Artery Stenting In Patients Research Articles

Staged angioplasty versus regular carotid artery stenting in patients with carotid artery stenosis at high risk of hyperperfusion: a randomised clinical trial

Background and purposeHyperperfusion (HP) is a devastating complication associated with carotid artery stenting (CAS) or endarterectomy. The efficacy and safety of staged angioplasty (SAP) in patients with CAS at high...

Three-Month Outcome of Carotid Artery Stenting in Patients with/without Coexistent Unruptured Intracranial Aneurysms

Introduction: Safety of carotid artery stenting (CAS) in patients having carotid stenosis with coexistent unruptured intracranial aneurysms (UIAs) is rarely reported. Thus, we studied the 3-month outcome of CAS in the presence of coexistent UIAs in our institution. Methods: A retrospective analysis of patients receiving CAS at our institution from September 2011 to December 2019 was carried out. Patients were stratified into 2 groups: group of CAS with UIAs (CAS-UIA) and group of CAS without UIAs (CAS). The main complications within 3 months after stenting were TIA, ischemic stroke, symptomatic intracranial hemorrhage (sICH), rupture of UIAs, and death. The baseline characteristics and complications of the 2 groups were compared. Results: Five hundred fifty-six patients (CAS, n = 468; CAS-UIA, n = 88) were included and 604 stenting procedures were performed. More patients had hypertension in the CAS-UIA group (87.5 vs. 73.7%, p = 0.006). There was no significant difference in TIAs, ischemic stroke, sICH, and death within 3 months after stenting between the CAS and CAS-UIA groups. None of the 113 coexistent UIAs detected in 88 patients had aneurysm rupture within 3 months after CAS. Conclusions: In our large cohort of CAS patients, coexistent UIAs are not uncommon. Stenting of a carotid artery in the presence of coexistent UIAs could be conducted safely. Together with 3-month dual antiplatelet therapy, CAS did not increase the rupture risk of the coexistent UIAs within 3 months.

Stenting of Popliteal Lesions Improves Patency Compared to Drug-Coated Balloon Angioplasty

Popliteal artery stenting in patients with peripheral arterial disease remains controversial due to perceived risks of stent fracture and occlusion. Drug-coated balloons (DCBs) have been introduced as a better no-stent alternative while dedicated novel stents (NS) are increasingly used for treatment of popliteal lesions. Our aim was to compare midterm outcomes of stents to DCBs in the popliteal segment.

Long-term Clinical Outcomes of Elective Carotid Artery Stenting in Patients Undergoing Maintenance Hemodialysis.

Objective Carotid artery stenting (CAS) in patients undergoing maintenance hemodialysis is characterized by high complication rates. These patients are excluded from clinical trials of CAS. The purpose of our retrospective study was to investigate the long-term clinical outcomes of CAS in patients undergoing maintenance hemodialysis. Methods CAS was performed under local anesthesia. The technical success rate, periprocedural complications, 30-day major vascular event rate (stroke, myocardial infarction, and/or death), 3-month morbidity and mortality rates, and 5-year survival probability were investigated. Patients Nineteen patients undergoing maintenance hemodialysis were identified. Results The mean age of the patients was 69 years. Periprocedural complications occurred in two patients (confusion following CAS in one and transient hemiparesis in the other). Complete neurological recovery was achieved in both patients. No major cardiovascular events occurred within 30 days after CAS. Asymptomatic intracranial hemorrhage only occurred in one patient, and seven patients died during the follow-up period at a mean of 3.5 years after the procedure (range, 6 months to 8 years). No permanent neurologic deficit remained in the patient with intracranial hemorrhage. The causes of death were cardiovascular disease (n = 4), cancer (n = 2), and pneumonia (n = 1). No patients died of stroke. The 5-year survival probability in patients undergoing maintenance hemodialysis was 57%. Conclusion CAS in maintenance hemodialysis patients may be feasible and effective for the prevention of stroke with proper case selection, appropriate technique and strict perioperative management. The most common causes of death during the follow-up of maintenance hemodialysis patients were diseases other than stroke.

