Stent-induced flow disturbances in the ipsilateral external carotid artery following internal carotid artery stenting: a temporary cause of jaw claudication

Abstract

SummaryBackgroundWe hypothesize that stenting of the internal carotid artery can immediately impede blood flow to the external carotid artery by either plaque shift or stent coverage of the ostium, and thereby cause ischemic symptoms like ipsilateral jaw claudication.MethodsThirty-three patients with high-grade asymptomatic stenosis of the internal carotid artery who underwent endovascular treatment were examined by ultrasound of the external carotid artery and performed an exercise test by chewing chewing gum synchronously to an electronic metronome for 3 min. Tests were performed before, the day after, and 1 week after the stenting procedure. Claudication time was defined as the timespan until occurrence of pain of the masseter muscle and/or chewing dyssynchrony to the metronome for more than 15 s. Ten patients with an isolated, atherosclerotic stenosis of the external carotid artery served as controls.ResultsA significantly reduced claudication time (in seconds) was recorded in patients who underwent carotid artery stenting compared to baseline values; median 89 (interquartile range, IQR, 57 to 124) vs. median 180 (IQR 153 to 180; p < 0.001). By categorization of the flow velocity at the external carotid artery into faster or slower as 200 cm/sec, the effect was even accentuated. Stenting values showed improvement 1 week after but did not return to baseline levels. No respective changes were found in controls.ConclusionStenting of the internal carotid artery lead to ipsilateral flow deterioration at the external carotid artery resulting in temporary jaw claudication. This impairment attenuated over the time and was significantly reduced after 1 week.

Jaw claudication and branch perfusion reduction as rare complications of fenestrated thoracic endovascular aortic repair

“… 4 Carotid artery stenting can sometimes cause ECA stenosis or occlusion, 5 which can cause jaw claudication after carotid artery stenting. 6 , 7 Jaw claudication after TEVAR has not been reported, and jaw claudication caused by BCA stenosis is uncommon. Jaw claudication is considered to be caused by ischemia from decreased blood flow through the facial ECA branches.…”

Hemodynamic Impact of Stenting on Carotid Bifurcation: A Potential Role of the Stented Segment and External Carotid Artery

“…Despite the complicated and multifactorial reasons for these adverse events, the changed hemodynamics caused by stenting has an essential role in the procession of adverse in-stent events and the ipsilateral branch occlusion [8][9][10]. The implanted stent certainly disturbs the local blood flow in the host artery and causes flow separation and stagnation flow around the stent struts, manifested by high relative residence time (RRT) and oscillating shear stress index (OSI), but low wall shear stress (WSS) [11][12][13], which are evidenced to contribute the vascular injury and ISR and stent thrombosis [8][9][10]. Since little information is available both on the stented vessel and other branches of bifurcations after stenting, we herein aimed to investigate a potential role of intervention in ECA and stented ICA, based on images of in vivo human patient-specific carotid bifurcation.…”

Hemodynamic Impact of Stenting on Carotid Bifurcation: A Potential Role in the Stented Segment and External Carotid Artery

“…Despite complicated and multifactorial reasons for these adverse events, the changed hemodynamics caused by stenting has been shown to have an essential role in the procession of adverse in-stent events and lateral branch occlusion [8][9][10]. The implanted stent certainly disturbs the local blood flow in the host artery and cause flow separation and stagnation flow around the stent struts, manifested by high relative residence time (RRT) and oscillating shear stress index (OSI), but low wall shear stress (WSS) [11][12][13], which are evidenced to contribute the vascular injury and ISR and stent thrombosis [8][9][10]. Since little information is available both on the stented vessel and other branches in bifurcations after stenting, we herein aimed to investigate a potential role of intervention in ECA and stented ICA, based on images of in vivo human patientspecific carotid bifurcation.…”