Document Detail


Predictors of carotid clamping intolerance during endarterectomy that would be wise to apply to stenting procedures.
MedLine Citation:
PMID:  18810236     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Carotid artery stenting procedures are increasingly being performed with devices such as the MO.MA or the Parodi system that involve endovascular clamping of the common carotid artery, thus exposing the ipsilateral hemisphere to the risk of hypoperfusion. The aim of the present study was to look for predictors of carotid clamping intolerance by means of transcranial Doppler. PATIENTS AND METHODS: We analysed the findings of an earlier Italian multicentre prospective study (SCITEA, Italian Cooperative Study of Transcranial Doppler in Carotid Endarterectomy) in which 513 consecutive patients (males/females 397/116, mean age 67 +/- 7 years, mean carotid stenosis 81 +/- 11%, NASCET method) scheduled to undergo carotid endarterectomy had been investigated non-invasively with transcranial Doppler, and we correlated the data obtained preoperatively with the need to insert a shunt during surgery as an index of intolerance to carotid clamping. RESULTS: Four hundred and thirty-nine patients (85.6%) underwent surgery without and 74 (14.4%) with the insertion of a shunt. Patients who needed a shunt (intolerant) had a significantly higher decrement in mean flow velocity in the ipsilateral middle cerebral artery (MCA) after compression of the ipsilateral common carotid artery (71.8 +/- 22 vs. 30.6 +/- 24%) and were significantly more likely to have non-recruitable collateral pathways (75 vs. 18%). Logistic regression analysis confirmed that an MCA decrement of >85% (p = 0.005) and no potential collateralization (p = 0.011) were independent predictors of clamping intolerance. Combining the results of both compression tests (MCA decrement and collateral recruitment) yielded a sensitivity of 64%, a specificity of 99%, a positive predicted value of 88%, a negative predicted value of 95% and an overall accuracy of 95% in predicting shunt insertion. CONCLUSIONS: The preoperative assessment of recruitable collaterals and of maximal decrement in MCA mean flow velocity after carotid compression are useful predictors of carotid clamping intolerance. The criteria derived from carotid endarterectomy need to be applied and validated in a prospective series of patients undergoing carotid artery stenting procedures.
Authors:
G P Anzola; P Limoni; G Cavrini
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2008-09-23
Journal Detail:
Title:  Cerebrovascular diseases (Basel, Switzerland)     Volume:  26     ISSN:  1421-9786     ISO Abbreviation:  Cerebrovasc. Dis.     Publication Date:  2008  
Date Detail:
Created Date:  2008-11-05     Completed Date:  2009-01-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9100851     Medline TA:  Cerebrovasc Dis     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  494-501     Citation Subset:  IM    
Copyright Information:
2008 S. Karger AG, Basel.
Affiliation:
Heart and Brain Department, S. Orsola Hospital FBF, Brescia, Italy. gpanzola@fatebenefratelli.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty / adverse effects*,  instrumentation
Arteriovenous Shunt, Surgical
Blood Flow Velocity
Carotid Stenosis / physiopathology,  surgery*,  ultrasonography
Cerebrovascular Circulation*
Cerebrovascular Disorders / etiology,  physiopathology,  prevention & control*,  ultrasonography
Collateral Circulation
Constriction
Endarterectomy, Carotid / adverse effects*
Female
Humans
Italy
Logistic Models
Male
Middle Aged
Middle Cerebral Artery / physiopathology,  ultrasonography*
Predictive Value of Tests
Prospective Studies
Risk Assessment
Sensitivity and Specificity
Stents*
Ultrasonography, Doppler, Transcranial*

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