Document Detail


Catheter-based neurosalvage for acute embolic complication during carotid intervention.
MedLine Citation:
PMID:  20591603     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Iatrogenic emboli may be released during carotid intervention, causing permanent neurologic complications and catastrophic outcomes. This article reports the procedural details and clinical results of our series of neurosalvage techniques to manage thromboembolic events during carotid procedures.
METHODS: Between March 2003 and December 2007, 342 patients (283 men, 72.1 +/- 8.9 years old, 121 symptomatic) underwent percutaneous stent deployment in 407 cervical internal carotid arteries in our institution. Visible distal embolization with flow occlusion caused neurologic complications in 10 patients (2.5%), and a structured and stepwise neurosalvage approach was attempted.
RESULTS: Guidewire fragmentation and microcatheter injection of heparin and nitroglycerin were performed in all 10 patients as step 1. Intra-arterial thrombolysis was given in four patients and balloon angioplasty in five, as step 2. Intracranial stenting was done in one patient as the last step. Successful angiographic recanalization (Thrombolysis in Myocardial Infarction [TIMI] grade 2-3) occurred in 9 of 10 (90%). Residual neurologic sequel was observed in five, including three patients with hemorrhage complications (1 received emergent craniotomy). There was no neurologic mortality in this series.
CONCLUSIONS: Acute embolic complication during carotid artery stenting can be managed by catheter-based neurosalvage with effective angiographic recanalization and marginal clinical success.
Authors:
Mao-Shin Lin; Ying-Hsien Chen; Chi-Chao Chao; Cheng-Hsin Lin; Hung-Yuan Li; Chia-Lun Chao; Ming-Fong Chen; Hsien-Li Kao
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Publication Detail:
Type:  Journal Article     Date:  2010-06-29
Journal Detail:
Title:  Journal of vascular surgery     Volume:  52     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-30     Completed Date:  2010-08-31     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  308-13     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Aged, 80 and over
Angioplasty, Balloon / adverse effects*,  instrumentation
Carotid Artery Diseases / therapy*
Cerebral Angiography / methods
Cerebrovascular Circulation / drug effects
Combined Modality Therapy
Female
Fibrinolytic Agents / administration & dosage*
Heparin / administration & dosage
Humans
Iatrogenic Disease
Intracranial Embolism / etiology,  physiopathology,  radiography,  therapy*
Male
Microinjections
Middle Aged
Nervous System Diseases / etiology,  therapy
Nitroglycerin / administration & dosage
Retrospective Studies
Stents
Thrombolytic Therapy*
Tissue Plasminogen Activator / administration & dosage
Tomography, X-Ray Computed
Treatment Outcome
Vasodilator Agents / administration & dosage*
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Vasodilator Agents; 55-63-0/Nitroglycerin; 9005-49-6/Heparin; EC 3.4.21.68/Tissue Plasminogen Activator

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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