Document Detail

Transcranial Doppler monitoring in angioplasty and stenting of the carotid bifurcation.
MedLine Citation:
PMID:  14533974     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To assess the impact of cerebral embolism and hemodynamic changes during the successive stages of carotid angioplasty and stenting (CAS) using transcranial Doppler (TCD) monitoring of the middle cerebral artery (MCA). METHODS: In 297 patients (206 men; mean age 69.9+/-8.0 years), the association of various TCD emboli and velocity variables with procedure-related death and cerebral events (amaurosis fugax, transient ischemic attacks, and stroke) was evaluated. Baseline patient characteristics (age, sex, preoperative cerebral symptoms, and prior carotid endarterectomy) and their associations with procedure-related cerebral events were also assessed. A distinction was made between adverse events that occurred during CAS and those that happened within 7 days. RESULTS: Of the 36 procedure-related retinal and cerebral events, 28 (78%) were encountered intraprocedurally; an additional 6 (2%) events occurred within 7 days after the procedure. Two (0.7%) patients died. At 1 week, the combined minor and major stroke and death rate was 3.7%. Adverse outcome was associated with >4 showers of microemboli at postdilation (odds ratio [OR] 3.2, 95% CI 1.3 to 7.8, p=0.03), particulate macroemboli (OR 9.1, 95% CI 5.1 to 16.1, p<0.001), massive air embolism from ruptured balloons (OR 11.3, 95% CI 7.6 to 16.6, p<0.001), and angioplasty-induced asystole with significant hypotension plus MCA blood flow reduction (OR 3.3, 95% CI 1.4 to 8.3, p=0.03). Of the patient characteristics, male gender (OR 10.5, 95% CI 1.4 to 75.8, p=0.02) and preoperative cerebral ischemia (OR 3.3, 95% CI 1.6 to 6.6, p=0.003) were also related to outcome. CONCLUSIONS: In CAS, TCD monitoring provides insight into the pathogenesis of procedure-related cerebral events. Microemboli during poststent dilation, particulate macroembolism, massive air embolism, and angioplasty-induced asystole are associated with adverse outcome, as are male gender and prior cerebral ischemia.
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists     Volume:  10     ISSN:  1526-6028     ISO Abbreviation:  J. Endovasc. Ther.     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-10-09     Completed Date:  2004-03-11     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100896915     Medline TA:  J Endovasc Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  702-10     Citation Subset:  IM    
St Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
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MeSH Terms
Angioplasty, Balloon / adverse effects
Blood Flow Velocity
Carotid Artery, Internal
Carotid Stenosis / therapy*,  ultrasonography
Chi-Square Distribution
Endarterectomy, Carotid / adverse effects
Intracranial Embolism / etiology,  ultrasonography*
Logistic Models
Middle Cerebral Artery / ultrasonography*
Monitoring, Intraoperative / methods*
Statistics, Nonparametric
Stents / adverse effects
Ultrasonography, Doppler, Transcranial*

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

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