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<meta name="DC.Language" content="en" />
<meta name="DC.Title" content="Intracranial Hemorrhage after Stenting and Angioplasty of Extracranial Carotid Stenosis" />
<meta name="DC.Date" content="2000-11-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: The transluminal angioplasty and stenting procedure has been recently advocated as a potential alternative to surgical endarterectomy for the treatment of severe extracranial carotid stenosis. This study assesses the incidence and significance of intracranial hemorrhage occurring after this procedure.

METHODS: We retrospectively reviewed 104 carotid arteries (96 internal, two external, and six common) in 90 patients (63 male; mean age, 69.4 years; range, 48–88 years) who underwent primary stenting and angioplasty by use of Wallstents (103/104) at three centers between January 1996 and January 1999. Seventy-five (83%) patients were referred by neurosurgery departments. Seventy-one (68%) arteries were symptomatic; the mean stenosis percentage was 85% (range, 40–99%).

RESULTS: Four intraparenchymal hemorrhages occurred, representing 4.4% of patients and 3.8% of vessels, after angioplasty and stent placement. The mean preoperative stenosis percentage was 95% (range, 90–99%). One hemorrhage occurred immediately after stent placement, whereas the three other hemorrhages occurred in a delayed fashion (mean, 2.8 days). The mean hematoma size was 4.8 cm (range, 2–8 cm). Three patients had associated subarachnoid or intraventricular bleeding; the fourth had associated subdural hemorrhage. Three hemorrhages were fatal; the fourth experienced two seizures only. No acute neurologic symptoms were present prior to hemorrhages, and there was no postprocedural hypertension in these patients. All had been receiving antiplatelet agents as well as intraprocedural IV heparin.

CONCLUSION: Intracranial hemorrhage can occur after carotid angioplasty and stenting. We speculate that this represents cerebral hyperperfusion injury. The 3.8% incidence of cerebral hemorrhage observed is approximately sixfold greater than that reported post endarterectomy (0.6%) (95% CI, 0.2–8.7%). This is not statistically significant in this small study group. This trend may reflect patient selection, different anticoagulation protocols, and/or study population size. Additional data are needed to determine the safety and efficiency of carotid stenting as a treatment for carotid stenosis." />
<meta name="DC.Contributor" content="William Morrish" />
<meta name="DC.Contributor" content="Stephen Grahovac" />
<meta name="DC.Contributor" content="Andre Douen" />
<meta name="DC.Contributor" content="Gordon Cheung" />
<meta name="DC.Contributor" content="William Hu" />
<meta name="DC.Contributor" content="Richard Farb" />
<meta name="DC.Contributor" content="Paul Kalapos" />
<meta name="DC.Contributor" content="Roberto Wee" />
<meta name="DC.Contributor" content="Mark Hudon" />
<meta name="DC.Contributor" content="Charles Agbi" />
<meta name="DC.Contributor" content="Michael Richard" />
<meta name="article:published_time" content="2000-11-01" />
<meta name="article:section" content="INTERVENTIONAL" />
<meta name="citation_title" content="Intracranial Hemorrhage after Stenting and Angioplasty of Extracranial Carotid Stenosis" />
<meta name="citation_abstract" lang="en" content="&lt;p&gt;&lt;i&gt;BACKGROUND AND PURPOSE:&lt;/i&gt; The transluminal angioplasty and stenting procedure has been recently advocated as a potential alternative to surgical endarterectomy for the treatment of severe extracranial carotid stenosis. This study assesses the incidence and significance of intracranial hemorrhage occurring after this procedure.&lt;/p&gt;&lt;p&gt;&lt;i&gt;METHODS:&lt;/i&gt; We retrospectively reviewed 104 carotid arteries (96 internal, two external, and six common) in 90 patients (63 male; mean age, 69.4 years; range, 48–88 years) who underwent primary stenting and angioplasty by use of Wallstents (103/104) at three centers between January 1996 and January 1999. Seventy-five (83%) patients were referred by neurosurgery departments. Seventy-one (68%) arteries were symptomatic; the mean stenosis percentage was 85% (range, 40–99%).&lt;/p&gt;&lt;p&gt;&lt;i&gt;RESULTS:&lt;/i&gt; Four intraparenchymal hemorrhages occurred, representing 4.4% of patients and 3.8% of vessels, after angioplasty and stent placement. The mean preoperative stenosis percentage was 95% (range, 90–99%). One hemorrhage occurred immediately after stent placement, whereas the three other hemorrhages occurred in a delayed fashion (mean, 2.8 days). The mean hematoma size was 4.8 cm (range, 2–8 cm). Three patients had associated subarachnoid or intraventricular bleeding; the fourth had associated subdural hemorrhage. Three hemorrhages were fatal; the fourth experienced two seizures only. No acute neurologic symptoms were present prior to hemorrhages, and there was no postprocedural hypertension in these patients. All had been receiving antiplatelet agents as well as intraprocedural IV heparin.&lt;/p&gt;&lt;p&gt;&lt;i&gt;CONCLUSION:&lt;/i&gt; Intracranial hemorrhage can occur after carotid angioplasty and stenting. We speculate that this represents cerebral hyperperfusion injury. The 3.8% incidence of cerebral hemorrhage observed is approximately sixfold greater than that reported post endarterectomy (0.6%) (95% CI, 0.2–8.7%). This is not statistically significant in this small study group. This trend may reflect patient selection, different anticoagulation protocols, and/or study population size. Additional data are needed to determine the safety and efficiency of carotid stenting as a treatment for carotid stenosis.&lt;/p&gt;" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: The transluminal angioplasty and stenting procedure has been recently advocated as a potential alternative to surgical endarterectomy for the treatment of severe extracranial carotid stenosis. This study assesses the incidence and significance of intracranial hemorrhage occurring after this procedure.

