title: Analysis of periinterventional complications of intracranial angioplasty and stenting: a single center experience.
abstract: OBJECTIVE
  Treatment of symptomatic intracranial atherosclerotic disease by angioplasty and stenting (PTAS) is limited by a high rate of periinterventional strokes. We performed a detailed analysis of these strokes at our center in order to identify strategies to reduce the risk of periinterventional complications.
  
  
  METHODS
  Case records and imaging data of 80 patients with a symptomatic 70-99% stenosis of a major intracranial artery treated with PTAS between July 2007 and December 2013 were reviewed. All patients had a sufficient response to aspirin and clopidogrel. Periinterventional strokes were categorized as either ischemic (perforator territory, distal embolic or delayed stent thrombosis) or hemorrhagic (intraparenchymal, subarachnoid).
  
  
  RESULTS
  Periinterventional complications occurred in 6/80 (7.5%) patients, consisting of 2 ischemic strokes (2.5%, both perforator territory), 3 hemorrhagic strokes (3.8%, 2 intraparenchymal due to reperfusion injury, 1 subarachnoid due to vessel rupture) and one death (1.3%) unrelated to stroke. All strokes occurred within 24h after PTAS.
  
  
  CONCLUSIONS
  Our retrospective data analysis suggests that the risk of periinterventional stroke after PTAS of symptomatic intracranial atherosclerotic disease might be reduced by sufficient antiplatelet therapy and optimized management of patients with high risk for reperfusion injury or perforator strokes, including selection of a stenting device adapted to individual vessel morphology.
authors.affiliation: Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Germany.
authors.forename: Toni
authors.initials: T
authors.lastname: Silber
authors.affiliation: Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Ziemann
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Ernemann
authors.affiliation: Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Germany. Electronic address: felix.bischof@uni-tuebingen.de.
authors.forename: Felix
authors.initials: F
authors.lastname: Bischof
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects*; D001241:Aspirin / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D000077144:Clopidogrel; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: 30-day-outcome; Intracranial stenting; Periinterventional risk