Emergent carotid artery stenting in patients with acute ischemic stroke due to cervical internal carotid artery steno-occlusive lesion: Comparison of tandem intracranial occlusion and isolated cervical internal carotid artery occlusion

Acute ischemic strokes caused by steno-occlusive lesion of the cervical internal carotid artery are associated with poor clinical outcome. We evaluated the clinical efficacy of emergent carotid artery stenting for the management of these lesions. We compared the clinical outcomes regarding the intracranial lesion, namely tandem occlusions versus isolated cervical internal carotid artery occlusion. We retrospectively reviewed patients with acute ischemic stroke who underwent carotid artery stenting for cervical internal carotid artery steno-occlusive lesion between 2011 and 2018. After dividing the patients into two groups according to the presence or absence of intracranial lesions (tandem group and isolated cervical group), we analyzed demographic data, angiographic findings, and clinical outcomes. A modified Rankin Scale score ≤2 was defined as a favorable clinical outcome. Of 75 patients, 46 patients (61.3%) had tandem lesions, and the remaining 29 had only cervical internal carotid artery steno-occlusive lesion. Successful stenting was performed in all patients with favorable clinical outcomes (64.0%). Successful reperfusion score (thrombolysis in cerebral infarction ≥2 b) was 84.0%; tandem group (76.1%) versus isolated cervical group (96.6%) of cases. Mean modified Rankin Scale score at 90-days was 2.09. The rate of favorable clinical outcome showed no statistically significant difference between the two groups (p = 0.454). Endovascular treatment in patients with acute ischemic stroke due to cervical internal carotid artery steno-occlusive lesion is a technically feasible and clinically effective intervention regardless of intracranial occlusion. Therefore, we recommend endovascular treatment regardless of the presence of concomitant intracranial artery occlusion for patients with acute ischemic stroke caused by cervical internal carotid artery steno-occlusive lesion.

In-hospital results of renal artery stenting in patients with multifocal atherosclerosis

A retrospective analysis of in-hospital results of renal artery stenting in patients with multifocal atherosclerosis. The study included 19 patients who underwent stenting for renal artery stenosis for the period 2011-2015 in the Kemerovo Cardiology Dispensary. Renal function was assessed considering glomerular filtration rate (GFR). Blood pressure and GFR were evaluated before the stenting procedure and at discharge. Stenting resulted optimal outcomes in all 19 patients. Severity of residual stenosis was 11±3%. In-hospital mortality was absent. Blood pressure in early postoperative period was similar to baseline values. One patient had a normalization of blood pressure up to 115-140/85-90 mm Hg without administration of antihypertensive drugs. Decrease of systolic blood pressure up to 155.3±32.6 mm Hg was noted in other patients at discharge. Blood creatinine levels decreased up to 0.167±0.56 mmol/L. In addition, mean GFR increased from 34.17 ml/min/1.69 m2 up to 37.16 ml/min/1.69 m2. Endovascular treatment of renal artery stenosis and secondary hypertension is effective and relatively safe approach.

Three-year outcomes of vertebral artery stenting in patients with asymptomatic cerebral ischemia

