Abstract 1959: A Normal Intracranial Angiogram Predicts a Favorable Outcome in Patients with Neurologic Deficits during Carotid Artery Stenting
Introduction: Despite advances in embolic protection devices and other equipment, some patients still develop neurological deficits during carotid artery stenting (CAS). Severity of in-lab deficit, however, poorly predicts neurological outcome at discharge. We evaluated predictive value of intracranial angiography after carotid stenting on neurological status at discharge.
Methods: We evaluated discharge NIH stroke scores (NIHSS) and intracranial angiograms for those patients with intra-procedural neurological deficits during CAS, excluding patients with intracranial hemorrhage. Operators performed intracranial angiograms in all patients before and after CAS, irrespective of neurological status. A neurologist, blinded to clinical outcomes, reviewed the angiograms, and an independent neurologist examined patients prior to and after the procedure.
Results: In 916 CAS procedures at our institution performed between February 1998 and August 2005, 21 (2.3%) patients developed a new neurological deficit not related to hemorrhage, and we had 14 angiograms available for review. Eight patients had normal angiograms and all returned to baseline NIHSS. Conversely, six patients had new segmental flow abnormalities on final intracranial angiography, and five of these patients did not return to baseline NIHSS. A sixth patient, who had delayed filling of a cortical branch without evidence of thrombus, returned to baseline NIHSS.
Conclusion: In patients with neurological deficits that develop during carotid artery stenting, a normal intracranial angiogram predicts a good neurological outcome at hospital discharge.