TY - JOUR
T1 - Hemorrhagic risk of emergent endovascular treatment plus stenting in patients with acute ischemic stroke
AU - Dorado, Laura
AU - Castaño, Carlos
AU - Millán, Mònica
AU - Aleu, Aitziber
AU - De La Ossa, Natàlia Pérez
AU - Gomis, Meritxell
AU - López-Cancio, Elena
AU - Vivas, Elio
AU - Rodriguez-Campello, Ana
AU - Castellanos, Mar
AU - Dávalos, Antoni
PY - 2013/1/1
Y1 - 2013/1/1
N2 - Background: Several endovascular revascularization strategies have been described for the treatment of acute ischemic stroke (AIS). One of them is stenting when a very narrow stenosis with high reocclusion risk remains after recanalization. This study describes the risk of symptomatic intracerebral hemorrhage (SICH) after emergent stenting in patients with AIS treated with endovascular therapies. Methods: Consecutive patients who underwent endovascular treatment over a 37-month period were retrospectively analyzed. Patients were classified in 2 groups: (1) patients in whom a stent was deployed; and (2) patients without stenting. Double antiplatelet treatment with aspirin and clopidogrel was administered at the time of stenting. SICH was defined as any hemorrhagic transformation with National Institutes of Health Stroke Scale (NIHSS) score worsening 4 points or more (European-Australasian Acute Stroke Study II criteria). Results: A total of 143 patients were included (mean age: 66.1 ± 11.7 years, median NIHSS score: 18). Acute phase stenting was performed in 24 subjects (16.8%): 4 intracranial (3 in basilar artery, 1 in middle cerebral artery) and 20 extracranial (internal carotid artery). SICH occurred in 11 patients, 5 of 24 (20.8%) in patients with stenting and in 3 of 119 (2.5%) without (P =.008). No differences were found with respect to baseline NIHSS score or intravenous tissue plasminogen activator administration. Acute phase stenting emerged as an independent predictor of SICH after adjustment for potential confounders and procedure duration: odds ratio 7.3 (confidence interval 1.4-36.8, P =.016). Conclusions: Our findings suggest that emergent stenting in endovascular treatment of AIS is associated with SICH. © 2013 Elsevier B.V. All rights reserved.
AB - Background: Several endovascular revascularization strategies have been described for the treatment of acute ischemic stroke (AIS). One of them is stenting when a very narrow stenosis with high reocclusion risk remains after recanalization. This study describes the risk of symptomatic intracerebral hemorrhage (SICH) after emergent stenting in patients with AIS treated with endovascular therapies. Methods: Consecutive patients who underwent endovascular treatment over a 37-month period were retrospectively analyzed. Patients were classified in 2 groups: (1) patients in whom a stent was deployed; and (2) patients without stenting. Double antiplatelet treatment with aspirin and clopidogrel was administered at the time of stenting. SICH was defined as any hemorrhagic transformation with National Institutes of Health Stroke Scale (NIHSS) score worsening 4 points or more (European-Australasian Acute Stroke Study II criteria). Results: A total of 143 patients were included (mean age: 66.1 ± 11.7 years, median NIHSS score: 18). Acute phase stenting was performed in 24 subjects (16.8%): 4 intracranial (3 in basilar artery, 1 in middle cerebral artery) and 20 extracranial (internal carotid artery). SICH occurred in 11 patients, 5 of 24 (20.8%) in patients with stenting and in 3 of 119 (2.5%) without (P =.008). No differences were found with respect to baseline NIHSS score or intravenous tissue plasminogen activator administration. Acute phase stenting emerged as an independent predictor of SICH after adjustment for potential confounders and procedure duration: odds ratio 7.3 (confidence interval 1.4-36.8, P =.016). Conclusions: Our findings suggest that emergent stenting in endovascular treatment of AIS is associated with SICH. © 2013 Elsevier B.V. All rights reserved.
KW - Acute ischemic stroke
KW - emergent stenting
KW - endovascular stroke therapy
KW - intracranial hemorrhage
U2 - 10.1016/j.jstrokecerebrovasdis.2012.12.006
DO - 10.1016/j.jstrokecerebrovasdis.2012.12.006
M3 - Article
VL - 22
SP - 1326
EP - 1331
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
SN - 1052-3057
IS - 8
ER -