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Leptomeningeal collateral vessels are a major risk factor for intracranial hemorrhage after carotid stenting in patients with carotid atherosclerotic plaque
  1. Kang Ji Lee,
  2. Hyo Sung Kwak,
  3. Gyung Ho Chung,
  4. Ji Soo Song,
  5. Seung Bae Hwang
  1. Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-shi, South Korea
  1. Correspondence to Professor Hyo Sung Kwak, Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 634-18, Keumam-Dong, Jeonju-shi, Jeonbuk 561-712, South Korea; kwak8140{at}jbnu.ac.kr

Abstract

Aim To evaluate the relationship between leptomeningeal collaterals and intracranial hemorrhage (ICH) after carotid artery stenting (CAS).

Methods A retrospective study was undertaken of 228 patients (median age 75 years (range 44–90); 187 men and 41 women) who underwent CAS due to unilateral carotid atherosclerotic plaque from January 2009 to December 2013. Cerebral angiographic findings were classified into three patterns: type I, normal visualization of the anterior and middle cerebral arteries without leptomeningeal collaterals; type II, visualization of the middle cerebral artery only without leptomeningeal collaterals; and type III, visualization of leptomeningeal collateral flow.

Results For all cerebral angiographic findings, 146 (64.0%) were type I, 61 (26.8%) were type II, and 21 (9.2%) were type III. Four patients (1.8%) died with fatal ICH after CAS and had type III angiographic findings (19%). The prevalence of ICH in patients with leptomeningeal collateral vessels was significantly higher than in patients without leptomeningeal collateral vessels (19% vs 0%, p<0.0001). The percentage of carotid stenosis in patients with ICH based on North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria was significantly higher than in patients without ICH (89.8±3.6% vs 72.8±12.8%, p=0.014).

Conclusions Leptomeningeal collateral vessels are a major risk factor for ICH after CAS in patients with carotid atherosclerotic plaque.

  • Cervical
  • Stroke
  • Stent
  • Hemorrhage

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