Objectives: To study relationship between carotid artery plaques characteristics and haemodynamic changes after carotid stenting. Patients and Methods: This observational prospective (pilot) study included 20 patients—who underwent CAS. The study was carried out in Ain shams university hospitals—Railway hospital (ERMED) and Suez insurance hospital from December 2018 to February 2020. Inclusion criteria, Symptomatic (defined as amaurosis fugax, TIA, Minor stroke or Major stroke) stenosis > 70%. Asymptomatic stenosis > 80% (accidentally discovered during pre-operative assessment for CABG and during full assessment for irrelevant stroke). Results: Regarding to plaque character for degree of stenosis, calcification and ulceration revealed significantly higher degree of stenosis in hemodynamic events group (P = 0.024). On the other hand, that there was no statistically significant difference between the two groups as regard calcification, ulceration and lesion location. Conclusion: The study revealed that HI is a common occurrence following CAS procedures and significantly higher degree of stenosis in hemodynamic events group. Plaque shape, ulcerations hardly affect haeodynamic instability after carotid stenting.
References
[1]
Benjamin, E.J., Blaha, M.J., Chiuve, S.E., Cushman, M., Das, S.R., Deo, R. and Jiménez, M.C. (2017) Heart Disease and Stroke Statistics—2017 Update: A Report from the American Heart Association. Circulation, 135, e146-e603. https://doi.org/10.1161/CIR.0000000000000485
[2]
Brott, T.G, Halperin, J.L, Abbara, S., Bacharach, J.M., Barr, J.D., et al. (2010) Stenting versus Endarterectomy for Treatment of Carotid Artery Stenosis. New England Journal of Medicine, 363, 11-23. https://doi.org/10.1056/NEJMoa0912321
[3]
Csobay-Novák, C., Bárány, T., Zima, E., Nemes, B., Sótonyi, P., Merkely, B. and Hüttl, K. (2015) Role of Stent Selection in the Incidence of Persisting Hemodynamic Depression after Carotid Artery Stenting. Journal of Endovascular Therapy, 22, 122-129. https://doi.org/10.1177/1526602814566404
[4]
National Institute of Health, National Institute of Neurological Disorders and Stroke. Stroke Scale. https://www.ninds.nih.gov/sites/default/files/NIH_Stroke_Scale_Booklet.pdf
[5]
De Rango, P., Parlani, G., Verzini, F., Giordano, G., Panuccio, G., Barbante, M. and Cao, P. (2011) Long-Term Prevention of Stroke: A Modern Comparison of Current Carotid Stenting and Carotid Endarterectomy. Journal of the American College of Cardiology, 57, 664-671. https://doi.org/10.1016/j.jacc.2010.09.041
[6]
Lin P.H, Zhou, W. and Kougias, P. (2007) Factors Associated with Hypotension and Bradycardia after Carotid Angioplasty and Stenting. Journal of Vascular Surgery, 46, 846-854. https://doi.org/10.1016/j.jvs.2007.07.020
[7]
Mangin, L., Medigue, C., Merle, J.C., et al. (2003) Cardiac Autonomic Control during Balloon Carotid Angioplasty and Stenting. Canadian Journal of Physiology and Pharmacology, 81, 944-951. https://doi.org/10.1139/y03-092
[8]
Park, J.H and Lee, J.H. (2018) Carotid Artery Stenting. Korean Circulation Journal, 48, 97-113. https://doi.org/10.4070/kcj.2017.0208
[9]
Nonaka, T., Oka, S., Miyata, K., Mikami, T., Koyanagi, I., Houkin, K. and Imaizumi, T. (2005) Prediction of Prolonged Postprocedural Hypotension after Carotid Artery Stenting. Neurosurgery, 57, 472-477. https://doi.org/10.1227/01.NEU.0000170541.23101.81
[10]
Taha, M.M., Toma, N., Sakaida, H., Hori, K., Maeda, M., Asakura, F. and Taki, W. (2008) Periprocedural Hemodynamic Instability with Carotid Angioplasty and Stenting. Surgical Neurology, 70, 279-285. https://doi.org/10.1016/j.surneu.2007.07.006
