Hemorrhagic risk of emergent endovascular treatment plus stenting in patients with acute ischemic stroke.
BACKGROUND
Several endovascular revascularization strategies have been described for the treatment of acute ischemic stroke (AIS). One of them is stenting when a very narrow stenosis with high reocclusion risk remains after recanalization. This study describes the risk of symptomatic intracerebral hemorrhage (SICH) after emergent stenting in patients with AIS treated with endovascular therapies.


METHODS
Consecutive patients who underwent endovascular treatment over a 37-month period were retrospectively analyzed. Patients were classified in 2 groups: (1) patients in whom a stent was deployed; and (2) patients without stenting. Double antiplatelet treatment with aspirin and clopidogrel was administered at the time of stenting. SICH was defined as any hemorrhagic transformation with National Institutes of Health Stroke Scale (NIHSS) score worsening 4 points or more (European-Australasian Acute Stroke Study II criteria).


RESULTS
A total of 143 patients were included (mean age: 66.1±11.7 years, median NIHSS score: 18). Acute phase stenting was performed in 24 subjects (16.8%): 4 intracranial (3 in basilar artery, 1 in middle cerebral artery) and 20 extracranial (internal carotid artery). SICH occurred in 11 patients, 5 of 24 (20.8%) in patients with stenting and in 3 of 119 (2.5%) without (P=.008). No differences were found with respect to baseline NIHSS score or intravenous tissue plasminogen activator administration. Acute phase stenting emerged as an independent predictor of SICH after adjustment for potential confounders and procedure duration: odds ratio 7.3 (confidence interval 1.4-36.8, P=.016).


CONCLUSIONS
Our findings suggest that emergent stenting in endovascular treatment of AIS is associated with SICH.
Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain. Electronic address: lauritadb@yahoo.es.
Laura
L
Dorado
Carlos
C
Castaño
Mònica
M
Millán
Aitziber
A
Aleu
Natàlia Pérez
NP
de la Ossa
Meritxell
M
Gomis
Elena
E
López-Cancio
Elio
E
Vivas
Ana
A
Rodriguez-Campello
Mar
M
Castellanos
Antoni
A
Dávalos
D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D002548:Cerebral Revascularization; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
Acute ischemic stroke; emergent stenting; endovascular stroke therapy; intracranial hemorrhage