Document Detail


Intensive treatment of hypertension decreases the risk of hyperperfusion and intracerebral hemorrhage following carotid artery stenting.
MedLine Citation:
PMID:  17377975     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Alex Abou-Chebl; Joel Reginelli; Chris T Bajzer; Jay S Yadav
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Publication Detail:
Type:  Journal Article    
Journal Detail:
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:
Created Date:  2007-04-03     Completed Date:  2007-08-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  690-6     Citation Subset:  IM    
Affiliation:
Interventional Neurology, Section of Stroke and Neurological Critical Care, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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MeSH Terms
Descriptor/Qualifier:
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:
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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