Predictors of periprocedural complications of carotid artery stenting - a multivariate analysis of a single-centre experience

VASA ◽  
2016 ◽  
Vol 45 (5) ◽  
pp. 387-393 ◽  
Author(s):  
Mehmet Bulent Vatan ◽  
Bilgehan Atılgan Acar ◽  
Murat Aksoy ◽  
Yusuf Can ◽  
Ceyhun Varım ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Multivariate Regression Analysis ◽  
Neurological Complications ◽  
Lesion Length ◽  
Plaque Morphology ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Independent Risk Factors

Abstract. Background: Carotid artery stenting (CAS) is currently used as an alternative treatment to carotid endarterectomy (CEA). The objective of this study was to analyse our 5-year experience performing CAS. Secondarily, we sought to determine independent risk factors which predict periprocedural complications. Patients and Methods: A total of 146 patients who underwent 153 CAS procedures were analysed. The majority of patients (123, 84.2%) had symptomatic carotid stenosis. Demographic and interventional data, angiographic lesion characteristics, and periprocedural complications were recorded. Using univariate and multivariate logistic regression analyses, risk factors associated with adverse clinical outcomes were determined. Results: Periprocedural neurological complications, including four (2.7 %) major strokes, three (2 %) transient ischaemic attacks, one (0.7%) amaurosis fugax, and two (1.3 %) cases of hyperperfusion syndrome occurred in ten (6.8%) patients. The incidence of periprocedural complications significantly increased in female patients (r = 0.214, p = 0.009) and patients with longer lesions (r = 0.183, p = 0.027), contralateral stenosis ≥50 % (r = 0.222, p = 0.007), the presence of complicated plaques (r = 0.478, p < 0.001) and inadequate glycaemic control (r = 0.259, p = 0.002). Multivariate regression analysis also determined four variables to be potential independent risk factors for 30-day adverse events: higher age (Odds ratio [OR] = 1.283; 95 % CI, 1.051 to 1.566, p = 0.014); longer lesions (OR = 1.459, 95 % CI, 1.124 to 1.893, p = 0.004); higher tortuosity index (OR = 1.015, 95 % CI, 1.001 to 1.030, p = 0.034), and the presence of complicated plaque morphology (OR = 4.321, 95 % CI, 1.621 to 10.23, p = 0.001). Conclusions: Patient and lesion characteristics including age, lesion length, complicated plaque morphology and tortuosity index, may be associated with periprocedural complications.

Risk factors and frequency of postprocedural hemodynamic instability after carotid artery stent placement

2021 ◽  
Vol 99 (4) ◽  
pp. 162-168
Author(s):  
Jarosław Świstak ◽  
Aleksander Dębiec ◽  
Wojciech Szypowski ◽  
Piotr Piasecki ◽  
Krzysztof Brzozowski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Hemodynamic Instability ◽  
Neurological Complications ◽  
Lesion Length ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Before And After ◽  
Patients At Risk

The frequency, risk factors and long term consequences of reflexive postprocedural hypotension (PH) following carotid artery stenting (CAS) are not well known. Prospective analysis of 30 patients with 6-month follow-up undergoing CAS with an emboli-protection device was performed. A validated 24-hour ABPM was taken 24 hours before and after CAS. PH was defined as systolic blood pressure (SBP) <90mm Hg, or decrease in mean arterial BP (MAP) of ≥20% or systolic BP (SBP) of ≥30 mm Hg of baseline BP reading. Neurological assessments were performed 24 hours after CAS and at 6 month follow-up visit. Median age was 69 years, 70% were male, 86% of patients had symptomatic carotid stenosis. Twenty patients (67%) experienced PH, 43% had transient bradycardia, 30% had both PH and bradycardia. The cumulated postprocedural mean SBP and DBP decreased from baseline 128/67 mm Hg to 108/54 mm Hg (p <0.01), mean day (69/min) and night HR (58/min) decreased to respectively 58/min and 49/min (p <0.01). We found no association of PH with age, ischemic heart disease, bifurcation involvement, balloon size, inflation pressure, longer lesion length. Patients with PH significantly (p <0.05) less often were treated with Ca-antagonist (25% vs 70%), more often had ipsilateral ulcerated plaque (85% vs 50%) and had hemodynamically significant stenosis of contralateral ICA (60% vs 30%). During 6 month follow-up only 1 case of neurological deterioration was noticed. PH was a common phenomenon after CAS, however it did not result in neurological complications. Patients at risk can be possibly identified through clinical and angiographic variables.

scholarly journals Computed tomography indicators of cerebral microperfusion improve long term after carotid stenting in symptomatic patients

