title: Leptomeningeal collateral vessels are a major risk factor for intracranial hemorrhage after carotid stenting in patients with carotid atherosclerotic plaque.
abstract: OBJECTIVE
  To evaluate the relationship between leptomeningeal collaterals and intracranial hemorrhage (ICH) after carotid artery stenting (CAS).
  
  
  METHODS
  A retrospective study was undertaken of 228 patients (median age 75 years (range 44-90); 187 men and 41 women) who underwent CAS due to unilateral carotid atherosclerotic plaque from January 2009 to December 2013. Cerebral angiographic findings were classified into three patterns: type I, normal visualization of the anterior and middle cerebral arteries without leptomeningeal collaterals; type II, visualization of the middle cerebral artery only without leptomeningeal collaterals; and type III, visualization of leptomeningeal collateral flow.
  
  
  RESULTS
  For all cerebral angiographic findings, 146 (64.0%) were type I, 61 (26.8%) were type II, and 21 (9.2%) were type III. Four patients (1.8%) died with fatal ICH after CAS and had type III angiographic findings (19%). The prevalence of ICH in patients with leptomeningeal collateral vessels was significantly higher than in patients without leptomeningeal collateral vessels (19% vs 0%, p<0.0001). The percentage of carotid stenosis in patients with ICH based on North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria was significantly higher than in patients without ICH (89.8±3.6% vs 72.8±12.8%, p=0.014).
  
  
  CONCLUSIONS
  Leptomeningeal collateral vessels are a major risk factor for ICH after CAS in patients with carotid atherosclerotic plaque.
authors.affiliation: Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-shi, South Korea.
authors.forename: Kang Ji
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-shi, South Korea.
authors.forename: Hyo Sung
authors.initials: HS
authors.lastname: Kwak
authors.affiliation: Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-shi, South Korea.
authors.forename: Gyung Ho
authors.initials: GH
authors.lastname: Chung
authors.affiliation: Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-shi, South Korea.
authors.forename: Ji Soo
authors.initials: JS
authors.lastname: Song
authors.affiliation: Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-shi, South Korea.
authors.forename: Seung Bae
authors.initials: SB
authors.lastname: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D002533:Cerebral Angiography; D003097:Collateral Circulation; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008576:Meningeal Arteries / Q000000981:diagnostic imaging*; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects
keywords: Cervical; Hemorrhage; Stent; Stroke