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Оценить трехлетние результаты эндоваскулярных вмешательств у бессимптомных пациентов с атеросклеротическими стенозами позвоночных артерий как метода вторичной профилактики нарушений мозгового кровообращения (НМК). <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В группе A (<i>n</i>=34) вторичная профилактика НМК проводилась комбинированным способом — стентирование позвоночных артерий в сочетании с медикаментозной терапией, в группе B (<i>n</i>=36) — только медикаментозное лечение. Результаты оценивали через 12, 24 и 36 мес. Критерии включения пациентов в исследование: бессимптомные пациенты со стенозами позвоночных артерий 50—95%; диаметр позвоночных артерий не менее 3 мм и не более 5 мм; наличие общемозговых и очаговых симптомов, соответствующих начальной (асимптомной) стадии хронической ишемии мозга (по Е.В. Шмидту); наличие хотя бы одного фактора неблагоприятного прогноза хронической ишемии головного мозга (аритмия, уровень общего холестерина более 6,0 ммоль/л, незамкнутый виллизиев круг, артериальная гипертензия, двустороннее поражение позвоночных артерий, уровень липопротеинов низкой плотности более 3,5 ммоль/л, сочетанное поражение позвоночных и сонных артерий, кальциноз позвоночных артерий, ишемическая болезнь сердца в анамнезе). Критерии оценки результатов (первичная конечная точка): суммарная частота сердечно-сосудистых осложнений (смерть, преходящие нарушения мозгового кровообращения или инсульт, инфаркт миокарда). <h3>РЕЗУЛЬТАТЫ</h3> У всех пациентов из группы A стентирование позвоночных артерий выполнялось без использования устройств защиты от эмболии. Суммарная частота больших церебральных осложнений к моменту окончания исследования составила 5,9% в группе A и 25% в группе B (χ²=4,825; <i>p</i>=0,023). В группе A к моменту окончания исследования суммарная частота инсульта составила 2,9%, а в группе B она достигала 30,5%. Суммарная частота преходящих нарушений мозгового кровообращения составила 5,8% и 8,3% соответственно (χ²=4,135; <i>p</i>=0,042). Частота кардиальных осложнений составила 8,8% и 27,8% соответственно (χ²=4,154; <i>p</i>=0,042). Выживаемость без значимых церебральных и кардиальных осложнений была достоверно выше у пациентов, которым проводилось комбинированное лечение (стентирование позвоночной артерии в сочетании с медикаментозной терапией). Максимальное количество пациентов, достигших к 36 месяцу целевых значений общего холестерина, составило 88,2% в группе A и 83,3% в группе B (<i>p</i>&gt;0,05), целевых значений ЛПНП — 90,9% и 80,6% соответственно (<i>p</i>&gt;0,05), триглицеридов — 100% в обеих группах. Выживаемость без рестенозов в группе A составила 94,1±4%. Рестеноз выявлен у 6,45% пациентов в группе комбинированного лечения, однако сам по себе рестеноз не влиял на частоту больших мозговых осложнений в отдаленном периоде (χ²=0,6911; <i>p</i>=0,4057). <h3>ВЫВОД</h3> У пациентов с атеросклеротическим поражением позвоночных артерий и бессимптомным течением хронической ишемии головного мозга, имеющих факторы неблагоприятного прогноза, вторичную профилактику НМК целесообразно проводить комбинированным способом, включающим стентирование позвоночных артерий и медикаментозную терапию.

In-hospital outcomes of carotid artery stenting in patients with multifocal atherosclerosis

In-hospital outcomes of carotid artery stenting in patients with multifocal atherosclerosis

Successful carotid artery stenting in patients with aortic dissection

Background: There are no guidelines for the optimal timing of surgery (emergency vs. delayed) for ascending aortic dissection with acute ischemic stroke. We retrospectively compared the prognoses and radiological and clinical findings for concomitant aortic dissection and ischemic stroke in a series of case reports. Case presentation: Three patients presented with left hemiparesis. Patient 1 underwent surgery for acute aortic dissection without treatment for acute ischemic stroke. In Patient 2, emergency stenting could not be performed due to cardiac tamponade and hypotension. Therefore, emergency acute aortic dissection surgery was performed. Patient 3 underwent emergency right common carotid artery stenting followed by surgery for acute aortic dissection. Brain perfusion computed tomography angiography (CTA) was performed to diagnose severe stenosis of the right common carotid artery or occlusion concomitant with acute aortic dissection involving the aortic arch with a cerebral perfusion mismatch in all the patients. Patient 3 had postoperative local cerebral infarction, whereas patients 1 and 2 (without stent insertion) had extensive postoperative cerebral infarction. Conclusion: Patient 3 showed a better prognosis than patients without stent treatment. We suggest that perfusion CTA of the aortic arch in suspected acute ischemic stroke can facilitate early diagnosis and prompt treatment in similar patients.

