Prediction of Prolonged Hemodynamic Instability During Carotid Angioplasty and Stenting / 신경중재치료의학

PURPOSE: The aim of this study was to assess the risk factors of prolonged hemodynamic instability (HDI) after carotid angioplasty and stenting (CAS). Herein, a simplified predictive scoring system for prolonged HDI is proposed. MATERIALS AND METHODS: Sixty-six patients who had CAS from 2011 to 2016 at a single institution were evaluated. Prolonged HDI was defined as systolic blood pressure >160 mm Hg or <90 mm Hg or heart rate <50 beats/min, lasting over 30 minutes despite medical treatments. For the study, clinical data and radiologic data, including plaque morphology and stenosis were analyzed. RESULTS: Prolonged HDI was observed in 21 patients (31.8%). Multivariable analysis revealed that calcification (OR, 6.726; p=0.006), eccentric stenosis (OR, 3.645; p=0.047) and extensive plaque distribution (OR, 7.169; p=0.006) were related to prolonged HDI. According to these results, a simplified scoring scale was proposed based on the summation of points: 2 points for calcified plaque, 2 points for extensive plaque distribution, and 1 point for eccentric stenosis. The percentages of prolonged HDI according to the total score were as follows: score 0, 8.7%; score 1, 20.0%; score 2, 38.5%; score 3, 72.7%; score 4, 66.7%; score 5, 100%. From the analysis, the total score in patients with prolonged HDI was significantly higher than those without prolonged HDI (p<0.001). CONCLUSION: Prolonged HDI can be associated with calcification of plaque, eccentric stenosis and extensive plaque distribution, and a simplified scoring system enables prediction of prolonged HDI according to our cohort.

Changes of hemodynamic after carotid angioplasty and stenting in patients with carotid artery stenosis / 临床神经病学杂志

Objective To explore the changes of hemodynamic after carotid angioplasty and stenting ( CAS) in patients with carotid artery stenosis .Methods Thirty-one carotid artery stenosis patients were treated with CAS , and were examined by color Doppler flow imaging ( CDFI) before operation and 1 d,3 months,one year after operation . Compared the carotid artery diameter , peak flow velocity (PSV) and end-diastolic velocity (EDV) before and after the operation.Results Compared with before operation , carotid artery diameter were significantly increased ,PSV, EDV were significantly decreased at each time point after operation ( all P<0.01 ) .Compared with 1 d after operation, there was no statistical difference on the CDFI results of carotid artery in 3 months after operation;compared with 1 d after operation the carotid artery diameter was significanty decreased in one year after operation ( P<0.05 ) , there was no statistical difference in PSV and EDV .Conclusions CAS can alleviate the carotid stenosis and improve the indicator of hemodynamics significantly .Vascular restenosis is found in some patients one year after operation , but there was no statistical difference in the indicator of hemodynamic .

Hemodynamic Instability during Carotid Angioplasty and Stenting-Relationship of Calcified Plaque and Its Characteristics

PURPOSE: During carotid angioplasty and stenting (CAS), hemodynamic instability (HDI) can occur, possibly causing post-procedural ischemic complications. The goal of this study was to investigate the risk factors of HDI focusing on characteristics of plaque. MATERIALS AND METHODS: Thirty nine CAS patients were retrospectively evaluated for HDI. Prolonged HDI that lasted over 30 minutes was analyzed in relation to characteristics of calcified plaque. RESULTS: Nineteen (48.7%) patients had HDI. Ten of the 19 had both bradycardia and hypotension, and nine had only bradycardia. All bradycardia was treated well with a transcutaneous temporary cardiac pacemaker. But eight patients presented with prolonged hypotension in spite of recovery of bradycardia. Calcified plaque was a related factor associated with HDI (odds ratio, 8.571; 95% confidence interval, 1.321-55.62; p=0.024). Extensive and eccentric type calcified plaques were associated with prolonged hypotension (p=0.04, and p=0.028, respectively). CONCLUSION: The calcification of plaque is a predictable factor of HDI during CAS, and its extensive and eccentric calcified plaques may be related to prolonged HDI.

Ophthalmic Artery Occlusion After Carotid Revascularization

Distal embolization resulting from carotid angioplasty and stenting (CAS) occurs mainly in the cerebral hemisphere. We report a case of ophthalmic artery occlusion after carotid revascularization. A 75-year old man received emergency CAS for cervical internal carotid artery occlusion. Two months later, the patient was readmitted for decreased visual acuity. We found ophthalmic artery occlusion that was not noticed soon after CAS. Although ophthalmic artery occlusion after CAS is rare, endovascular neurosurgeons should be aware of this potential complication.

