Safety and efficacy of simultaneous bilateral carotid angioplasty and stenting

Abstract

In this study, we aimed to evaluate the safety and feasibility of simultaneous bilateral carotid artery stenting (BCAS) compared with staged BCAS in patients with bilateral atherosclerotic carotid stenosis (BCS). From January 2004 to March 2012, 68 patients who underwent BCAS were identified from the Nanjing Stroke Registry Program. Of these patients, 42 (61.8 %) underwent simultaneous BCAS (simultaneous group), and 26 (38.2 %) underwent staged BCAS (staged group). We compared demographic data, major vascular risk factors, procedural parameters, and 30 day outcomes between the simultaneous and staged groups. No significant differences were detected in baseline data between the groups. Patients in the simultaneous group had a lower post-operative systolic pressure compared with the staged group (119.1 ± 16.1 vs. 130.2 ± 17.5 mmHg, P = 0.009). Technical success was 100 % of patients in the simultaneous group and 98.1 % in the staged group. Hemodynamic depression was observed in 57.4 % of procedures, with no significant difference between groups in the rate of HD. Four (5.9 %) patients had neurological complications within 30 days, including two cases of hyperperfusion syndrome in the simultaneous group, and two ischemic events in the staged group. There was no significant difference in the 30 day complication rate between the simultaneous and staged groups (4.8 vs. 7.7 %, P = 0.633). Simultaneous BCAS may be safe and feasible for most patients with BCS, with a similar 30 day complication rate to staged BCAS. Multicenter randomized control studies with larger sample sizes are warranted to further explore the safety and efficacy of simultaneous BCAS.

Simultaneous Bilateral Carotid Stenting for Symptomatic Bilateral High-Grade Carotid Stenosis: A Retrospective Clinical Investigation

“…The sole exception would be that our patients all had bilateral high-grade CS, whereas patients in other investigations just had unilateral or bilateral middle-grade CS. With this in mind, our incidence of HPS was, in fact, much lower than that reported by Liu et al [33]. On the other hand, another characteristic difference between our study and Liu’s investigation was their finding that HPS developed at between 11 days and 3 weeks after the SBCAS procedure.…”

“…In high-risk patients, even more precise management of blood pressure (≤120–130/80–90 mmHg), as in the present investigation, has been shown to help lower incidence of HPS [30,50]. For this reason, the perioperative systolic BP should be reduced to the target level as much as possible, and maintained for at least 3–5 days, as in previous investigations [33,35], in order to avoid HPS.…”

“…On the other hand, although we initially thought that the SBCAS would give rise to an increased risk for stroke owing to its more severe CS nature in the present investigation, our data finally revealed that the incidence of endpoint events at 30-day follow-up was similar to or even lower than the incidence reported in other investigations [29,32,33,35,36]. Thus, our data supported the fact that the SBCAS helped alleviate symptomatic bilateral high-grade CS within 30 days.…”

“…HD is defined as persistent severe bradycardia (fewer than 60 beats/min) and hypotension (systolic pressure lower than 90 mmHg) following SBCAS [39], both of which are caused by activation of the carotid sinus reflex [33]. Most cases of HD occur after predilation of balloon or carotid stent implantation, since the carotid sinus is often activated at that time.…”

“…Theoretically speaking, SBCAS may bring about a higher incidence of HD and give rise to more severe, frequent, and long-lasting sequelae due to the procedure’s bilateral nature and more intense activation of carotid sinus right after balloon predilation or carotid stent implantation [35]. With this in mind, it is no wonder that we found a higher incidence of HD following the SBCAS relative to staged bilateral or unilateral CAS [18,30–33,35,36]. On the other hand, our incidence of HD following the SBCAS was also much higher than those reported by any other similar investigations [31–33,35–37].…”