Document Detail


Ischemic preconditioning during the use of the PercuSurge occlusion balloon for carotid angioplasty and stenting.
MedLine Citation:
PMID:  18258156     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Ischemic preconditioning (IP) uses transient ischemia to render tissues tolerant to subsequent, prolonged ischemia. This study sought to evaluate factors that contributed to the development of cerebral ischemia during PercuSurge balloon (Medtronic, Santa Rosa, CA) occlusion in patients undergoing carotid angioplasty and stenting (CAS). The PercuSurge occlusion balloon was used in 43 of 165 patients treated with CAS for high-grade stenosis; 20% were symptomatic. Symptoms of cerebral hypoperfusion during temporary occlusion of the internal carotid artery occurred in 10 of 43 patients and included dysarthria, agitation, decreased level of consciousness, and focal hemispheric deficit. The development of neurologic symptoms after initial PercuSurge balloon inflation and occluded internal carotid artery flow was associated with a decrease in the mean Glasgow Coma Scale (GCS) from 15 to 10 (range 9-14); the GCS returned to normal after occlusion balloon deflation. The mean time to spontaneous recovery of full neurologic function was 8 minutes (range 4-15 minutes). The mean subsequent procedure duration was 11.9 minutes (range 6-21 minutes). No recurrence of neurologic symptoms occurred when the occlusion balloon was reinflated. All 10 patients underwent successful CAS without occlusion, dissection, cerebrovascular accident, or death. Ischemic preconditioning can be used to enable CAS with embolic protection in patients who cannot tolerate initial interruption of antegrade cerebral perfusion by PercuSurge occlusion.
Authors:
Peter L Faries; Brian DeRubertis; Susan Trocciola; John Karwowski; K Craig Kent; Rabih A Chaer
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Vascular     Volume:  16     ISSN:  1708-5381     ISO Abbreviation:  Vascular     Publication Date:    2008 Jan-Feb
Date Detail:
Created Date:  2008-02-08     Completed Date:  2008-08-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101196722     Medline TA:  Vascular     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  1-9     Citation Subset:  IM    
Affiliation:
Division of Vascular Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA. peter.faries@mountsinai.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angiography, Digital Subtraction
Angioplasty, Balloon / adverse effects,  methods*
Brain Ischemia / etiology,  therapy
Carotid Artery, Internal* / radiography
Carotid Stenosis / radiography,  therapy*
Collateral Circulation
Female
Glasgow Coma Scale
Humans
Ischemic Preconditioning / methods*
Male
Prospective Studies
Risk Factors
Stents*
Treatment Outcome

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


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