The dynamics of blood pressure within 12 months after carotid artery stenting in patients with stenotic carotid lesions

Aim. To assess the dynamics of blood pressure (BP) and determine the predictors of the hypotensive effect after carotid artery stenting (CAS).Material and methods. The analysis included 99 patients who underwent CAS in a period of March 2014 and May 2016. Inclusion criteria: (1) the presence of 50% symptomatic or 70% asymptomatic stenosis of the carotid artery (according to NASCET criteria), (2) follow-up for at least 1 year, (3) measurement and recording of BP at four points: 24 hours before surgery, 1 hour, 24 hours and 12 months after surgery. Results. According to office measurement of BP, the average systolic/diastolic pressure was 117,11/60,75, 119,73/60,75, 134,75/70,48 mm Hg after 1 hour, one day and 12 months after the intervention, respectively. In comparison with the average numbers of BP before the intervention, 148,13/89,52 mm Hg there was a significantly significant decrease in BP levels after CAS (p&lt;0,01). According to the results of daily monitoring of blood pressure, a statistically important decrease in blood pressure was observed after 1 year of observation (p&lt;0,01) (136,52/76,84 compared with 145,91/87,63 before the intervention). Dissociated circle of Willis (odds ratio=10,37, 95% confidence interval, from 3,64 to 29,52; p&lt;0,001) and the occurrence of intraoperative hypotension (odds ratio =3,62, 95% confidence interval, from 1,16 to 11,28; p&lt;0,027) were predictors of a persistent decrease in BP after CAS. Conclusion. The obtained results indicated the need for more thorough conservative postoperative management, especially for patients with a dissociated circle of Willis. It is also necessary to achieve the target blood pressure values by individualized correction of antihypertensive therapy.

Hemodynamic Surveillance of Unilateral Carotid Artery Stenting in Patients With or Without Contralateral Carotid Occlusion by TCD/TCCD in the Early Stage Following Procedure.

Objective: To evaluate the cerebral hemodynamic variations in patients with unilateral carotid artery stenosis and contralateral carotid occlusion (CCO) in hours following carotid artery stenting (CAS) by transcranial Doppler (TCD) or transcranial color-code Doppler (TCCD).Methods: Sixty-five consecutive patients who underwent unilateral CAS were enrolled. Among them, 14 patients had ipsilateral severe stenosis and CCO (CCO group) while the other 51 patients had only unilateral severe carotid stenosis without CCO (UCS group). All patients underwent TCD or TCCD monitoring before, at 1 and 3 h after CAS. We monitored bilateral middle cerebral artery (MCA) peak systolic velocity (PSV), pulsatility index (PI), and blood pressure (BP), and compared that data between two groups.Results: In UCS group, ipsilateral MCA PSV increased relative to baseline at 1 h (96 ± 30 vs. 85 ± 26 cm/s, 15%, P < 0.001) and 3 h (97 ± 29 vs. 85 ± 26 cm/s, 17%, P < 0.001) following CAS. Significant PI increases were observed at 1 and 3 h following CAS on the ipsilateral side. In CCO group, ipsilateral MCA PSV increased relative to baseline at 1 h (111 ± 30 vs. 83 ± 26 cm/s, 35%, P < 0.001) and 3 h (107 ± 28 vs. 83 ± 26 cm/s, 32%, P <0.001) following CAS. The magnitude of ipsilateral MCA PSV increase was significantly higher in CCO group compared with UCS group at 1 h (P = 0.002) and 3 h (P = 0.024) following CAS, while BP similarly decreased between the two groups. On the contralateral side, significant MCA PSV increases were observed following CAS in CCO group but not in UCS group. Bilateral MCA PSV increases were higher in patients with a stenosis degree of ≥90% than in patients with stenosis degree of 70–89% only in CCO group.Conclusion: The ipsilateral MCA PSV and PI increase moderately in the initial hours after unilateral CAS in patients without CCO. In patients with CCO, the ipsilateral, and contralateral MCA PSV increase significantly in the early stage following CAS. CCO is a factor of the increased blood flow velocity in ipsilateral MCA after unilateral CAS.