2019 ◽  
Author(s):  
Pawel J Winklewski ◽  
Mariusz Kaszubowski ◽  
Grzegorz Halena ◽  
Agnieszka Sabisz ◽  
Kamil Chwojnicki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Predictive Value ◽  
Carotid Artery Stenting ◽  
Ct Perfusion ◽  
Carotid Stenting ◽  
Cerebral Microcirculation ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Before And After

Objectives: We tested the hypothesis that computed tomography (CT) perfusion markers of cerebral microcirculation would improve 36 months after internal carotid artery stenting for symptomatic carotid stenosis while results obtained 6–8 weeks after the stenting procedure would yield a predictive value. Methods: We recruited consecutive eligible patients with >70% symptomatic carotid stenosis with a complete circle of Willis and normal vertebral arteries to the observational cohort study. We detected changes in the cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP) and permeability surface area-product (PS) before and after carotid stenting. We have also compared the absolute differences in the ipsilateral and contralateral CT perfusion markers before and after stenting. The search for regression models of “36 months after stenting” results was based on a stepwise analysis with bidirectional elimination method. Results: A total of 34 patients completed the 36 months follow-up (15 females, mean age of 69.68±S.D. 7.61 years). At 36 months after stenting, the absolute values for CT perfusion markers had improved: CBF (ipsilateral: +7.76%, contralateral: +0.95%); CBV (ipsilateral: +5.13%, contralateral: +3.00%); MTT (ipsilateral: –12.90%; contralateral: –5.63%); TTP (ipsilateral: –2.10%, contralateral: –4.73%) and PS (ipsilateral: –35.21%, contralateral: –35.45%). MTT assessed 6–8 weeks after stenting predicted the MTT value 36 months after stenting (ipsilateral: R2=0.867, contralateral R2=0.688). Conclusions: We have demonstrated improvements in CT perfusion markers of cerebral microcirculation health that persist for at least 3 years after carotid artery stenting in symptomatic patients. MTT assessed 6–8 weeks after stenting yields a predictive value.

Early versus late carotid artery stenting for symptomatic carotid stenosis

2015 ◽  
Vol 42 (3) ◽  
pp. 169-175 ◽  
Author(s):  
Luis Henrique de Castro-Afonso ◽  
Guilherme S. Nakiri ◽  
Lucas M. Monsignore ◽  
Antônio C. Dos Santos ◽  
João Pereira Leite ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenting ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

scholarly journals Physician Approaches to Imaging and Revascularization for Acutely Symptomatic Carotid Stenosis: Insights from the Hot Carotid Qualitative Study

2022 ◽  
Vol 2 (1) ◽  
Author(s):  
Aravind Ganesh ◽  
Benjamin Beland ◽  
Gordon A.E. Jewett ◽  
David J.T. Campbell ◽  
Malavika Varma ◽  
...  
Keyword(s):  
Decision Making ◽  
Carotid Artery ◽  
Qualitative Study ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenting ◽  
Practice Patterns ◽  
Imaging Modality ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Background Evidence informing the choice between carotid endarterectomy and carotid artery stenting for acutely symptomatic carotid stenosis (“hot carotid”) is dated and does not factor in contemporary therapies or techniques. The optimal imaging modality is also uncertain. We explored the attitudes of stroke physicians regarding imaging and revascularization of patients with acute symptomatic carotid stenosis. Methods We used a qualitative descriptive methodology to examine decision‐making approaches and opinions of physicians regarding the choice of imaging and revascularization procedures for hot carotids. We conducted semistructured interviews with purposive sampling of 22 stroke physicians from 16 centers in 6 world regions and various specialties: 11 neurologists, 3 geriatricians, 5 interventional neuroradiologists, and 3 neurovascular surgeons. Results Qualitative analysis revealed several themes regarding clinical decision‐making for hot carotids. Whereas CT angiography was favored by most participants, timely imaging availability, breadth of information gained, and surgeon/interventionalist preferences were important themes influencing the choice of imaging modality. Carotid endarterectomy was generally favored over carotid artery stenting, but participants’ choice of intervention was influenced by healthcare system factors such as use of multidisciplinary vascular teams and operating room or angiography suite availability, and patient factors like age and infarct size. Areas of uncertainty included choice of imaging modality for borderline stenosis, utility of carotid plaque imaging, timing of revascularization, and the role of intervention with borderline stenosis or intraluminal thrombus. Conclusions This qualitative study highlights practice patterns common in different centers around the world, such as the general preference for CT angiography imaging and carotid endarterectomy over carotid artery stenting but also identified important differences in availability, selection, and timing of imaging and revascularization options. To gain widespread support, future carotid trials will need to accommodate identified variations in practice patterns and address areas of uncertainty, such as optimal timing of revascularization with modern best medical management and risk‐stratification with imaging features other than just degree of stenosis.

