Periprocedural hemodynamic instability with carotid angioplasty and stenting

Taha, Mahmoud M.; Toma, Naoki; Sakaida, Hiroshi; Hori, Kotaro; Maeda, Masayuki; Asakura, Fumio; Fujimoto, Masashi; Matsushima, Satoshi; Taki, Waro

doi:10.1016/j.surneu.2007.07.006

Cited by 46 publications

(39 citation statements)

References 16 publications

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“…Finally, the total incidence of HD in our series was not higher than that in reported studies. 18,22,[35][36][37] All of the patients with HD in our study recovered spontaneously or after infusion of normal saline and/or volume expanders or occasionally with the use of vasopressors and/or anticholinergics. HD during CAS is relatively common and benign, without an increase of perioperative risks.…”

Section: Discussionmentioning

confidence: 77%

Simultaneous Bilateral Carotid Stenting in High-Risk Patients

Liu¹,

Jung²,

Kim³

et al. 2010

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 77%

Simultaneous Bilateral Carotid Stenting in High-Risk Patients

Liu¹,

Jung²,

Kim³

et al. 2010

AJNR Am J Neuroradiol

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“…The frequency of development of prolonged CSR following CAS procedures varies from 11% to 42%, and plaque characteristics and anatomic risk factors associated with such hemodynamic depression include calcified plaque, fibrous plaque, eccentric plaque, lesions involving the carotid bulb, presence of contralateral stenosis or occlusion, length of stenosis, right-sided lesions, and balloon-to-artery ratio. [12][13][14][15][16] The clinical efficacy of CEA was established in clinical trials for symptomatic and asymptomatic carotid occlusive disease. 17,18 CAS has been recommended as a less invasive but potentially equally effective treatment for carotid disease.…”

mentioning

confidence: 99%

Prolonged Carotid Sinus Reflex Is a Risk Factor for Contrast-Induced Nephropathy following Carotid Artery Stenting

Kato¹,

Sakai²,

Tsujimoto³

et al. 2011

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Although many studies have demonstrated that CIN is associated with in-hospital and long-term mortality, the incidence of CIN following CAS is unclear. We investigated the incidence of CIN, defined as an increase from a baseline creatinine value of at least 0.5 mg/dL or 25% within 72 hours of contrast administration, and we also examined renal function in the late phase after CAS.

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“…Both diameter and length of the balloon and stent were shown to affect HI. 19) Balloons are generally selected to be 3-4 mm in diameter and 15-40 mm in length at predilation, and 4.5-6 mm in diameter and 15-30 mm in length at postdilation. 1) The main difference between our study and others may be that a large predilation balloon was used for dilation in our institute.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports have shown that the frequencies of HI and new ischemic brain lesions detected on DWI differ depending on the type of EPD and stent employed. 12,18,19) The procedure, especially the use of stents and EPDs, varies among surgeons. 12,18) This study is highly credible because both devices and procedures were constant.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Instability Increases New Ischemic Brain Lesions on Diffusion-Weighted Imaging After Carotid Artery Stenting

Ito

Kato

Matsumura

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Hemodynamic instability (HI) may impair the washout of debris during distal intracranial circulation and increase the risk of clinically evident cerebral ischemia. However, the interaction between HI and new ischemic brain lesions detected on diffusion-weighted imaging (DWI) has not been examined. This study evaluated whether HI was significantly associated with the incidence of new ischemic brain lesions on DWI. Data on 128 patients who underwent carotid artery stenting (CAS) with the same devices and procedures between January 2005 and May 2010 were retrospectively analyzed. HI was noted in 31 (24.2%) patients. New ischemic brain lesions were detected on DWI in 25 (19.5%) patients. Ten of 31 (32.2%) patients with HI showed new ischemic brain lesions on DWI. Fifteen of 97 (15.5%) patients without HI showed new lesions. Univariate analysis showed that patients with HI had a significantly higher incidence of new ischemic brain lesions than patients without HI (p ＝ 0.04). A multivariable model showed that age and HI were significantly associated with the incidence of new ischemic brain lesions. In patients with carotid artery stenosis, decreased blood pressure produced no active vascular response, but reduced the cerebral blood volume and velocity due to impaired dynamic cerebral autoregulation. The results of this study suggest that HI with CAS induces impaired clearance of microembolisms and causes an increased number of new ischemic brain lesions detected on DWI.

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Periprocedural hemodynamic instability with carotid angioplasty and stenting

Cited by 46 publications

References 16 publications

Simultaneous Bilateral Carotid Stenting in High-Risk Patients

Simultaneous Bilateral Carotid Stenting in High-Risk Patients

Prolonged Carotid Sinus Reflex Is a Risk Factor for Contrast-Induced Nephropathy following Carotid Artery Stenting

Hemodynamic Instability Increases New Ischemic Brain Lesions on Diffusion-Weighted Imaging After Carotid Artery Stenting

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