Prevalence and Clinical Predictors of Intracranial Hemorrhage Following Carotid Artery Stenting for Symptomatic Severe Carotid Stenosis

Abstract

Hyperperfusion-induced intracranial hemorrhage (HICH) is the most frequent cause of death following carotid artery stenting (CAS). This study aimed to identify the presence of HICH after CAS and evaluate demographic and clinical variables associated with HICH. We retrospectively reviewed clinical data of 446 consecutive patients with symptomatic severe carotid stenosis treated with CAS between November 2011 and August 2018. Good collateral compensation was defined as patency of the anterior communicating artery with well-developed bilateral A1 segments with or without posterior communicating arteries, according to the classification of Katano etal. Univariate and multivariate analyses were performed to determine whether there was a correlation between demographic and clinical variables and development of HICH. Stent placement was successful in all patients. Of 446 patients, 14 had HICH (3.14%); 1 of 14 (7.14%) patients displayed 80%-90% stenosis, and 13 patients had stenosis ≥90%. Thirteen patients (92.86%) had poor collateral circulation compensation. Two patients (14.3%) died despite rescue efforts. Age (≥70 years), degree of carotid artery stenosis (≥90%), and poor compensation of collateral circulation were associated with a higher frequency of HICH after CAS. Severe carotid artery stenosis (≥90%) was independently associated with HICH after stenting (odds ratio 13.633, P= 0.014). The incidence rate of HICH was 3.14%. Patients with severe carotid artery stenosis (≥90%) are at high risk for developing HICH after CAS. Further investigations are needed to better describe the contribution of other risk factors, including poor compensation of collateral circulation (especially anterior circulation).