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 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.


CONCLUSIONS
Angioplasty and stenting in these high-risk patients may not confer any advantage over conventional surgery in terms of both haemodynamic ischaemia and embolization.
Department of Vascular Surgery, The General Infirmary at Leeds, UK.
A J
AJ
McCleary
M
M
Nelson
N M
NM
Dearden
T A
TA
Calvey
M J
MJ
Gough
D000368:Aged; D001783:Blood Flow Velocity; D001794:Blood Pressure / Q000502:physiology; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000503:physiopathology / Q000628:therapy*; D002536:Cerebral Arteries / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006940:Hyperemia / Q000209:etiology; D002542:Intracranial Embolism and Thrombosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents; D018608:Ultrasonography, Doppler