Analysis Of Factors Associated With Hyperperfusion Intracranial Hemorrhage After Carotid Artery Stenting

Objective:To investigate the preoperative risk factors associated with the occurrence of Hyperperfusion Intracranial Hemorrhage(HICH)after carotid artery stenting(CAS).Methods :We collected clinical data from 85 patients undergoing carotid artery stenting during January 2020-September 2022 at the Neurology Dept.2,China-Japan Union Hospital of Jilin University.They were divided into HICH and non-HICH groups according to whether Hyperperfusion Intracranial Hemorrhage occurred after CAS,and the clinical characteristics of 9 patients in the HICH group were summarized,and the preoperative clinical data and related imaging analysis of the two groups were compared separately,and the risk factors associated with the occurrence of CAS and HICH were further explored.Univariate outcomes with statistically significant differences were then included in a multivariate logistic regression analysis to obtain independent risk factors for hyperperfusion bleeding after carotid stenting.Result :A total of 85 patients with CAS were included in this study,including 9 in the HICH group and 76 in the non-HICH group.In the univariate outcome analysis,by comparing the clinical baseline data of the two groups,the results showed that there were no statistically significant differences in age,history of smoking,alcohol consumption,history of stroke,history of coronary artery disease,history of hypertension,history of diabetes,history of atrial fibrillation,dyslipidemia,glycosylated hemoglobin,homocysteine,NIHSS score,pre-onset MRS score,side of surgery,degree of contralateral carotid stenosis,mode of anesthesia,surgical procedure,timing,cranial CT perfusion staging,and whether the anterior and posterior communicating arteries and chondral branches were open.(P>0.05).In contrast,the HICH group had a higher proportion of female patients(55.6% vs 13.2%),more severe carotid stenosis(88.64±7.65 vs 77.40±8.20),and higher postoperative blood pressure(66.7% vs 9.2%)compared with the non-HICH group,with statistically significant differences(P<0.05).Multifactorial logistic regression analysis showed that women(OR=0.122,95%CI: 0.016-0.939,P=0.043),degree of carotid artery stenosis(OR=0.841,95% CI:0.719-0.985,P=0.031),and postoperative blood pressure control(OR=9.879,95% CI.1.370-71.231,P=0.023)were statistically different(P<0.05).Conclusion:High degree of carotid stenosis,and high postoperative blood pressure are independent risk factors for hyperperfusion bleeding after internal carotid artery stenting.Although limited by the insufficient sample size of the study may lead to limited conclusions,it is still a guide for clinical work.Therefore,adequate preoperative assessment is important to predict the occurrence of postoperative cerebral hemorrhage.The remaining relevant risk factors need to be confirmed by further expansion of the sample size.