Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis.
Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis.
复制标题
颅外颈动脉狭窄支架置入和血管成形术后颅内出血。
DOI：
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发表时间：
2000
期刊：
影响因子：
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通讯作者：
M. Richard
中科院分区：
文献类型：
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作者：
W. Morrish;S. Grahovac;A. Douen;Gordon Cheung;William Y. Hu;R. Farb;P. Kalapos;R. Wee;M. Hudon;C. Agbi;M. Richard
背景和目的
经腔血管成形术和支架植入术最近被认为是治疗严重颅外颈动脉狭窄的外科动脉内膜切除术的潜在替代方法。本研究评估了该手术后颅内出血的发生率和意义。
方法
我们回顾性分析了1996年1月至1999年1月期间在三家中心使用Wallstents（103/104）接受初次支架植入术和血管成形术的90例患者（63例男性;平均年龄69.4岁;范围48-88岁）的104条颈动脉（96条颈内动脉，2条颈外动脉和6条颈总动脉）。75例（83%）患者由神经外科转诊。71条（68%）动脉有症状;平均狭窄百分比为85%（范围：40-99%）。
结果
在血管成形术和支架置入术后，发生了4例实质内出血，占患者的4.4%和血管的3.8%。平均术前狭窄百分比为95%（范围：90-99%）。1例出血发生在支架置入后即刻，而其他3例出血发生在延迟时间（平均2.8天）。平均血肿大小为4.8 cm（范围：2-8 cm）。3例患者伴有蛛网膜下腔或脑室内出血;第4例伴有硬膜下出血。三次癫痫是致命的;第四次只经历了两次癫痫发作。这些患者在手术前没有急性神经系统症状，也没有术后高血压。所有患者均接受抗血小板药物和术中IV肝素治疗。
结论
颅内出血可发生在颈动脉血管成形术和支架术后。我们推测这代表脑过度灌注损伤。观察到的脑出血发生率为3.8%，约为动脉内膜切除术后报告发生率（0.6%）的6倍（95% CI，0.2-8.7%）。这在这个小的研究组中没有统计学意义。这种趋势可能反映了患者选择、不同的抗凝方案和/或研究人群规模。需要更多的数据来确定颈动脉支架植入术治疗颈动脉狭窄的安全性和有效性。
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.