<b>Correlation of Periprocedural Systolic Blood Pressure Changes With Neurological Events in High-Risk Carotid Stent Patients</b>

Howell, Marcus H.; Krajcer, Zvonimir; Dougherty, Kathryn G.; Strickman, Neil E.; Skolkin, Mark D.; Toombs, Barry D.; Paniagua, David

doi:10.1583/1545-1550(2002)009<0810:copsbp>2.0.co;2

Cited by 37 publications

(34 citation statements)

References 16 publications

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“…[17][18][19][20] However, this association has not been found in every study. [21][22][23] In the current study, 12% of the patients treated by CAS had periprocedural hemodynamic depression requiring treatment, whereas uncontrolled series of patients treated by CAS have reported frequencies of arterial hypotension or hemodynamic depression ranging from 19% to 51%.…”

Section: Discussionmentioning

confidence: 84%

Periprocedural Hemodynamic Depression Is Associated With a Higher Number of New Ischemic Brain Lesions After Stenting in the International Carotid Stenting Study-MRI Substudy

Altinbas

Algra

Bonati

et al. 2014

Stroke

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In patients with symptomatic carotid artery stenosis, carotid artery stenting (CAS) is associated with a higher risk of periprocedural stroke than carotid endarterectomy (CEA). 1Patients treated by CAS also more frequently have new ischemic lesions on post-treatment MRI scans with diffusionweighted imaging (DWI). 2 The cause of the higher risk of new cerebral ischemia early after CAS compared with CEA is uncertain.Embolism from the carotid artery plaque during stent deployment or arterial dissection is generally held responsible for the majority of new ischemic lesions during carotid revascularization. During CAS and CEA, cerebral microembolic signals are often detected with transcranial Doppler. 3A high frequency of these signals has been associated with a higher risk of stroke, 4 but the majority of the underlying emboli do not lead to cerebral ischemia.5 It has been proposed that under circumstances of a normal cerebral perfusion, most of these emboli are cleared by the cerebral circulation and that hypoperfusion increases the risk of a focal ischemic lesion. This is supported by a study that showed that patients with impaired perfusion in the hemisphere ipsilateral to the carotid artery stenosis before stenting had more ischemic lesions Background and Purpose-Carotid artery stenting (CAS) is associated with a higher risk of both hemodynamic depression and new ischemic brain lesions on diffusion-weighted imaging than carotid endarterectomy (CEA). We assessed whether the occurrence of hemodynamic depression is associated with these lesions in patients with symptomatic carotid stenosis treated by CAS or CEA in the randomized International Carotid Stenting Study (ICSS)-MRI substudy. Methods-The number and total volume of new ischemic lesions on diffusion-weighted imaging 1 to 3 days after CAS or CEA was measured in the ICSS-MRI substudy. Hemodynamic depression was defined as periprocedural bradycardia, asystole, or hypotension requiring treatment. The number of new ischemic lesions was the primary outcome measure. We calculated risk ratios and 95% confidence intervals per treatment with Poisson regression comparing the number of lesions in patients with or without hemodynamic depression. Results-A total of 229 patients were included (122 allocated CAS; 107 CEA). After CAS, patients with hemodynamic depression had a mean of 13 new diffusion-weighted imaging lesions, compared with a mean of 4 in those without hemodynamic depression (risk ratio, 3.36; 95% confidence interval, 1.73-6.50). The number of lesions after CEA was too small for reliable analysis. Lesion volumes did not differ between patients with or without hemodynamic depression. Conclusions-In

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Section: Discussionmentioning

confidence: 84%

Periprocedural Hemodynamic Depression Is Associated With a Higher Number of New Ischemic Brain Lesions After Stenting in the International Carotid Stenting Study-MRI Substudy

Altinbas

Algra

Bonati

et al. 2014

Stroke

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“…Caplan et al 8) suggested that emboli are not washed out due to a reduced perfusion pressure of the brain as a mechanism of cerebral infarction, and Howell et al 9) reported that the frequency of ischemic neurological symptoms increased significantly when the SBP decreased by 51 mmHg or more in the peri-CAS period compared with the usual pressure. We administered noradrenaline to all such patients to promptly increase the blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Outcomes between 30 Days and 1 Year after Carotid Artery Stenting Using FilterWire EZ: Clinical Results and Diffusion-weighted MRI Findings in 262 Consecutive Patients

