Baroreceptor failure related to bilateral carotid artery disease: an uncommon cause of labile hypertension

Objectives: Simultaneous bilateral carotid artery stenting (SBCAS) is a challenging procedure, and selection criteria play an important role in determining the final outcome. The aim of the present study was to determine the efficacy and safety of the SBCAS in a series of 9 patients with significant bilateral carotid artery disease (>50% on the symptomatic side and >60% on the asymptomatic side). Materials and Methods: The present study is a retrospective study of 9 patients from January 2005 to December 2012 in a tertiary care center. There were 8 males and 1 female in the age range 50 to 75 years and an average mean age of 63 years. Inclusion criteria of the present study were patients with bilateral internal carotid artery stenosis >50% (50 - 99%) in the symptomatic side and >60% in the asymptomatic side as seen on digital subtraction angiography (DSA). SBCAS with use of distal protection device (Spider device, ev3), to prevent intra-procedural embolic migration, was done in all the patients. Results: Technical success was achieved in all patients (100%). Post-procedural events in the form of hypotension and bradycardia occurred in 3 patients after the placement of stent on both the sides, in 2 patients after the placement of the first stent, and in 1 patient after the placement of the second stent. We did not encounter any cases of hyperperfusion, which was a concern in these patients. There were no deaths, major or minor strokes, or myocardial infarction either in the post-procedural period (up to 1 month) or on clinical follow-up 3 and 6 months post-treatment. Conclusion: SBCAS was an effective and safe alternative treatment method in a select group of patients with bilateral carotid artery disease. It can be considered as a feasible treatment option with acceptable risks.

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OP-093: VISUALIZATION OF SUBCLAVIAN ARTERY IN COMBINED CORONARY AND BILATERAL CAROTID ARTERY DISEASE: A CRUCIAL PITFALL

International Journal of Cardiology ◽

10.1016/s0167-5273(11)70179-6 ◽

2011 ◽

Vol 147 ◽

pp. S61

Author(s):

U. Sevuk ◽

B. Erdolu ◽

E. Kubat ◽

S. Tak ◽

A. Hicazi ◽

...

Keyword(s):

Carotid Artery ◽

Subclavian Artery ◽

Carotid Artery Disease ◽

Bilateral Carotid ◽

Artery Disease ◽

Bilateral Carotid Artery

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Cardiopulmonary perfusion and cerebral blood flow in bilateral carotid artery disease

The Annals of Thoracic Surgery ◽

10.1016/0003-4975(91)90315-h ◽

1991 ◽

Vol 51 (4) ◽

pp. 579-584 ◽

Cited By ~ 33

Author(s):

Per Johnsson ◽

Lars Algotsson ◽

Erik Ryding ◽

Erik Ståhl ◽

Kenneth Messeter

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Carotid Artery Disease ◽

Bilateral Carotid ◽

Artery Disease ◽

Bilateral Carotid Artery

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INCREASED ONE YEAR CARDIOVASCULAR EVENT RATE IN PATIENTS WITH CORONARY ARTERY DISEASE AND BILATERAL CAROTID ARTERY INFLAMMATION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)61575-3 ◽

2015 ◽

Vol 65 (10) ◽

pp. A1575

Author(s):

Georgios Benetos ◽

Konstantinos Toutouzas ◽

Maria Drakopoulou ◽

Charalampia Nikolaou ◽

Pavlos Bounas ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Carotid Artery ◽

Cardiovascular Event ◽

Event Rate ◽

Bilateral Carotid ◽

Artery Disease ◽

One Year ◽

Bilateral Carotid Artery

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Assessment of intracranial hemodynamics in carotid artery disease by transcranial Doppler ultrasound

Journal of Neurosurgery ◽

10.3171/jns.1985.63.6.0890 ◽

1985 ◽

Vol 63 (6) ◽

pp. 890-898 ◽

Cited By ~ 198

Author(s):

Karl-Fredrik Lindegaard ◽

Søren Jacob Bakke ◽

Peter Grolimund ◽

Rune Aaslid ◽

Peter Huber ◽

...