Outcomes After Carotid Artery Stenting in Patients With Normal Neck Anatomy and Hostile Neck Anatomy Are Comparable

Outcomes After Carotid Artery Stenting in Patients With Normal Neck Anatomy and Hostile Neck Anatomy Are Comparable

Cognitive improvement after carotid artery stenting in patients with symptomatic internal carotid artery near-occlusion

Background and purposeTo investigate the influence of carotid artery stenting (CAS) with embolic protection device (EPD) on the cognitive function of patients with near-occlusion of the cervical internal carotid artery (ICA). MethodsFrom February 2014 to December 2017, a total of 79 symptomatic patients were recruited in this study. Of these patients, 31 patients refused to receive CAS therapy. They were divided into the CAS group (48 patients) and the medical treatment group (31 patients). Montreal cognitive assessment (MoCA) instrument was used for the evaluation of cognitive function. The analyzed endpoints included cumulative 12 month incidence of ipsilateral ischemic cerebrovascular events and MoCA scores at 1 month and 12 months after treatment. ResultsCumulative 12 months incidence of ipsilateral ischemic cerebrovascular events was lower in patients who underwent CAS than in patients on medical treatment (P < 0.05). In CAS group, the total MoCA score, scores of attention and delayed recall at months 1 and 12 increased when compared with those at baseline (P < 0.05). In medical treatment group, the total MoCA score and attention score at month 12 decreased when compared with those at baseline (P < 0.05). In CAS group, the total MoCA score, scores of line connection test, drawing clock, attention and delayed recall were improved at 1 and 12 months when compared with medical treatment at the same time points (P < 0.05). ConclusionsCAS with EPD not only decreases the risk of ipsilateral TIA and stroke but also may improve the cognitive function of symptomatic patients with ICA near-occlusion.

Lack of Consensus Among Stroke Experts on the Optimal Management of Patients With Acute Tandem Occlusion

Background and Purpose- In patients with acute stroke caused by tandem occlusion, the benefit of immediate revascularization (stenting) of the cervical internal carotid artery lesion during endovascular thrombectomy is uncertain. We sought to determine current practice patterns and whether consensus existed among physicians with stroke expertise. Methods- We distributed an online survey to stroke experts affiliated with the Canadian Stroke Consortium, the Canadian Interventional Neuro Group, the Society of Vascular and Interventional Neurology, and international ESCAPE trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times) collaborators. Questions were based on clinical scenarios, and multiple choice responses across a Likert-type scale were provided. The survey was sent out in September 2017. After 2 months, data were extracted and then analyzed using descriptive statistics. Results- Responses from 162 stroke experts were analyzed; most were stroke physicians (n=65, 40.1%) and neurointerventionalists (n=74, 45.7%), from Canada (n=95, 58.6%), the United States (n=42, 25.9%), and other countries (n=25, 15.4%). Over half (n=96, 59.3%) of respondents consider acute stenting of the cervical internal carotid artery as a treatment option, whereas 40.7% (n=66) would never use it. Most respondents (n=113, 69.8%) agree that there exists uncertainty about the optimal acute management of patients with tandem occlusion. A majority (n=88, 54.3%) of physicians surveyed would include patients in a randomized trial addressing this question. Conclusions- This survey shows high variability in practice about acute management of tandem occlusion. The existence of community equipoise underscores the importance of a randomized trial evaluating the benefit of acute internal carotid artery stenting in patients with tandem occlusion undergoing endovascular thrombectomy.

