(Stroke. 2000;31:376.)
© 2000 American Heart Association, Inc.
Original Contributions |
Identification of Patients at Risk for Periprocedural Neurological Deficits Associated With Carotid Angioplasty and Stenting
From the Department of Neurosurgery and Toshiba Stroke Research Center (A.I.Q., A.R.L., M.F.K.S., M.S., G.L., A.K.W., L.R.G., L.N.H.) and Department of Neurology (V.J.), School of Medicine and Biomedical Sciences, State University of New York at Buffalo, NY.
Correspondence to Adnan I. Qureshi, MD, SUNYAB Department of Neurosurgery, Millard Fillmore Hospital, 3 Gates Circle, Buffalo, NY 14209-1194. E-mail qureshi{at}acsu.buffalo.edu
Background and Purpose—Transient or permanent neurological deficits can occur in the periprocedural period following carotid angioplasty and stenting (CAS), presumably due to distal embolization and/or hemodynamic compromise. We performed this study to identify predictors of neurological deficits associated with carotid angioplasty and stent placement.
Methods—We reviewed medical records and angiograms in a consecutive series of patients who underwent CAS for symptomatic or asymptomatic cervical internal carotid artery stenosis from June 1996 through December 1998. Using logistic regression analysis, we evaluated the effect of demographic, clinical, intraprocedural, and angiographic risk factors on subsequent development of periprocedural neurological deficits. Periprocedural neurological deficits were defined as new or worsening transient or permanent neurological deficits that occurred during or within 48 hours of the procedure.
Results—A total of 111 patients (mean age 68.2±9.1 years) who
underwent CAS for asymptomatic (n=54) or
symptomatic (n=57) stenoses were included in this
study. A total of 14 periprocedural neurological deficits (13%) were
observed either during (n=4) or after (n=10) the procedure. Three
identified variables were independently associated with
periprocedural neurological deficits: symptomatic lesion
(OR 8.3, 95% CI 1.6 to 42.6), length of stenotic segment
11.2 mm (OR 5.2, 95% CI 1.2 to 22.5), and absence of
hypercholesterolemia (OR 5.4, 95% CI 1.4 to
20.9). Other variables, including age and degree of
stenosis (defined by NASCET criteria), were not associated with
periprocedural neurological deficits.
Conclusions—A combination of clinical and angiographic variables can be used to identify patients at risk for periprocedural neurological deficits after CAS. Such identification may help in selection of patients who may benefit from novel pharmacological and mechanical preventive approaches.
Key Words: angioplasty • carotid stenosis • cerebral ischemia, transient • stent • stroke
This article has been cited by other articles:
 |
|
 |
|
  K. Groschel, U. Ernemann, J. B. Schulz, T. Nagele, C. Terborg, and A. Kastrup Statin Therapy at Carotid Angioplasty and Stent Placement: Effect on Procedure-related Stroke, Myocardial Infarction, and Death. Radiology, July 1, 2006; 240(1): 145 - 151. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.D. Hill, W. Morrish, G. Soulez, A. Nevelsteen, G. Maleux, C. Rogers, K.E. Hauptmann, A. Bonafe, R. Beyar, L. Gruberg, et al. Multicenter evaluation of a self-expanding carotid stent system with distal protection in the treatment of carotid stenosis. AJNR Am. J. Neuroradiol., April 1, 2006; 27(4): 759 - 765. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. M. Kessler, C. Mounayer, M. Piotin, L. Spelle, J. R. Vanzin, and J. Moret The Use of Balloon-Expandable Stents in the Management of Intracranial Arterial Diseases: A 5-Year Single-Center Experience AJNR Am. J. Neuroradiol., October 1, 2005; 26(9): 2342 - 2348. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Kastrup, K. Groschel, J. B. Schulz, T. Nagele, and U. Ernemann Clinical Predictors of Transient Ischemic Attack, Stroke, or Death Within 30 Days of Carotid Angioplasty and Stenting Stroke, April 1, 2005; 36(4): 787 - 791. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. G. Roh, H. S. Byun, J. W. Ryoo, D. G. Na, W.-J. Moon, B. B. Lee, and D.-I. Kim Prospective Analysis of Cerebral Infarction After Carotid Endarterectomy and Carotid Artery Stent Placement by Using Diffusion-Weighted Imaging AJNR Am. J. Neuroradiol., February 1, 2005; 26(2): 376 - 384. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. K. Sztriha, E. Voros, K. Sas, R. Szentgyorgyi, A. Pocsik, P. Barzo, P. Szikra, A. Makai, A. Szolics, P. Elek, et al. Favorable Early Outcome of Carotid Artery Stenting Without Protection Devices Stroke, December 1, 2004; 35(12): 2862 - 2866. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Rogers, R. Huynh, P. A. Seifert, B. Chevalier, J. Schofer, E. R. Edelman, G. Toegel, A. Kuchela, A. Woupio, R. E. Kuntz, et al. Embolic Protection With Filtering or Occlusion Balloons During Saphenous Vein Graft Stenting Retrieves Identical Volumes and Sizes of Particulate Debris Circulation, April 13, 2004; 109(14): 1735 - 1740. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Linfante, J. A. Hirsch, M. Selim, G. Schlaug, L. R. Caplan, and A. S. Reddy Safety of Latest-Generation Self-expanding Stents in Patients With NASCET-Ineligible Severe Symptomatic Extracranial Internal Carotid Artery Stenosis Arch Neurol, January 1, 2004; 61(1): 39 - 43. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Fox Jr, C. J. Moran, D. T. Cross III, R. L. Grubb Jr, K. M. Rich, M. R. Chicoine, R. G. Dacey Jr, and C. P. Derdeyn Long-Term Outcome After Angioplasty for Symptomatic Extracranial Carotid Stenosis in Poor Surgical Candidates Stroke, December 1, 2002; 33(12): 2877 - 2880. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Chaturvedi and R. Fessler Angioplasty and stenting for stroke prevention: Good questions that need answers Neurology, September 10, 2002; 59(5): 664 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Orlandi, S. Fanucchi, C. Fioretti, G. Acerbi, M. Puglioli, R. Padolecchia, F. Sartucci, and L. Murri Characteristics of Cerebral Microembolism During Carotid Stenting and Angioplasty Alone Arch Neurol, September 1, 2001; 58(9): 1410 - 1413. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. S. Roubin, G. New, S. S. Iyer, J. J. Vitek, N. Al-Mubarak, M. W. Liu, J. Yadav, C. Gomez, and R. E. Kuntz Immediate and Late Clinical Outcomes of Carotid Artery Stenting in Patients With Symptomatic and Asymptomatic Carotid Artery Stenosis : A 5-Year Prospective Analysis Circulation, January 30, 2001; 103(4): 532 - 537. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Barth, L. Remonda, K.-O. Lovblad, G. Schroth, and R. W. Seiler Silent Cerebral Ischemia Detected by Diffusion-Weighted MRI After Carotid Endarterectomy Stroke, August 1, 2000; 31(8): 1824 - 1828. [Abstract] [Full Text] [PDF]
|
|