Intensive treatment of hypertension decreases the risk of hyperperfusion and intracerebral hemorrhage following carotid artery stenting

Aböu-Chebl, Alex; Reginelli, Joel; Bajzer, Chris; Yadav, Jay S.

doi:10.1002/ccd.20693

Cited by 122 publications

(66 citation statements)

References 10 publications

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“…Therefore, our data suggested that careful management of BP is required for almost 1 month after BSCAS to avoid HPS, though the incidence was relatively low. 1,21,32 Although staged CAS, because it may decrease the occurrence of HPS and HD, is more acceptable and therefore more frequently performed, there are obvious disadvantages to a staged intervention, including the higher medical cost and inconvenience to the patient. It may also potentially cause the delay of life-saving treatment such as open-heart surgery or even cause another cerebral infarction.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Bilateral Carotid Stenting in High-Risk Patients

Liu¹,

Jung²,

Kim³

et al. 2010

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Simultaneous Bilateral Carotid Stenting in High-Risk Patients

Liu¹,

Jung²,

Kim³

et al. 2010

AJNR Am J Neuroradiol

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“…15,25) Both CEA 8,11,13,25,28) and CAS can improve CBF impairment. 12,18,29) However, hyperperfusion syndrome (HPS) has been reported after both procedures, 1,2,10,16,17,22,23) so prevention and treatment of HPS are important issues in the perioperative management of patients undergoing CAS. Postprocedural HPS is most common in patients with CBF increases of more than 100% compared with the preoperative value, and rare in patients with CBF gains of less than 100% of the baseline value.…”

Section: Discussionmentioning

confidence: 99%

“…However, marked hemodynamic changes in the cerebral circulation associated with the reconstruction of the blood flow in the carotid artery may occur and may require intensive post-procedure management after CAS, 1,2,10,12,16,18,29) as seen in patients treated by CEA. 8,11,13,25,28) Therefore, mild hypertension to keep sufficient cerebral perfusion pressure is recommended in postoperative care for patients with preceding impaired cerebral circulation if adequate improvement in cerebral blood flow (CBF) is not observed after carotid revascularization.…”

Section: Introductionmentioning

confidence: 99%

Intraprocedural Changes in Angiographic Cerebral Circulation Time Predict Cerebral Blood Flow After Carotid Artery Stenting

Aikawa

Kaneda

Tsutsumi

et al. 2010

Neurol. Med. Chir.(Tokyo)

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Changes in the cerebral blood flow (CBF) are important for planning postoperative care in patients treated by carotid artery stenting (CAS). The relationship between intraprocedural changes in the angiographic cerebral circulation time (CCT) and perioperative CBF changes were retrospectively studied in 49 CAS procedures performed in 46 patients with carotid artery stenosis. The CCT, defined as the interval between the timing of maximal opacification at the terminal portion of the internal carotid artery and at the cortical vein, was determined by referring to time-density curves of data obtained from routine intraprocedural digital subtraction angiography. The intraoperative change in CCT (DCCT) was calculated for each of the 49 procedures. CBF studies, using dynamic perfusion computed tomography, were performed 10-2 days before and 2-4 days after CAS. Perioperative changes in the ratio of the CBF in the territory of the middle cerebral artery on the affected side to CBF on the contralateral side (%CBF) were calculated by subtracting pre-from postoperative %CBF (D%CBF) and the correlation between DCCT and D%CBF was evaluated. Mean CCT was shortened by 1.1 seconds from 5.3 to 4.2 seconds after CAS. Mean %CBF increased by 11.9% from 91.8% to 103.7% after the procedure. DCCT and D%CBF showed a significant positive correlation (r ＝ 0.61, p ＝ 0.008). Intraprocedural changes in angiographic CCT are predictive of postoperative CBF in patients with CAS.

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“…14,15) However, antiplatelet agents are considered essential in CAS or for the prevention of thrombus formation at sites of stenosis. As the outcome is exacerbated by hemorrhage, even if recanalization can be achieved, we used antiplatelet agents after confirming the narrowness of the infarct area by pretreatment MRI and maintained the blood pressure low after treatment, 16) to avoid hemorrhagic complications. There has also been a report of cases in which an uneventful course without hemorrhagic complications could be obtained by performing CAS with dual-antiplatelet therapy using 100 mg aspirin and 75 mg clopidogrel following intravenous thrombolysis with rt-PA. 17) Many patients with VA or BA occlusion treated at our hospital showed satisfactory outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Therapeutic Strategy and Outcome of Endovascular Therapy for Acute Stroke with Cerebral Proximal Artery Occlusion due to Atherosclerotic Artery Stenosis

Kakumoto

Sankoda

Kin

et al. 2018

JNET

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Objective: While intracranial mechanical thrombectomy has been established as a treatment, atherothrombotic brain infarction due to stenosis of major cerebral arteries is occasionally difficult to treat as severe stenosis persists after recanalization, eventually requiring percutaneous transluminal angioplasty (PTA) or stent placement. The contents and results of mechanical thrombectomy for atherothrombotic brain infarction that we have encountered are presented. Methods:The subjects were 17 patients diagnosed with atherothrombotic brain infarction among the 99 patients with cerebral infarction accompanied by major intracranial artery occlusion treated at our hospital during the 30 months from January 2014 and June 2016. Recanalization graded as Thrombolysis in Cerebral Infarction (TICI) 2b or higher was regarded as effective, and the outcome was evaluated using the modified Rankin Scale (mRS). Results:The responsible lesion was located at the origin of the internal carotid artery (ICA) in three patients, in the ICA siphon in four patients, middle cerebral artery (MCA) in five patients, vertebral artery (VA) in two patients, and basilar artery (BA) in three patients. Effective recanalization was achieved in 82.4%, the mRS score was 0-2 in 52.9%, and the postoperative mRS score was the same as before treatment in 11.8%. Conclusion:The outcome of intracranial mechanical thrombectomy for atherothrombotic brain infarction accompanied by major intracranial artery stenosis was favorable in many patients, and aggressive treatment is considered recommendable. In addition, safe and appropriate execution of additional treatments for residual stenotic lesions leads to favorable outcomes.

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Intensive treatment of hypertension decreases the risk of hyperperfusion and intracerebral hemorrhage following carotid artery stenting

Abstract: Comprehensive management of arterial hypertension can lower the incidence of ICH and HPS in high-risk patients following CAS, without additional complications or prolonged hospitalizations.

Cited by 122 publications

References 10 publications

Simultaneous Bilateral Carotid Stenting in High-Risk Patients

Simultaneous Bilateral Carotid Stenting in High-Risk Patients

Intraprocedural Changes in Angiographic Cerebral Circulation Time Predict Cerebral Blood Flow After Carotid Artery Stenting

The Therapeutic Strategy and Outcome of Endovascular Therapy for Acute Stroke with Cerebral Proximal Artery Occlusion due to Atherosclerotic Artery Stenosis

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