Can we predict complications after elective carotid artery angioplasty and stenting with a simple Valsalva test?

Abstract OBJECTIVE Hyperperfusion syndrome is a rare and potentially devastating complication of carotid endarterectomy or carotid artery angioplasty and stenting. With the advent of new imaging techniques, we reviewed our experience with this phenomenon. METHODS This report is a retrospective review of 129 consecutive cases of carotid endarterectomy performed between June 1, 2000, and May 31, 2002, and 44 consecutive cases of carotid artery angioplasty and stenting performed between January 1, 1997, and May 31, 2002. We specifically searched for examples of patients who developed postprocedural nonthrombotic neurological deficits that typified the hyperperfusion syndrome. RESULTS Seven cases of hyperperfusion syndrome occurred, four after endarterectomy (3.1% of carotid endarterectomy cases) and three after stenting (6.8% of stenting cases). The cases of hyperperfusion were classified as presenting with 1) acute focal edema (two cases with stroke-like presentation, attributable to edema immediately after revascularization), 2) acute hemorrhage (two cases of intracerebral hemorrhage immediately after stenting and one case immediately after endarterectomy), or 3) delayed classic presentation (two cases with seizures, focal motor weakness, and/or late intracerebral hemorrhage at least 24 hours after endarterectomy). CONCLUSION Hyperperfusion syndrome may be more common and more variable in clinical presentation than previously appreciated.

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Percutaneous transluminal angioplasty and stenting for recurrent carotid artery stenosis

Neurosurgical FOCUS ◽

10.3171/foc.1998.5.6.8 ◽

1998 ◽

Vol 5 (6) ◽

pp. E7

Author(s):

Giuseppe Lanzino ◽

Robert A. Mericle ◽

Demetrius K. Lopes ◽

Ajay K. Wakhloo ◽

Lee R. Guterman ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Artery Stenosis ◽

Cardiac Complications ◽

Neurological Event ◽

Angioplasty And Stenting ◽

Percutaneous Transluminal

Percutaneous transluminal angioplasty (PTA) and stenting has recently been proposed as an alternative to surgical reexploration in patients with recurrent carotid artery stenosis following endarterectomy. The authors retrospectively reviewed their experience after performing 25 procedures in 21 patients to assess the safety and efficacy of PTA with or without stenting for carotid artery restenosis. The mean interval between endarterectomy and the endovascular procedure was 57 months (range 8-220 months). Seven arteries in five patients were treated by PTA alone (including bilateral procedures in one patient and repeated angioplasty in the same vessel in another). Early suboptimum results and recurrent stenosis in some of these initial cases prompted the authors to combine PTA with stenting in the treatment of 18 arteries over the past 3 years. No major periprocedural deficits (neurological or cardiac complications) or death occurred. There was one periprocedural transient neurological event. A pseudoaneurysm of the femoral artery (at the access site) required surgical repair. In the 16 patients who each underwent at least 6 months of follow-up review, no neurological events ipsilateral to the treated artery had occurred after a mean follow-up period of 27 months (range 6-57 months). Three of five patients who underwent PTA alone developed significant (> 50%) asymptomatic restenoses that required repeated angioplasty in one and PTA with stenting in two patients. Significant restenosis (55%) was observed in only one of the vessels treated by combined angioplasty with stenting. Endovascular PTA and stenting of recurrent carotid artery stenosis is both technically feasible and safe and has a satisfactory midterm patency. This procedure can be considered a viable alternative to surgical reexploration in patients with recurrent carotid artery stenosis.

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Comparison of angioplasty and stenting with cerebral protection versus endarterectomy for treatment of internal carotid artery stenosis in elderly patients

Journal of Vascular Surgery ◽

10.1016/j.jvs.2004.08.022 ◽

2004 ◽

Vol 40 (5) ◽

pp. 945-951 ◽

Cited By ~ 59

Author(s):

Andreas Kastrup ◽

J.örg B. Schulz ◽

Sabine Raygrotzki ◽

Klaus Gröschel ◽

Ulrike Ernemann

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Elderly Patients ◽

Carotid Artery Stenosis ◽

Internal Carotid ◽

Internal Carotid Artery Stenosis ◽

Artery Stenosis ◽

Cerebral Protection ◽

Angioplasty And Stenting

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Angioplasty and Stenting for Non-atherosclerotic Diseases of the Carotid Artery

Neurological Disease and Therapy - Carotid Artery Stenosis ◽

10.1201/b14239-20 ◽

2005 ◽

pp. 317-323

Author(s):

Kumar Rajamani

Keyword(s):

Carotid Artery ◽

Angioplasty And Stenting

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Angioplasty and stenting for carotid artery stenosis: indications, techniques, results, and complications

Neurosurgical FOCUS ◽

10.3171/foc.1998.5.6.6 ◽

1998 ◽

Vol 5 (6) ◽

pp. E5 ◽

Cited By ~ 1

Author(s):

Giuseppe Lanzino ◽

Richard D. Fessler ◽

Robert A. Mericle ◽

Ajay K. Wakhloo ◽

Lee R. Guterman ◽

...

Keyword(s):

High Risk ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Artery Disease ◽

Artery Stenosis ◽

High Risk Patients ◽

Clinical Series ◽

Risk Patients ◽

Artery Disease ◽

Angioplasty And Stenting

Following the favorable results obtained in the treatment of coronary artery disease, combined angioplasty and stenting has been advocated for the treatment of carotid artery stenosis as well. Although widespread application of angioplasty and stenting for carotid artery disease is neither indicated nor recommended, it may be a viable alternative therapy for select patients who are high-risk patients for surgery. The results of early series have suggested that endoluminal revascularization in these high-risk patients can be performed with an acceptable degree of safety. Although the incidence of death and major stroke rates following angioplasty and stenting procedures compares favorably with surgery, results of more recent clinical series have suggested that the incidence of perioperative transient neurological events and minor strokes may be higher than suggested by earlier reports, especially in patients with recent neurological symptoms and “unstable” plaques. In this article, the authors review the current potential indications for and preliminary results of angioplasty and stenting and describe their procedural technique. In addition, potential applications of stenting to intracranial thromboocclusive carotid artery disease are reviewed.

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