Analysis of the risk factors for persistent hemodynamic depression after carotid angioplasty and stenting / 中国医师进修杂志

Objective To investigate the risk factors for persistent hemodynamic depression after carotid angioplasty and stenting(CAS). Methods Sixty-one patients with CAS were included. By univariate Logistic regression analysis,the influencing factors for persistent hemodynamic depression were analyzed,by stepwise Logistic regression analysis and adjustment for age and gender factors,the independent risk factors for persistent hemodynamic depression were analyzed. Results In 61 patients,25 cases had hypotension,25 cases had bradycardia,all for 41.0% incidence. According to the patients intraoperative and postoperative blood pressure,heart rate conditions,the duration of hemodynamic depression,the cases were divided into persistent hemodynamic depression group (20 cases) and no-persistent hemodynamic depression group(41 cases). Univariate Logistic regression analysis indicated that persistent hemodynamic depression influencing factors were the symptomatic stenosis, severe stenosis, using balloon dilatation, implantation of laser-carving stent(P<0.05). With adjustment for age and gender factors, stepwise Logistic regression analysis showed that using balloon dilatation, implantation of laser-carving stent were the independent risk factors for persistent hemodynamic depression (OR = 5.046,95%CI 1.342-18.977,P = 0.017;OR = 4.142,95%CI 1.151-14.902, P= 0.030),symptomatic stenosis was the independent protective factor for persistent hemodynamic depression (OR = 0.264,95% CI 0.073-0.964,P= 0.044). Conclusions Persistent hemodynamic depression after CAS is a common complication.CAS patients with using balloon dilatation, implantation of laser-carving stent are more susceptible to persistent hemodynamic depression, while symptomatic stenosis is its protective factor.

Prolonged Hemodynamic Depression After Bilateral Carotid Angioplasty and Stent Insertion

Hemodynamic depression (hypotension and bradycardia) can occur during or after carotid angioplasty and stenting (CAS) due to stretching of the baroreceptors in the carotid sinus. The predisposing factors of hemodynamic depression have not been reported previously. In general, hemodynamic depression after CAS may continue for up to 3-5 days, but disappears within 7 days. We report herein a 65-year-old man with severe hemodynamic depression after sequential CAS, and discuss the possible causes from an anatomical point of view.

Ocular Ischemic Syndrome Successfully Treated With Carotid Angioplasty and Stenting

PURPOSE: To report a case of ocular ischemic syndrome successfully treated with delayed carotid angioplasty and stenting (CAS). CASE SUMMARY: A 52-year-old male was admitted to our hospital because of amaurosis fugax-like symptoms in the right eye for several months. His visual acuity was 0.8 in the right eye and he did not have rubeosis iridis. Neovascularization of the disc, narrowing of the retinal artery and multiple retinal hemorrhages were diagnosed by fundus examination. Fluorescein angiography showed delayed choroidal filling, a delayed arm-to-retina time, prolongation of arteriovenous transit time, neovascularization of the disc, retinal capillary nonperfusion, and staining of the retinal vessels. MR angiography showed severe stenosis in the proximal portion of the right carotid artery. We diagnosed this case as ocular ischemic syndrome. The patient was recommended carotid angioplasty and stenting at the severely narrowed portion of the right carotid artery, but it was postponed about six months after diagnosis because of personal problems. At the final follow-up, 24 months after stenting, the amaurosis fugax symptoms had disappeared, the patient had an improved visual acuity of 1.0, and the new vessels on the disc changed to fibrous tissue. Fluorescein angiography showed resolution of the delayed arm-to-retina time and prolongation of the arteriovenous transit time, disappearances of the leakage around the disc and the retinal capillary nonperfusion.

Delayed Carotid Wallstent Shortening Resulting in Restenosis Following Successful Carotid Artery Angioplasty and Stenting

Carotid angioplasty and stenting (CAS) for carotid stenosis has been increasingly used as an alternative treatment in patients not eligible for surgery. Even though CAS can be performed relatively simply in many cases, various complications can occur. We report four cases of CAS using the Carotid Wallstent, which were complicated by delayed shortening of the stent, resulting in restenosis after successful CAS.

Surgical Management of High-Risk Carotid Stenosis(Report of 24 Cases) / 中国普外基础与临床杂志

Objective To summarize our experience in treating high risk carotid stenosis. Methods We retrospectively analyzed the clinical characteristics, treatment, and outcomes of 24 patients with high risk carotid stenosis in our department from January 2001 with emphasis on the application of carotid stents and shunting tubes. Results All patients were successfully treated, with 11 patients undergoing carotid angioplasty and stenting (CAS) and 13 patients receiving carotid endarterectomy (CEA) and shunting. No death, stroke, and ischemic neurological deficit occurred in 30 days postoperatively. Conclusion Selective application of CAS and shunting in CEA can effectively reduce complications and improve therapeutic effects in patients with high risk carotid stenosis.

Observation on therapeutic effects of carotid angioplasty and stenting with cerebral protection fitler for elder and high-risk with symptomatic carotid stenosis / 临床神经病学杂志

Objective To investigate the effectivety and safety of carotid angioplasty and stenting (CAS) with cerebral protection fitler for elder and high risk patients with symptomatic carotid stenosis.Methods 25 patients with symptomatic carotid stenosis over 60 years old at high risk were treated with CAS. Results The procedures were technically successful in all patients. All the degrees of stenosis after CAS were less than 20%. Clinical symptoms disappeared. Heart rate and blood pressure were decreased differently in 24 cases.None of them experienced serious clinical complications. Conclusion CAS with cerebral protection fitler are safe and effective in treatment of elder and high risk of patients with symptomatic carotid stenosis.