Carotid Artery Stenting May Be Losing the Battle against Carotid Endarterectomy for the Management of Symptomatic Carotid Artery Stenosis, But the Jury Is Still Out

Vascular ◽  
2009 ◽  
Vol 17 (4) ◽  
pp. 183-189 ◽  
Author(s):  
Kosmas I. Paraskevas ◽  
Dimitri P. Mikhailidis ◽  
Frank J. Veith
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Artery Stenosis ◽  
Long Term Results ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Carotid artery stenting (CAS) has emerged as a potential alternative to carotid endarterectomy (CEA) for the management of carotid artery stenosis. The purpose of this article is to provide an evaluation and critical overview of the trials comparing the early and later results of CAS with CEA for symptomatic carotid stenosis. The Cochrane Controlled Trials Register, PubMed/Medline, and EMBASE databases were searched up to February 1, 2009, to identify trials comparing the long-term outcomes of CAS with CEA. The MeSH terms used were “carotid artery stenting,” “carotid endarterectomy,” “symptomatic carotid artery stenosis,” “treatment,” “clinical trial,” “randomized,” and “long-term results,” in various combinations. One single-center and three multicenter randomized studies reporting their long-term results from the comparison of CAS with CEA for symptomatic carotid stenosis were identified. All four studies independently reached the conclusion that CAS may not provide results equivalent to those of CEA for the management of symptomatic carotid stenosis. A higher incidence of recurrent stenosis and peri- and postprocedural events accounted for the inferior results reported for CAS compared with CEA. Current data from randomized studies indicate that CAS provides inferior long-term results compared with CEA for the management of symptomatic carotid artery stenosis. However, it can be argued that all of these trials were performed when both CAS equipment and CAS operators had not evolved to their current status. Given that current equipment and mature experience are required for CAS before comparing it with the current “gold standard” procedure (CEA), the results of soon-to-be reported trials (Carotid Revascularization Endarterectomy vs Stenting Trial [CREST], International Carotid Stenting Study [ICSS], or others) may alter the current impression that CAS is inferior to CEA for the treatment of symptomatic carotid stenosis.

Hypotension and Bradycardia after Elective Carotid Stenting: Frequency and Risk Factors

2003 ◽  
Vol 10 (5) ◽  
pp. 851-859 ◽  
Author(s):  
Wolfgang Mlekusch ◽  
Martin Schillinger ◽  
Schila Sabeti ◽  
Tassilo Nachtmann ◽  
Wilfried Lang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Carotid Stenting ◽  
Hemodynamic Instability ◽  
Neurological Complications ◽  
Severe Hypotension ◽  
Artery Disease

Purpose: To investigate the frequency of and risk factors for hypotension and bradycardia in response to elective carotid stenting and their association with neurological complications. Methods: A retrospective analysis was conducted of 471 patients (321 men; median age 72 years, interquartile range 64–77) who underwent elective carotid artery stenting without cerebral protection for high-grade (>70%) symptomatic (n = 147) or asymptomatic (n=324) internal carotid artery stenosis at a single center. Frequency and potential risk factors for severe hypotension (systolic blood pressure <80 mmHg) or bradycardia (heart rate <50 bpm) were studied. Results: Thirty-four (7%) patients had severe hypotension (n=23), bradycardia (n=2), or both (n=9) despite routine premedication with atropine and adequate fluid balance. Intravenous catecholamines (dopamine) were necessary in 8 patients with prolonged hypotension; none of the patients with bradycardia needed pacemaker support. Neurological complications (transient ischemic attack, minor stroke, major stroke, death) occurring in 33 (7%) patients were not significantly associated with hemodynamic instability (4/34 [12%] versus 29/437 [7%], p = 0.26). Age >77 years (fourth quartile; OR 6.40, 95% CI 1.80 to 22.78, p=0.004) and coronary artery disease (OR 2.81, 95% CI 1.29 to 6.14, p=0.010) were associated with an increased adjusted risk for hypotension or bradycardia. Conclusions: Hemodynamic instability due to hypotension and bradycardia in response to carotid artery stenting occurs in a relatively low proportion of patients. Elderly patients and those with coronary artery disease are at highest risk. Although the rate of neurological complications was not significantly increased in patients with hemodynamic instability, the higher frequencies of neurological complications in these patients admonish us to be careful.

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