| Intensive treatment of hypertension decreases the risk of hyperperfusion and intracerebral hemorrhage following carotid artery stenting. | |
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MedLine Citation:
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PMID: 17377975 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To assess the efficacy of a comprehensive blood pressure (BP) management protocol in reducing intracerebral hemorrhage (ICH) following carotid artery stenting (CAS). BACKGROUND: Following CAS hyperperfusion syndrome (HPS) can lead to significant morbidity and mortality. Hypertension plays an essential role in its development. METHODS: We instituted a comprehensive BP protocol following the last case of ICH complicating a CAS procedure. All patients received comprehensive monitoring of BP and treatment to a BP < 140/90 mm Hg; those with a treated stenosis >or=90%, contralateral stenosis >or=80%, and hypertension (i.e., risk factors for HPS) were treated to a BP < 120/80 mm Hg. Patients who developed HPS received parenteral beta-blockers or nitrates titrated to resolution of symptoms and discharged when asymptomatic and normotensive. Patients and families were instructed to measure BP twice daily for 2 weeks and to call if hypertension or headache developed. RESULTS: A total of 836 patients had CAS, 266 prior to the comprehensive BP management program and 570 subsequently. The incidence of HPS/ICH was 5/266 (1.9%) patients prior to comprehensive BP management and 3/570 (0.5%) patients afterwards, P = 0.12. The incidence of ICH was 3/266 (1.1%) and 0/570, respectively, P = 0.032. In high-risk patients both HPS and ICH were significantly reduced from 29.4 to 4.2% (P = 0.006) and 17.6-0% (P = 0.006), respectively. There were no complications attributable to the comprehensive program and lengths of hospitalization were similar (2.6 vs. 2.1 days, P = 0.18). CONCLUSIONS: 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. |
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Authors:
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Alex Abou-Chebl; Joel Reginelli; Chris T Bajzer; Jay S Yadav |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions Volume: 69 ISSN: 1522-1946 ISO Abbreviation: Catheter Cardiovasc Interv Publication Date: 2007 Apr |
Date Detail:
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Created Date: 2007-04-03 Completed Date: 2007-08-17 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100884139 Medline TA: Catheter Cardiovasc Interv Country: United States |
Other Details:
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Languages: eng Pagination: 690-6 Citation Subset: IM |
Affiliation:
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Interventional Neurology, Section of Stroke and Neurological Critical Care, The Cleveland Clinic Foundation, Cleveland, Ohio, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Antihypertensive Agents / therapeutic use Blood Pressure / drug effects Blood Vessel Prosthesis Implantation Carotid Artery, Common / surgery* Carotid Stenosis / surgery* Cerebral Hemorrhage / epidemiology, etiology, physiopathology, prevention & control* Cerebrovascular Circulation / drug effects Collateral Circulation / drug effects Female Follow-Up Studies Humans Hypertension / drug therapy*, physiopathology Incidence Intracranial Hypertension / complications, epidemiology, physiopathology, prevention & control* Length of Stay Male Middle Aged Multivariate Analysis Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors Risk Factors Stents* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Antihypertensive Agents; 0/Platelet Glycoprotein GPIIb-IIIa Complex |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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