Staged carotid artery stenting in patients with severe carotid stenosis: Multicenter experience. (July 2018)

• Record Type: Journal Article
• Authors: Yoo, Dong Hyun; Roh, Hong Gee; Choi, See-Sung; Moon, Jusun; Lee, Jeongjun; Cho, Young Dae; Han, Moon Hee; Jung, Keun-Hwa; Yoon, Byung-Woo; Kang, Hyun-Seung
• Is Part Of: Journal of clinical neuroscience. Volume 53(2018)
• Page Start: 74
• Page End: 78
• Publication Date: 2018-07
• Subjects: Carotid stenosis -- Carotid angioplasty -- Carotid artery stenting -- Hyperperfusion syndrome -- Intracranial hemorrhage; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.04.007
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Cerebral hyperperfusion syndrome (CHS) may occur after stenting of severe carotid stenosis. Staged carotid artery stenting (CAS) consists of partial balloon angioplasty and delayed stenting. There was no severe CHS after staged CAS of carotid stenosis with hemodynamic instability. Abstract: Cerebral hyperperfusion syndrome (CHS) is serious complication after carotid artery stenting (CAS) caused by decreased cerebral vasoreactivity (CVR) due to long standing hypoperfusion of the brain. We hypothesized that partial dilatation of carotid stenosis would allow the recovery of CVR, and prevent CHS when definitive angioplasty with stent is performed afterward. In this study, we aimed to evaluate the safety and efficacy of staged CAS in patients with severe carotid artery stenosis with evident hemodynamic compromise in regard to preventing hyperperfusion syndrome. From January 2005 to February 2016, 53 patients with 55 severe carotid artery stenosis lesions showing decreased CVR and/or cerebral basal flow at the perfusion studies underwent staged CAS in three institutes. The procedure consisted of initial partial balloon angioplasty (BA), recovery period, and delayed definitive stenting (DS). We analyzed immediate results, complications, recoil and CHS related to staged CAS. We experienced no symptomatic manifestation of CHS except self-limited headache after the procedures. The median of intervals between BA and DS stages were 10 days. There was no case of severe recoil during the interval between BA and DS stage. Where perfusion imaging data was available, hyperperfusion was present in three and one patients after BA and DS stage, respectively, with no clinical symptom of CHS. In conclusion, staged CAS was feasible in patients with severe carotid artery stenosis and hemodynamic compromise, without inducing severe complication of CHS such as intracranial hemorrhage.