Cerebral haemodynamics and embolization during carotid angioplasty in high-risk patients
Background Patients with symptomatic internal carotid artery (ICA) stenosis greater than 70 per cent in association with a contralateral ICA occlusion may have an increased risk of stroke following carotid endarterectomy. Such patients might benefit from the theoretically shorter ischaemic time offe...
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| Veröffentlicht in: | British journal of surgery 1998-06, Vol.85 (6), p.771-774 |
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| creator | Mccleary, A. J. Nelson, M. Dearden, N. M. Calvey, T. A. J. Gough, M. J. |
| description | Background
Patients with symptomatic internal carotid artery (ICA) stenosis greater than 70 per cent in association with a contralateral ICA occlusion may have an increased risk of stroke following carotid endarterectomy. Such patients might benefit from the theoretically shorter ischaemic time offered by carotid angioplasty and stenting.
Methods
Nine patients who underwent carotid angioplasty and stenting were monitored using near‐infrared spectroscopy, continuous jugular venous oximetry and transcranial Doppler ultrasonography to detect both haemodynamic ischaemia and embolic events.
Results
Significant ischaemia occurred in four of the nine patients once the stenosis had been crossed by the guidewire (spectroscopy and oximetry). Inflation of the angioplasty balloon resulted in a brief period of ischaemia and showers of emboli in all patients (ultrasonography) and this persisted for more than 3 min after balloon deflation in three patients. One patient had a major disabling stroke due to ICA thrombosis.
Conclusion
Angioplasty and stenting in these high‐risk patients may not confer any advantage over conventional surgery in terms of both haemodynamic ischaemia and embolization. © 1998 British Journal of Surgery Society Ltd |
| doi_str_mv | 10.1046/j.1365-2168.1998.00723.x |
| format | Article |
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Patients with symptomatic internal carotid artery (ICA) stenosis greater than 70 per cent in association with a contralateral ICA occlusion may have an increased risk of stroke following carotid endarterectomy. Such patients might benefit from the theoretically shorter ischaemic time offered by carotid angioplasty and stenting.
Methods
Nine patients who underwent carotid angioplasty and stenting were monitored using near‐infrared spectroscopy, continuous jugular venous oximetry and transcranial Doppler ultrasonography to detect both haemodynamic ischaemia and embolic events.
Results
Significant ischaemia occurred in four of the nine patients once the stenosis had been crossed by the guidewire (spectroscopy and oximetry). Inflation of the angioplasty balloon resulted in a brief period of ischaemia and showers of emboli in all patients (ultrasonography) and this persisted for more than 3 min after balloon deflation in three patients. One patient had a major disabling stroke due to ICA thrombosis.
Conclusion
Angioplasty and stenting in these high‐risk patients may not confer any advantage over conventional surgery in terms of both haemodynamic ischaemia and embolization. © 1998 British Journal of Surgery Society Ltd</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1046/j.1365-2168.1998.00723.x</identifier><identifier>PMID: 9667704</identifier><identifier>CODEN: BJSUAM</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Ltd</publisher><subject>Aged ; Biological and medical sciences ; Blood Flow Velocity ; Blood Pressure - physiology ; Carotid Artery, Internal ; Carotid Stenosis - physiopathology ; Carotid Stenosis - therapy ; Cerebral Arteries - physiopathology ; Female ; Hemodynamics ; Humans ; Hyperemia - etiology ; Intracranial Embolism and Thrombosis - etiology ; Male ; Medical sciences ; Middle Aged ; Risk Factors ; Stents ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Ultrasonography, Doppler ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><ispartof>British journal of surgery, 1998-06, Vol.85 (6), p.771-774</ispartof><rights>1998 British Journal of Surgery Society Ltd</rights><rights>1998 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4312-990a4b8379c598e2fff31bd61188a5d8219a14f989268b59e2a1f20a62dc38083</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1046%2Fj.1365-2168.1998.00723.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1046%2Fj.1365-2168.1998.00723.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>309,310,314,780,784,789,790,1417,23930,23931,25140,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2294323$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9667704$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mccleary, A. J.</creatorcontrib><creatorcontrib>Nelson, M.</creatorcontrib><creatorcontrib>Dearden, N. M.</creatorcontrib><creatorcontrib>Calvey, T. A. J.</creatorcontrib><creatorcontrib>Gough, M. J.</creatorcontrib><title>Cerebral haemodynamics and embolization during carotid angioplasty in high-risk patients</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background
Patients with symptomatic internal carotid artery (ICA) stenosis greater than 70 per cent in association with a contralateral ICA occlusion may have an increased risk of stroke following carotid endarterectomy. Such patients might benefit from the theoretically shorter ischaemic time offered by carotid angioplasty and stenting.
Methods
Nine patients who underwent carotid angioplasty and stenting were monitored using near‐infrared spectroscopy, continuous jugular venous oximetry and transcranial Doppler ultrasonography to detect both haemodynamic ischaemia and embolic events.
Results
Significant ischaemia occurred in four of the nine patients once the stenosis had been crossed by the guidewire (spectroscopy and oximetry). Inflation of the angioplasty balloon resulted in a brief period of ischaemia and showers of emboli in all patients (ultrasonography) and this persisted for more than 3 min after balloon deflation in three patients. One patient had a major disabling stroke due to ICA thrombosis.
