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J Clin Neurosci. 2018 Jul;53:74-78. doi: 10.1016/j.jocn.2018.04.007. Epub 2018 Apr 21.

Staged carotid artery stenting in patients with severe carotid stenosis: Multicenter experience.

Author information

1
Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, South Korea.
2
Department of Radiology, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, South Korea.
3
Department of Radiology, Wonkwang University Hospital, Iksan, 895 Muwang-Ro, Iksan, Jeonlabuk-do, South Korea.
4
Department of Neurosurgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, South Korea.
5
Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, South Korea; Department of Neurosurgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, South Korea.
6
Department of Neurology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, South Korea.
7
Department of Neurosurgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, South Korea. Electronic address: kanghs@snuh.org.

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.

KEYWORDS:

Carotid angioplasty; Carotid artery stenting; Carotid stenosis; Hyperperfusion syndrome; Intracranial hemorrhage

PMID:
29685407
DOI:
10.1016/j.jocn.2018.04.007
[Indexed for MEDLINE]

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