METHODS: We retrospectively reviewed 104 carotid arteries (96 internal, two external, and six common) in 90 patients (63 male; mean age, 69.4 years; range, 48–88 years) who underwent primary stenting and angioplasty by use of Wallstents (103/104) at three centers between January 1996 and January 1999. Seventy-five (83%) patients were referred by neurosurgery departments. Seventy-one (68%) arteries were symptomatic; the mean stenosis percentage was 85% (range, 40–99%).

RESULTS: Four intraparenchymal hemorrhages occurred, representing 4.4% of patients and 3.8% of vessels, after angioplasty and stent placement. The mean preoperative stenosis percentage was 95% (range, 90–99%). One hemorrhage occurred immediately after stent placement, whereas the three other hemorrhages occurred in a delayed fashion (mean, 2.8 days). The mean hematoma size was 4.8 cm (range, 2–8 cm). Three patients had associated subarachnoid or intraventricular bleeding; the fourth had associated subdural hemorrhage. Three hemorrhages were fatal; the fourth experienced two seizures only. No acute neurologic symptoms were present prior to hemorrhages, and there was no postprocedural hypertension in these patients. All had been receiving antiplatelet agents as well as intraprocedural IV heparin.

CONCLUSION: Intracranial hemorrhage can occur after carotid angioplasty and stenting. We speculate that this represents cerebral hyperperfusion injury. The 3.8% incidence of cerebral hemorrhage observed is approximately sixfold greater than that reported post endarterectomy (0.6%) (95% CI, 0.2–8.7%). This is not statistically significant in this small study group. This trend may reflect patient selection, different anticoagulation protocols, and/or study population size. Additional data are needed to determine the safety and efficiency of carotid stenting as a treatment for carotid stenosis." />
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<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: The transluminal angioplasty and stenting procedure has been recently advocated as a potential alternative to surgical endarterectomy for the treatment of severe extracranial carotid stenosis. This study assesses the incidence and significance of intracranial hemorrhage occurring after this procedure.

METHODS: We retrospectively reviewed 104 carotid arteries (96 internal, two external, and six common) in 90 patients (63 male; mean age, 69.4 years; range, 48–88 years) who underwent primary stenting and angioplasty by use of Wallstents (103/104) at three centers between January 1996 and January 1999. Seventy-five (83%) patients were referred by neurosurgery departments. Seventy-one (68%) arteries were symptomatic; the mean stenosis percentage was 85% (range, 40–99%).

RESULTS: Four intraparenchymal hemorrhages occurred, representing 4.4% of patients and 3.8% of vessels, after angioplasty and stent placement. The mean preoperative stenosis percentage was 95% (range, 90–99%). One hemorrhage occurred immediately after stent placement, whereas the three other hemorrhages occurred in a delayed fashion (mean, 2.8 days). The mean hematoma size was 4.8 cm (range, 2–8 cm). Three patients had associated subarachnoid or intraventricular bleeding; the fourth had associated subdural hemorrhage. Three hemorrhages were fatal; the fourth experienced two seizures only. No acute neurologic symptoms were present prior to hemorrhages, and there was no postprocedural hypertension in these patients. All had been receiving antiplatelet agents as well as intraprocedural IV heparin.

