Fatal intracranial hemorrhage after carotid artery stenting: Three case reports and a literature review

Zhou, Yumiao; Zheng, Chao; Chen, Liang; Lin, Yanjie

doi:10.1177/0300060520937576

Cited by 4 publications

(1 citation statement)

References 26 publications

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“…Cerebral hyperperfusion syndrome (CHS) is an uncommon but critical complication after CAS, for which hyperperfusion-induced intracranial hemorrhage (ICH) is the most severe outcome if it is not managed properly and swiftly ( 2 , 3 ). The incidence of postoperative ICH following CAS is about 0.36–6.67%, and the mortality rate of ICH is about 75% ( 4 , 5 ). Although the incidence of postoperative ICH is low, given its detrimental consequences, it is an issue that needs to be urgently addressed in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Prediction of intracranial hemorrhage after internal carotid artery stenting in patients with symptomatic severe carotid stenosis by computed tomography perfusion

Zha¹,

Liu²,

Deng³

et al. 2023

Quant Imaging Med Surg

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Background: To explore the risk of intracranial hemorrhage (ICH) after internal carotid artery stenting (CAS) in patients with symptomatic severe carotid stenosis by computed tomography perfusion (CTP). Methods:The clinical and imaging data of 87 patients with symptomatic severe carotid stenosis who underwent CTP before CAS were retrospectively analyzed. The absolute values of the cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP) were calculated.The relative values (i.e., the rCBF, rCBV, rMTT, and rTTP), defined as the comparison between ipsilateral and contralateral hemispheres, were also derived. The degree of carotid artery stenosis was divided into 3 grades, and the Willis' circle was classified into 4 types. The relationship between the occurrence of the ICH and CTP parameters, the Willis' circle type, and the clinical baseline data were evaluated. A receiver operating characteristic (ROC) curve analysis was performed to determine the most effective CTP parameter for the prediction of ICH.Results: In total, 8 patients (9.2%) developed ICH after CAS. The results showed that the CBF (P=0.025), MTT (P=0.029), rCBF (P=0.006), rMTT (P=0.004), rTTP (P=0.006), and the degree of carotid artery stenosis (P=0.021) differed significantly between the ICH group and non-ICH group. The ROC curve analysis showed that the CTP parameter with the maximal area under the curve (AUC) for ICH was rMTT (AUC =0.808), which indicated that patients with an rMTT >1.88 were more likely to develop ICH (sensitivity: 62.5%, specificity: 96.2%). The occurrence of ICH after CAS was not related to the type of Willis' circle (P=0.713).Conclusions: CTP can be used to predict ICH after CAS in patients with symptomatic severe carotid stenosis, and patients with a preoperative rMTT >1.88 should be closely monitored for evidence of ICH after CAS.

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Section: Introductionmentioning

confidence: 99%

Prediction of intracranial hemorrhage after internal carotid artery stenting in patients with symptomatic severe carotid stenosis by computed tomography perfusion

Zha¹,

Liu²,

Deng³

et al. 2023

Quant Imaging Med Surg

View full text Add to dashboard Cite

show abstract

Angioembolization for hemostasis in craniofacial fractures had a higher probability of delayed traumatic intracerebral hemorrhage

Li,

Kang,

Chen

et al. 2025

The American Journal of Emergency Medicine

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Staged angioplasty in 2 patients with severe carotid artery stenosis: A case report and literature review

Zhou,

Liu,

Cao

et al. 2024

Medicine

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Rationale: Cerebral infarction is a common ischemic cerebrovascular disease, associated with high rates of morbidity, disability, and recurrence, that can seriously affect patient physical and mental health, as well as quality of life. Carotid artery stenosis is an independent risk factor of cerebral infarction. Following rapid developments in interventional technology and materials science, carotid artery stenting has arisen an important treatment option for carotid artery stenosis. However, surgery is associated with complications, such as postoperative hyperperfusion syndrome, which poses a serious threat to the life and health of patients. Staged angioplasty (SAP), that is, one-time revascularization of the carotid artery stenting, is divided into 2 stages. This method reduces the occurrence of hyperperfusion syndrome after stenting by increasing the ipsilateral cerebral blood flow in stages and gradually increasing the cerebral perfusion pressure. Patient concerns: Herein, we present 2 cases of elderly patients with severe carotid artery stenosis who underwent SAP to prevent hyperperfusion syndrome. Diagnoses: The final diagnosis was based on cervical vascular color Doppler ultrasonography, cervical vascular magnetic resonance angiography, and cerebral vascular digital subtraction angiography. Intervention: Both patients with severe carotid artery stenosis underwent a staged intravascular intervention. Outcomes: Both patients were followed up for 1 year, with neither developing any new cerebral infarction or recurrent stent restenosis. Lessons: When treating SAP, it is crucial to consider that patients with unstable carotid plaques may not be suitable for staging. Additionally, during phase II carotid stenting, it is important to assess any changes in the arterial morphology and select the appropriate device accordingly.

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Fatal intracranial hemorrhage after carotid artery stenting: Three case reports and a literature review

Cited by 4 publications

References 26 publications

Prediction of intracranial hemorrhage after internal carotid artery stenting in patients with symptomatic severe carotid stenosis by computed tomography perfusion

Prediction of intracranial hemorrhage after internal carotid artery stenting in patients with symptomatic severe carotid stenosis by computed tomography perfusion

Angioembolization for hemostasis in craniofacial fractures had a higher probability of delayed traumatic intracerebral hemorrhage

Staged angioplasty in 2 patients with severe carotid artery stenosis: A case report and literature review

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