Risk factors associated with major cerebrovascular complications after intracranial stenting

Abstract

Major cerebrovascular complications after intracranial stenting may be associated with posterior circulation stenosis, low volume sites, stenting soon after a qualifying event, and stroke as the qualifying event. These factors will need to be monitored in future trials of intracranial stenting.

Multicenter Prospective Trial of Stent Placement in Patients with Symptomatic High-Grade Intracranial Stenosis

“…The longer time interval may have allowed plaque stabilization and spontaneous lysis of overlying thrombus and probably also reduced the risk of hemorrhagic transformation for patients with recent ischemic stroke (Ͻ3 weeks). 17,[21][22][23] An analysis of the National Institutes of Health Multicenter Wingspan Intracranial Stent Registry Study found that stent placement performed within 10 days of a qualifying ischemic event was associated with a higher rate of 30-day stroke and/or death compared with procedures performed after 10 days (8% versus 17%, P ϭ .06). 21,24 In the SAMMPRIS trial, the rates of ischemic stroke, symptomatic hemorrhagic stroke, or any death within 1 month were 15.7% and 13.8% in the patients enrolled within 7 days or after 7 days of their qualifying event, respectively.…”

“…17,[21][22][23] An analysis of the National Institutes of Health Multicenter Wingspan Intracranial Stent Registry Study found that stent placement performed within 10 days of a qualifying ischemic event was associated with a higher rate of 30-day stroke and/or death compared with procedures performed after 10 days (8% versus 17%, P ϭ .06). 21,24 In the SAMMPRIS trial, the rates of ischemic stroke, symptomatic hemorrhagic stroke, or any death within 1 month were 15.7% and 13.8% in the patients enrolled within 7 days or after 7 days of their qualifying event, respectively. 15 Exclusion of patients with recent ischemic stroke may also exclude those with the highest risk of an ischemic event recurrence; therefore, the benefit of stent placement in the reduction of stroke recurrence may also be diminished.…”

Clinicoradiological Features and Outcomes of Patients with Atherosclerotic Basilar Artery Steno-Occlusion: A Single-Center Experience

“…Angioplasty and stenting were associated with a higher than expected rate of perioperative stroke in this trial (5). We found vertebrobasilar artery stenosis, in particular, to be the factor with the highest hazard ratio for ischemic stroke in the region of the stented artery (6,7).…”

Angioplasty and Stenting of Atherosclerotic Middle Cerebral Arteries with Wingspan: Evaluation of Clinical Outcome, Restenosis, and Procedure Outcome

“…12,18,19 Selection of stent size was based on an oversize of the native diameter of the target vessel by 0.5-1.0 mm and an extended stent length by 3 mm on either side of the lesion (Fig 2). 12,20 In the literature, the stenosis was usually crossed with a short microguidewire and a microcatheter (Transend Floppy, 160 cm, and Excel 14) first before the placement of a long microguidewire and subsequently the angioplasty catheter. 18,19 For the first 45 patients of the current study, the angioplasty balloon catheter was introduced across the stenosis directly by using a long microguidewire (Transend Floppy, 300 cm) without the use of a short microguidewire and a microcatheter.…”