemorrhage.
  
  
  CONCLUSIONS
  Efforts at reducing complications from angioplasty and stenting for ICAD must focus on reducing the risks of regional perforator infarction, delayed intraparenchymal hemorrhage, and wire perforation.
authors: Mallinckrodt Institute of Radiology, Department of Neurology, Washington University School of Medicine, St Louis, Missouri, USA. derdeync@wustl.edu
authors: Colin P
authors: CP
authors: Derdeyn
authors: David
authors: D
authors: Fiorella
authors: Michael J
authors: MJ
authors: Lynn
authors: Zoran
authors: Z
authors: Rumboldt
authors: Harry J
authors: HJ
authors: Cloft
authors: Daniel
authors: D
authors: Gibson
authors: Tanya N
authors: TN
authors: Turan
authors: Bethany F
authors: BF
authors: Lane
authors: L Scott
authors: LS
authors: Janis
authors: Marc I
authors: MI
authors: Chimowitz
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000401:mortality*; D002545:Brain Ischemia / Q000401:mortality*; D002543:Cerebral Hemorrhage / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D002537:Intracranial Arteriosclerosis / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D018570:Risk Assessment; D015607:Stents / Q000706:statistics & numerical data*; D020521:Stroke / Q000401:mortality*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology