Predictors and Outcomes of Periprocedural Intracranial Hemorrhage after Stenting for Symptomatic Intracranial Atherosclerotic Stenosis

A patient presented with progressive weakness in the right limbs for 28 days. The DWI of preprocedural MR) revealed subacute infarction in the right internal watershed area (A). Preprocedural CT perfusion showed extensive hypoperfusion in the right intracranial ICA distribution area, and CBF decreased significantly (B). Preprocedural DSA showed severe stenosis in the terminal segment of the right ICA, with a TICI scale of grade 2a (C). The lesion was treated with a 2.5 × 8 mm balloon-mounted Apollo stent (MicroPort Neuro Tech), with a residual stenosis rate of 10% (D). The CT scan immediately after the procedure showed slightly high attenuation in the right frontal lobe and was considered to be leakage of contrast media (E). The transcranial Doppler indicated elevated flow velocity in the right middle cerebral artery. The patient developed lethargy, slurred speech, and aggravation of left limb weakness 5 hours after the procedure, and a re-examination of head CT revealed cerebral hemorrhage in the right frontal lobe (F). After that, antiplatelet and anticoagulant drugs were stopped, and the CT scan 10 hours after the procedure revealed hemorrhage expansion (G). The CT scan 48 hours after the procedure showed that the hematoma had expanded again. The legal representative refused hematoma removal, and the patient died of respiratory and circulatory failure 7 days after the procedure (H).