Rate, Predictors, and Consequences of Hemodynamic Depression after Carotid Artery Stenting

Gupta, Rishi; Aböu-Chebl, Alex; Bajzer, Christopher; Schumacher, Helmut; Yadav, Jay S.

doi:10.1227/01.neu.0000310151.23982.75

Cited by 38 publications

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“…8) Hypotension may impair the washout of debris in distal intracranial circulation and increase the risk of clinically evident cerebral ischemia. 6) Low blood flow velocity in the middle cerebral artery is correlated with the development of DWI-characterized postoperative ischemic brain lesions associated with microembolization during CEA.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…HI increases the risk of major periprocedural adverse clinical events, defined as myocardial infarction and cerebrovascular events. 8) However, the interaction between HI and new ischemic brain lesions on diffusion-weighted imaging (DWI) has not yet been examined.…”

Section: Introductionmentioning

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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“…Those with persistent HI were at a significantly higher risk of periprocedural adverse outcomes including MI, stroke, or TIA. 5 The incidence of HI varies greatly in different studies from 1.7% to 42%. The incidence of HI in our study was roughly 63%, which is closer to the incidence reported by Gupta et al 5 The reason for the differences among these studies can be attributed to different definitions of HI.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic instability following carotid artery stenting

Kojuri

Ostovan

Zamiri

et al. 2011

FOC

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Object Postprocedural hypotension and bradycardia are important complications of carotid artery stenting (CAS) and are referred to as hemodynamic instability (HI). However, the incidence and impact of HI on the short-term prognosis of patients have been of a large debate. Methods Twenty-seven patients were selected based on NASCET criteria, and they underwent CAS between September 2008 and September 2009. Continuous electrocardiography monitoring and supine blood pressure (BP) monitoring were performed before and after stent deployment and on the following day to detect HI, defined as systolic BP lower than 90 mm Hg or a heart rate lower than 60 bpm. Patients were asked to perform a Valsalva maneuver before and after stent deployment. The Valsalva ratios (VRs) along with other demographic and procedural data were documented and compared between patients with and without incidence of HI. Results Seventeen patients (63%) developed HI after CAS. The degree of stenosis was found to have a significant correlation with occurrence of HI (p < 0.006). No other risk factor or demographic data showed any correlation with HI. The VRs were significantly lower in the HI group compared with the non-HI group, indicating a significant autonomic dysfunction (p < 0.003). During follow-up, 1 patient (4.3%) developed major stroke, and the remaining patients were symptom free. Conclusions Hemodynamic instability occurs frequently after CAS, but it seems to be a benign phenomenon and does not increase the risk of mortality or morbidity in the short term. A VR at rest less than 1.10, baseline autonomic dysfunction, and degree of carotid artery stenosis can be used as measures for predicting HI after CAS.

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“…Нормализация АД на уровне ВСА и частая травма-тизация КС приводили к рефлекторному расширению дистальных отделов артерий ГМ. Это сопровождалось па-дением перфузионного давления, вызывая гипоперфузию ГМ [13]. На фоне высокой потребности ГМ в кислороде и питательных веществах срабатывал механизм отрицатель-ной обратной связи и системное АД повышалось, разви-вался так называемый гиперперфузионный синдром [20].…”

Section: болезни аорты и ее ветвейunclassified

Features of the postoperative period after cerebral revascularization

Александрович¹,

Николаевич²,

Андреевич³

2015

Kardiol. serdechno-sosud. khir.

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В настоящее время в крупных многоцентровых иссле-дованиях доказана эффективность каротидной эндартер-эктомии (КЭАЭ) и ангиопластики сонных артерий (АП-СА) во вторичной профилактике острого нарушения моз-гового кровообращения (ОНМК) [8,11,17]. В этих работах продемонстрированы схожие результаты независимо от используемого метода, на сегодняшний день они являются взаимозаменяемыми. Одним из критериев выбора метода реваскуляризации головного мозга (ГМ) могут являться так называемые малые осложнения. От них зачастую за-висят трудозатраты медицинского персонала, и они могут усугублять послеоперационный период. Мы провели срав-нительный анализ частоты и причин осложнений после двух методов коррекции мозгового кровотока. Материал и методыВ исследование включены 1826 больных, которые бы-ли госпитализированы в Научно-исследовательский ин-ститут -Краевая клиническая больница №1 им. проф. Цель исследования. В настоящее время каротидная эндартерэктомия (КЭАЭ) и ангиопластика сонных артерий (АПСА) по результатам являются схожими методами для реваскуляризации артерий головного мозга (ГМ). Малые осложнения операций несут в себе увеличение трудозатрат медицинского персонала в послеоперационном периоде и должны также учитываться при выборе вмешательства. Материал и методы. В исследование включены 1826 больных, которым выполнены операции по поводу стенозов внутренних сонных артерий (ВСА). В 1-ю группу вошли 1018 больных, которым проведена КЭАЭ, во 2-ю -808 с АПСА. Больные 2-й группы были старше, чаще страдали ишемической болезнью сердца (ИБС), сахарным диабетом (СД), хроническими обструктивными болезнями легких (ХОБЛ), с острым нарушением мозгового кровообращения (ОНМК) в анамнезе (р<0,05). Результаты. В раннем послеоперационном периоде у больных была схожая летальность, частота неконтролируемой артериальной гипертензии (АГ) и транзиторных ишемических атак (ТИА). Частота ОНМК была выше у больных с АПСА -35 (4,3%) против 27 (2,6%) при КЭАЭ (р=0,02), а частота ИМ -после КЭАЭ: 38 (3,7%) против 13 (1,6%) при АПСА (р=0,008). Частота неконтролируемой гипертензии после операции была схожей. Выводы. Оба метода обладают схожей безопасностью, но требуют индивидуального применения к каждому больному.Ключевые слова: стентирование сонных артерий, каротидная эндартерэктомия, реваскуляризация головного мозга, острое нарушение мозгового кровообращения, гематома, гиперперфузионный синдром, инфаркт миокарда.Introduction. Currently, carotid endarterectomy (CEA) and carotid stenting (CAS) demonstrate the similar results in cerebral revascularization. Minor complications of surgery increase labor costs of medical personnel in the postoperative period and should also be taken into account in interventions planning. Material and methods. The study included 1826 patients who underwent surgery for internal carotid artery stenosis (ICA). Group 1 consisted of 1018 patients who underwent CEA, group 2 enrolled 808 patients after CAS. Patients in group 2 were older, more likely to suffer from coronary artery disease (CAD), diabetes, chronic obstructive pulmo...

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Rate, Predictors, and Consequences of Hemodynamic Depression after Carotid Artery Stenting

Cited by 38 publications

References 0 publications

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

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

Hemodynamic instability following carotid artery stenting

Features of the postoperative period after cerebral revascularization

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