Cerebral Hemodynamic Variations in the Early Stage after Carotid Artery Stenting in Patients with and without Near Occlusion

To evaluate the unclear cerebral hemodynamic variations in patients with and without near occlusion (NO) in hours after carotid artery stenting (CAS) by transcranial Doppler (TCD). Data of 56 patients (11 patients with carotid artery NO and 45 patients with severe stenosis without NO) who underwent unilateral CAS were analyzed. All patients underwent TCD or transcranial color-code Doppler monitoring before CAS and again at one and three hours after the procedure. We compared bilateral middle cerebral artery peak systolic velocity (MCA-PSV), pulsatility index (PI), and blood pressure (BP) data between the two groups. Ipsilateral MCA-PSV increased relative to baseline in the stenosis group at one hour (97±30 vs. 84±23cm/s, 16%, P<0.001) and three hours (96±28 vs. 84±23cm/s, 15%, P<0.001) after CAS. Corresponding increases were distinctly higher in the NO group than in the stenosis group at one hour (116±37 vs. 80±29cm/s, 51%, P<0.001) and three hours (113±39 vs. 80±29cm/s, 46%, P=0.001) after CAS, whereas BP decreased similarly between the two groups. The ipsilateral PI increased postsurgically in both groups, whereas contralateral MCA-PSV was unaltered. CAS can induce a significant increase in PSV and PI in ipsilateral MCA within three hours in patients with NO or severe stenosis but absent NO. The increment of ipsilateral MCA-PSV was greater in patients with NO. TCD can facilitate BP control in the early stage after CAS in patients with NO.

Pulmonary artery interventions after the arterial switch operation: Unique and significant risks.

In the modern era, results of the arterial switch operation (ASO) for transposition of the great arteries are excellent. However, because of the LeCompte maneuver, there may be a propensity for development of pulmonary artery stenosis. We encountered atypical complications of pulmonary artery stenting in patients after the ASO, including aorto-pulmonary fistula and coronary compression. We performed a 10-year retrospective review of catheterizations performed in patients after ASO in our institution with a focus on adverse events. Diagnostic and interventional catheterizations were performed in 47 patients. In 29 patients, 37 interventional procedures performed, which included pulmonary artery angioplasty and/or stenting. In this group, there were five major adverse events (14%), including three aorto-pulmonary fistulae and one coronary artery compression among patients having stent implantation or stent redilation. In addition, there were 6/37 (16%) intended stent procedures, which were aborted because there appeared to be high-risk of significant adverse events. This review suggests that percutaneous intervention on pulmonary artery stenosis after ASO has high-risk and should be undertaken advisedly. Prior thorough evaluation of coronary arteries is mandatory as coronary reimplantation sites may be adjacent to sites of pulmonary artery stenosis. Furthermore, if pulmonary artery stent implantation or stent redilation is contemplated, the risk of stent fracture and possible AP fistula should be recognized. Primary use of reinforced covered stents should be considered.

Risk factors for hyperperfusion-induced intracranial hemorrhage after carotid artery stenting in patients with symptomatic severe carotid stenosis evaluation

BackgroundAnalyzing risk factors for hyperperfusion-induced intracranial hemorrhage (HICH) after carotid artery stenting (CAS) in patients with symptomatic severe carotid stenosis.MethodsThis study retrospectively analyzed clinical data of 210 patients, who had...

Long-term outcomes of carotid artery stenting in patients with a contralateral carotid artery occlusion.