Keyword(s):

Carotid Artery ◽

Cerebral Artery ◽

Transcranial Doppler ◽

Pulsatility Index ◽

Anterior Cerebral Artery ◽

Carotid Artery Disease ◽

Collateral Flow ◽

Transmission Index ◽

Bilateral Carotid ◽

Artery Disease

✓ Noninvasive transcranial Doppler recordings were correlated to the angiographic findings in 77 patients with carotid artery disease. Stenoses reducing the luminal area of the internal carotid artery by 75% or more also reduced the pulsatility transmission index (PTI) of the ipsilateral middle cerebral artery (MCA). The PTI is the pulsatility index of the artery under study expressed as a percent of the pulsatility index of another intracranial artery with presumed unimpeded inflow in the same individual. For stenoses in the 75% to 89% category, PTI reduction was significantly greater in patients with bilateral carotid stenosis, indicating an impaired potential for collateral flow in these patients. The PTI reduction probably reflects both the pressure drop across the stenosis and the cerebral autoregulatory response. Two criteria proved useful in demonstrating collateral MCA supply through the circle of Willis. On the recipient side, retrograde flow in the proximal anterior cerebral artery was demonstrated in 29 of the 31 patients when this flow pattern was disclosed angiographically. In 26 of these patients, the anterior cerebral artery on the supplying side also had clearly increased flow velocity. Increased flow velocities in the proximal posterior cerebral artery were present in 26 of the 30 vessels that were acting as a collateral channel to the ipsilateral MCA.

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National trends in carotid artery revascularization surgery

Journal of Neurosurgery ◽

10.3171/2012.3.jns111320 ◽

2012 ◽

Vol 116 (6) ◽

pp. 1251-1257 ◽

Cited By ~ 56

Author(s):

Travis M. Dumont ◽

Anand I. Rughani

Keyword(s):

Carotid Artery ◽

Randomized Trials ◽

Carotid Artery Disease ◽

Transluminal Angioplasty ◽

Carotid Revascularization ◽

Bilateral Carotid ◽

Artery Disease ◽

National Trends ◽

Revascularization Surgery ◽

Revascularization Procedures

Object Several randomized trials have emerged with conflicting data on the overall safety of carotid artery stenting (CAS) in comparison with carotid endarterectomy (CEA). The authors hypothesize that changes in national trends correspond to publication of randomized trials, including an increase in utilization of CAS after publication of trials favorable to CAS (for example, Carotid and Vertebral Artery Transluminal Angioplasty Study [CAVATAS] and Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy [SAPPHIRE]) and decrease in utilization of CAS after publication of trials favorable to CEA (for example, Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis [EVA3-S] and Stent-Supported Percutaneous Angioplasty of the Carotid Artery versus Endarterectomy [SPACE]). Methods The Nationwide Inpatient Sample was obtained for the years 1998–2008. Individual cases were isolated for principal diagnosis of unilateral or bilateral carotid artery stenosis or occlusion undergoing CEA or CAS. The percentage of CAS for all carotid revascularization procedures was calculated for each year. Perioperative inpatient morbidity, including stroke or death, were calculated and compared. Results The percentage of patients undergoing CAS increased yearly from the start of the observed period to the end, with the exception of a decrease in 2007. The peak utilization of CAS for carotid artery revascularization procedures was 15% of all cases in 2006. The stroke or death rate was consistent at 5% among all patients undergoing CEA for all years, while the incidence of stroke or death decreased among patients undergoing CAS from 9% in 1998 to 5% in 2008. Conclusions The practice of CAS in the US is expanding, from less than 3% of all carotid artery revascularization procedures to 13% in 2008. The utilization of CAS was seen to correlate with publication of randomized trials. Utilization nearly doubled in 2005 after publication of the CAS-favorable SAPPHIRE in 2004, and decreased by 22% after publication of the CEA-favorable EVA-3S and SPACE in 2007. With the publication of Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST), the authors predict a resultant increase in the rate of CAS for carotid artery disease in the upcoming years.

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