Intracranial Stent Complication Risk Factors

When a blood vessel becomes narrow due to atherosclerosis, doctors sometimes can re-open it by performing an endovascular procedure in which a "stent", a small metal device, is placed in the area of narrowing in order to improve or reestablish the blood flow. This has been done in the heart and in the carotid arteries, which bring blood to the brain, for many years with great results. But doctors have been shy to place stents inside vessels that course through the brain (i.e., intracranial blood vessels) due to a dearth of studies about safety and efficacy of the procedure. Presently there is a trial to assess whether intracranial stents are superior to medical management after narrow vessel has caused a stroke.

Now I am happy to report that a new retrospective study by investigators at the NIH has identified some risk factors for poor outcomes after an intracranial stent procedure. This is important going forward as it will help identify those people who can benefit or be harmed from intracranial stenting procedures. The major risk factors identified included "posterior circulation" procedures, which refers to a group of blood vessels in the back of the brain. Interestingly, the hospital where the stenting procedure is performed also influenced the outcome so that hospitals where these procedures are not so common have worse outcomes. Another important factor was the timing of the stent placement, with worse outcomes when the procedure was performed fewer than 10 days after the event that prompted the decision to place it in the first place (e.g., stroke, tia, etc). Finally, people did worse when stroke was the reason for stenting.

Overall, the rate of stroke or death at 30 days was 9.2%. You can see more about this study in the original article, which is now published in the journal Neurology

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Recommended reading:
What is a Stroke?
Blood Thinners for Stroke
What is a Mini Stroke?