To examine the association between a contralateral carotid artery occlusion (CCO) and the rates of subsequent target-lesion restenosis and revascularization after carotid artery stenting (CAS). Patients with carotid artery disease undergoing revascularization often have a CCO. The association of a CCO with long-term outcomes after CAS is uncertain. At two institutions, 267 CAS procedures were performed from 2006 to 2016 including 47 (18%) with a CCO. Regular follow-up with duplex carotid ultrasound was performed to assess for restenosis. Univariate Cox regression analysis was performed to evaluate the association between the presence of a CCO and repeat revascularization. The mean patient age was 70 years. There was no significant difference (P > 0.05) in procedural indication (asymptomatic vs ischemic symptoms) or medical comorbidities between groups. During 5-year follow up, the rate of duplex-derived >80% stenosis was 6% in the non-CCO group and 9% in the CCO group (P = 0.45). Despite similar rates of >80% restenosis, there was a significant association between CCO and subsequent target-lesion revascularization (TLR), with rates of 6.4% vs 0.9% at 5 years (HR 7.2, confidence interval (CI) 1.2-43, P = 0.04). There were no significant differences between groups in the 5-year rates of stroke (4.3% in CCO group vs 4.5% in non-CCO group, HR 0.53, CI 0.07-4.22, P = 1.0) or MACCE (15% vs 18%, HR 0.55, CI 0.2-1.55, P = 0.68). Patients undergoing CAS with a CCO were more likely to undergo TLR during long-term follow up, but they did not have any differences in procedural success or short- and long-term outcomes.

A17659 Long-term blood pressure-lowering effect of carotid artery stenting in patients with carotid artery stenosis

Objectives: To evaluate the long-term blood pressure-lowering effects of carotid artery stenting (CAS) in patients with carotid artery stenosis and find out its predisposing factors on blood pressure (BP) lowering. Methods: 203 consecutive carotid artery stenosis patients underwent CAS from January 2016 to March 2017 were retrospectively analyzed in our institution. The office BP levels of all patients were monitored for 1 year. Thereafter, the preoperative levels of office BP were compared with office BP levels at the the first year intervals after the procedure. BP improvement was defined as an average reduction of systolic BP more than 10 mmHg. Results: Compared with preoperative level, the office systolic BP decreased from 141.6 ± 16.0 mmHg to 132.7 ± 12.2 mmHg (P < 0.01). Among them, 110 patients (54.2%) has BP improvement. The coronary artery bypass grafting (OR = 1.955, 95% CI, 1.116–3.425; p = 0.019), hemodynamic depression (OR = 4.064, 95%CI, 2.226–7.306; p < 0.001) and stent type (open-cell design) (OR = 2.362, 95%CI, 1.237 to 4.505; p = 0.009) were independent predisposing factors for BP-lowering effects of CAS by multivariate analysis. Conclusion: For patients with carotid artery stenosis, CAS might have a BP-lowering effect at the 1-year follow-up, especially in patients underwent coronary artery bypass grafting, hemodynamic depression or being implanted open-cell stents.

Staged carotid artery stenting in patients with severe carotid stenosis: Multicenter experience

Cerebral hyperperfusion syndrome (CHS) is serious complication after carotid artery stenting (CAS) caused by decreased cerebral vasoreactivity (CVR) due to long standing hypoperfusion of the brain. We hypothesized that partial dilatation of carotid stenosis would allow the recovery of CVR, and prevent CHS when definitive angioplasty with stent is performed afterward. In this study, we aimed to evaluate the safety and efficacy of staged CAS in patients with severe carotid artery stenosis with evident hemodynamic compromise in regard to preventing hyperperfusion syndrome. From January 2005 to February 2016, 53 patients with 55 severe carotid artery stenosis lesions showing decreased CVR and/or cerebral basal flow at the perfusion studies underwent staged CAS in three institutes. The procedure consisted of initial partial balloon angioplasty (BA), recovery period, and delayed definitive stenting (DS). We analyzed immediate results, complications, recoil and CHS related to staged CAS. We experienced no symptomatic manifestation of CHS except self-limited headache after the procedures. The median of intervals between BA and DS stages were 10 days. There was no case of severe recoil during the interval between BA and DS stage. Where perfusion imaging data was available, hyperperfusion was present in three and one patients after BA and DS stage, respectively, with no clinical symptom of CHS. In conclusion, staged CAS was feasible in patients with severe carotid artery stenosis and hemodynamic compromise, without inducing severe complication of CHS such as intracranial hemorrhage.