Conclusion
Angioplasty and stenting in these high‐risk patients may not confer any advantage over conventional surgery in terms of both haemodynamic ischaemia and embolization. © 1998 British Journal of Surgery Society Ltd</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Blood Flow Velocity</subject><subject>Blood Pressure - physiology</subject><subject>Carotid Artery, Internal</subject><subject>Carotid Stenosis - physiopathology</subject><subject>Carotid Stenosis - therapy</subject><subject>Cerebral Arteries - physiopathology</subject><subject>Female</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Hyperemia - etiology</subject><subject>Intracranial Embolism and Thrombosis - etiology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Risk Factors</subject><subject>Stents</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Ultrasonography, Doppler</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kclOwzAURS0EgjJ8ApIXiF2Ch8SxJTZQUQYxLADBznpJnNYlQ7FT0fL1uLTqytI753pxL0KYkpiSRFxMY8pFGjEqZEyVkjEhGePxYgcNtmAXDUg4R5QzfoAOvZ8SQjlJ2T7aV0JkGUkG6HNonMkd1HgCpunKZQuNLTyGtsSmybva_kJvuxaXc2fbMS7Adb0tAx_bblaD75fYtnhix5PIWf-FZ0E3be-P0V4FtTcnm_cIvY9u3oZ30ePL7f3w6jEqEk5ZpBSBJJc8U0WqpGFVVXGal4JSKSEtJaMKaFIpqZiQeaoMA1oxAoKVBZdE8iN0vv535rrvufG9bqwvTF1Da7q51zJ0wBJOgni6Eed5Y0o9c7YBt9SbKgI_23DwBdSVg7awfqsxppJQZNAu19qPrc1yiynRq2H0VK_616v-9WoY_T-MXujrh1dGWIhH67j1vVls4-C-tMh4luqP51v99nQ3elBU6A_-BzQNkBo</recordid><startdate>199806</startdate><enddate>199806</enddate><creator>Mccleary, A. J.</creator><creator>Nelson, M.</creator><creator>Dearden, N. M.</creator><creator>Calvey, T. A. J.</creator><creator>Gough, M. J.</creator><general>Blackwell Science Ltd</general><general>Wiley</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>199806</creationdate><title>Cerebral haemodynamics and embolization during carotid angioplasty in high-risk patients</title><author>Mccleary, A. J. ; Nelson, M. ; Dearden, N. M. ; Calvey, T. A. J. ; Gough, M. J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4312-990a4b8379c598e2fff31bd61188a5d8219a14f989268b59e2a1f20a62dc38083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Blood Flow Velocity</topic><topic>Blood Pressure - physiology</topic><topic>Carotid Artery, Internal</topic><topic>Carotid Stenosis - physiopathology</topic><topic>Carotid Stenosis - therapy</topic><topic>Cerebral Arteries - physiopathology</topic><topic>Female</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Hyperemia - etiology</topic><topic>Intracranial Embolism and Thrombosis - etiology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Risk Factors</topic><topic>Stents</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Ultrasonography, Doppler</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mccleary, A. J.</creatorcontrib><creatorcontrib>Nelson, M.</creatorcontrib><creatorcontrib>Dearden, N. M.</creatorcontrib><creatorcontrib>Calvey, T. A. J.</creatorcontrib><creatorcontrib>Gough, M. J.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mccleary, A. J.</au><au>Nelson, M.</au><au>Dearden, N. M.</au><au>Calvey, T. A. J.</au><au>Gough, M. J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cerebral haemodynamics and embolization during carotid angioplasty in high-risk patients</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>1998-06</date><risdate>1998</risdate><volume>85</volume><issue>6</issue><spage>771</spage><epage>774</epage><pages>771-774</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><coden>BJSUAM</coden><abstract>Background
Patients with symptomatic internal carotid artery (ICA) stenosis greater than 70 per cent in association with a contralateral ICA occlusion may have an increased risk of stroke following carotid endarterectomy. Such patients might benefit from the theoretically shorter ischaemic time offered by carotid angioplasty and stenting.
Methods
Nine patients who underwent carotid angioplasty and stenting were monitored using near‐infrared spectroscopy, continuous jugular venous oximetry and transcranial Doppler ultrasonography to detect both haemodynamic ischaemia and embolic events.
Results
Significant ischaemia occurred in four of the nine patients once the stenosis had been crossed by the guidewire (spectroscopy and oximetry). Inflation of the angioplasty balloon resulted in a brief period of ischaemia and showers of emboli in all patients (ultrasonography) and this persisted for more than 3 min after balloon deflation in three patients. One patient had a major disabling stroke due to ICA thrombosis.
Conclusion
Angioplasty and stenting in these high‐risk patients may not confer any advantage over conventional surgery in terms of both haemodynamic ischaemia and embolization. © 1998 British Journal of Surgery Society Ltd</abstract><cop>Oxford, UK</cop><pub>Blackwell Science Ltd</pub><pmid>9667704</pmid><doi>10.1046/j.1365-2168.1998.00723.x</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | British journal of surgery, 1998-06, Vol.85 (6), p.771-774 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Aged Biological and medical sciences Blood Flow Velocity Blood Pressure - physiology Carotid Artery, Internal Carotid Stenosis - physiopathology Carotid Stenosis - therapy Cerebral Arteries - physiopathology Female Hemodynamics Humans Hyperemia - etiology Intracranial Embolism and Thrombosis - etiology Male Medical sciences Middle Aged Risk Factors Stents Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Ultrasonography, Doppler Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels |
| title | Cerebral haemodynamics and embolization during carotid angioplasty in high-risk patients |
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