Mizobe

Nakamura

Motooka

et al. 2016

JNET

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Objective: To report the clinical outcomes of carotid artery stenting (CAS) using the FilterWire EZ (FWEZ) Embolic Protection System. Methods:In 262 consecutive patients who underwent CAS using FWEZ from May 2010 to December 31, 2015, major adverse events (MAEs) including stroke, myocardial infarction, and death that occurred between 30 days and 1 year after the procedure and findings on diffusion-weighted imaging (DWI) were evaluated. Results:Ischemic stroke was observed after CAS using FWEZ in four patients (1.53%), but the neurological symptoms disappeared within 30 days in all those patients. No cerebral hemorrhage, myocardial infarction, or death occurred within 30 days after CAS. New DWI lesions were observed in 53 patients (20.2%): ipsilateral hemisphere alone in 38 patients (14.5%), contralateral hemisphere alone in 5 patients (1.9%), and both hemispheres in 10 patients (3.82%). They were significantly related to age, smoking within 1 year, and prolonged post-procedural hypotension. In 235 patients who could be followed up, no ipsilateral stroke was noted between 31 days and 1 year after CAS. Non-ipsilateral strokes were observed in three patients (1.28%): contralateral cerebral infarction in one patient (0.43%), contralateral cerebral hemorrhage in one patient (0.43%), and death due to subarachnoid hemorrhage in one patient (0.43%). Other events included non-traumatic acute subdural hematoma in one patient (0.43%), myocardial infarction in six patients (2.55%), and death in seven patients (2.98%). No 50% or severer stenosis was observed within 1 year. Conclusion:The clinical outcomes and DWI-positive rates between 30 days and 1 year after CAS using FWEZ were favorable. CAS using FWEZ is a simple procedure and is considered effective for the treatment of carotid stenosis considered.

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“…Persistent hypotension lasting Ͼ1 hour was also assessed because this has previously been shown to relate to adverse neurological outcome, 6 although the magnitude of the change in systolic blood pressure (Ͼ50 mm Hg) has recently also been shown to relate to adverse neurological events after carotid stenting. 13 Comparison between the 2 groups in this regard was subject to bias because the surgical group received more active treatment. Furthermore, the surgical technique can influence the type of blood pressure disturbances seen, so that dissection methods that preserve the carotid nerve result in fewer episodes of hypertension.…”

Section: Mckevitt Et Al Effect Of Carotid Interventions On Blood Presmentioning

confidence: 99%

Effect of Treatment of Carotid Artery Stenosis on Blood Pressure

McKevitt

Sivaguru

Venables

et al. 2003

Stroke

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Background and Purpose-Carotid intervention by carotid endarterectomy (CEA) or endovascular treatment may cause hemodynamic change. The immediate and long-term effects on blood pressure after these procedures were assessed. Methods-Patients were randomized to CEA (nϭ49) or endovascular treatment (nϭ55) that comprised percutaneous transluminal angioplasty alone (nϭ31), balloon-expandable stent (nϭ13), or self-expandable stent (nϭ11). A baseline 24-hour ambulatory blood pressure recording was made before carotid intervention and repeated at 24 hours, 1 month, and 6 months after the procedure. Results-In the first 24 hours after the procedure, episodes of hypotension occurred in 75% of the CEA group and 76% of the endovascular group; hypertension occurred in 11% and 13%, respectively. There was a significant fall in blood pressure at 1 hour after the procedure in both groups (24 and 16 mm Hg fall in CEA and endovascular groups, respectively), but this was only sustained in the endovascular group. The pattern of blood pressure response in the first 24 hours was significantly different (PϽ0.0001, ANCOVA). Systolic blood pressure was significantly lower at 1 and 6 months only in the surgical group (6 and 5 mm Hg fall, respectively). Conclusions-Both

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Correlation of Periprocedural Systolic Blood Pressure Changes With Neurological Events in High-Risk Carotid Stent Patients

Cited by 37 publications

References 16 publications

Periprocedural Hemodynamic Depression Is Associated With a Higher Number of New Ischemic Brain Lesions After Stenting in the International Carotid Stenting Study-MRI Substudy

Periprocedural Hemodynamic Depression Is Associated With a Higher Number of New Ischemic Brain Lesions After Stenting in the International Carotid Stenting Study-MRI Substudy

Outcomes between 30 Days and 1 Year after Carotid Artery Stenting Using FilterWire EZ: Clinical Results and Diffusion-weighted MRI Findings in 262 Consecutive Patients

Effect of Treatment of Carotid Artery Stenosis on Blood Pressure

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