CONCLUSION: Intracranial hemorrhage can occur after carotid angioplasty and stenting. We speculate that this represents cerebral hyperperfusion injury. The 3.8% incidence of cerebral hemorrhage observed is approximately sixfold greater than that reported post endarterectomy (0.6%) (95% CI, 0.2–8.7%). This is not statistically significant in this small study group. This trend may reflect patient selection, different anticoagulation protocols, and/or study population size. Additional data are needed to determine the safety and efficiency of carotid stenting as a treatment for carotid stenosis." />
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      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">INTERVENTIONAL</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Intracranial Hemorrhage after Stenting and Angioplasty of Extracranial Carotid Stenosis</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">William Morrish</span>, <span class="highwire-citation-author" data-delta="1">Stephen Grahovac</span>, <span class="highwire-citation-author" data-delta="2">Andre Douen</span>, <span class="highwire-citation-author" data-delta="3">Gordon Cheung</span>, <span class="highwire-citation-author" data-delta="4">William Hu</span>, <span class="highwire-citation-author" data-delta="5">Richard Farb</span>, <span class="highwire-citation-author" data-delta="6">Paul Kalapos</span>, <span class="highwire-citation-author" data-delta="7">Roberto Wee</span>, <span class="highwire-citation-author" data-delta="8">Mark Hudon</span>, <span class="highwire-citation-author" data-delta="9">Charles Agbi</span> and <span class="highwire-citation-author" data-delta="10">Michael Richard</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">November 2000,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">21 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1911-1916; </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-2467--81364858182" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">William Morrish </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=William%2BMorrish%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Morrish%20W&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AWilliam%2BMorrish%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Stephen Grahovac 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">William Morrish</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-2"><span class="name">Stephen Grahovac</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-3"><span class="name">Andre Douen</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-4"><span class="name">Gordon Cheung</span><a id="xref-aff-1-4" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-5"><span class="name">William Hu</span><a id="xref-aff-1-5" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-6"><span class="name">Richard Farb</span><a id="xref-aff-1-6" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-7"><span class="name">Paul Kalapos</span><a id="xref-aff-1-7" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-8"><span class="name">Roberto Wee</span><a id="xref-aff-1-8" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-9"><span class="name">Mark Hudon</span><a id="xref-aff-1-9" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-10"><span class="name">Charles Agbi</span><a id="xref-aff-1-10" class="xref-aff" href="#aff-1">a</a> and </li><li class="last" id="contrib-11"><span class="name">Michael Richard</span><a id="xref-aff-1-11" class="xref-aff" href="#aff-1">a</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Department of Diagnostic Imaging (W.M., W.H., M.H.), Foothills Medical Centre, University of Calgary; the Department of Radiology (S.G., P.K., R.W.), and Divisions of Neurology (A.D.) and Neurosurgery (C.A., M.R.), The Ottawa Hospital, University of Ottawa; and Department of Radiology (G.C., R.F.), Sunnybrook Health Science Center, University of Toronto.</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>Address reprint requests to William F. Morrish, Dept. of Diagnostic Imaging, Foothills Medical Centre, 1403-29 Street N.W., Calgary, Alberta Canada T2N 2T9.</address></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/21/10/1911.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 21</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 10 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Nov 2000 </div></div>
      
      
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">William</span> <span class="nlm-surname">Morrish</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Stephen</span> <span class="nlm-surname">Grahovac</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Andre</span> <span class="nlm-surname">Douen</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Gordon</span> <span class="nlm-surname">Cheung</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">William</span> <span class="nlm-surname">Hu</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">Richard</span> <span class="nlm-surname">Farb</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">Paul</span> <span class="nlm-surname">Kalapos</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">Roberto</span> <span class="nlm-surname">Wee</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">Mark</span> <span class="nlm-surname">Hudon</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">Charles</span> <span class="nlm-surname">Agbi</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">Michael</span> <span class="nlm-surname">Richard</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Nov 2000, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">21 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1911-1916; </span></div>
  
  
  
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      <div class="highwire-cite-title">Intracranial Hemorrhage after Stenting and Angioplasty of Extracranial Carotid Stenosis</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">William</span> <span class="nlm-surname">Morrish</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Stephen</span> <span class="nlm-surname">Grahovac</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Andre</span> <span class="nlm-surname">Douen</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Gordon</span> <span class="nlm-surname">Cheung</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">William</span> <span class="nlm-surname">Hu</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">Richard</span> <span class="nlm-surname">Farb</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">Paul</span> <span class="nlm-surname">Kalapos</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">Roberto</span> <span class="nlm-surname">Wee</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">Mark</span> <span class="nlm-surname">Hudon</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">Charles</span> <span class="nlm-surname">Agbi</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">Michael</span> <span class="nlm-surname">Richard</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Nov 2000, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">21 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1911-1916; </span></div>
  
  
  
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