title: S-nitrosoglutathione reduces asymptomatic embolization after carotid angioplasty.
abstract: BACKGROUND
  The major complication of carotid angioplasty is embolic stroke, which may occur after balloon inflation and deflation or in the early postintervention period. Platelet adhesion and aggregation to the angioplasty site with subsequent embolization seems to plays a major role in early postangioplasty embolization and stroke. During this period, asymptomatic embolic signals can be detected in patients by transcranial Doppler ultrasound despite aspirin and heparin treatment. S-nitrosoglutathione (GSNO) is a nitric oxide donor that appears to have relative platelet specificity. We evaluated its effectiveness in reducing embolization after carotid angioplasty.
  
  
  RESULTS
  Sixteen patients undergoing carotid angioplasty and stenting for symptomatic > or =70% internal carotid artery stenosis were randomized in a double-blind manner to GSNO or placebo given after surgery for 90 minutes. All patients were pretreated with aspirin and given heparin for 24 hours after the procedure. Transcranial Doppler recordings were made from the ipsilateral middle cerebral artery for 1 hour before treatment and at 0 to 3, 6, and 24 hours after treatment. GSNO resulted in a rapid reduction in the frequency of embolic signals of 95% at 0 to 3 hours and 100% at 6 hours (P=0.007 and P=0.01 versus placebo, respectively). In the placebo group, 2 patients experienced ipsilateral stroke after the angioplasty. No cerebrovascular events occurred in the GSNO group.
  
  
  CONCLUSIONS
  S-nitrosoglutathione was highly effective in rapidly reducing the frequency of embolic signals after endovascular treatment for symptomatic high-grade carotid stenosis.
authors.affiliation: Clinical Neuroscience, St George's Hospital Medical School, London, UK.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Kaposzta
authors.forename: Andrew
authors.initials: A
authors.lastname: Clifton
authors.forename: Jane
authors.initials: J
authors.lastname: Molloy
authors.forename: John F
authors.initials: JF
authors.lastname: Martin
authors.forename: Hugh S
authors.initials: HS
authors.lastname: Markus
mesh_terms: D017130:Angioplasty / Q000009:adverse effects; D016893:Carotid Stenosis / Q000601:surgery; D004311:Double-Blind Method; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D020030:Nitric Oxide Donors / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D026422:S-Nitrosoglutathione / Q000627:therapeutic use*; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D020030:Nitric Oxide Donors; D010975:Platelet Aggregation Inhibitors; D026422:S-Nitrosoglutathione