title: Ischemic preconditioning during the use of the PercuSurge occlusion balloon for carotid angioplasty and stenting.
abstract: Ischemic preconditioning (IP) uses transient ischemia to render tissues tolerant to subsequent, prolonged ischemia. This study sought to evaluate factors that contributed to the development of cerebral ischemia during PercuSurge balloon (Medtronic, Santa Rosa, CA) occlusion in patients undergoing carotid angioplasty and stenting (CAS). The PercuSurge occlusion balloon was used in 43 of 165 patients treated with CAS for high-grade stenosis; 20% were symptomatic. Symptoms of cerebral hypoperfusion during temporary occlusion of the internal carotid artery occurred in 10 of 43 patients and included dysarthria, agitation, decreased level of consciousness, and focal hemispheric deficit. The development of neurologic symptoms after initial PercuSurge balloon inflation and occluded internal carotid artery flow was associated with a decrease in the mean Glasgow Coma Scale (GCS) from 15 to 10 (range 9-14); the GCS returned to normal after occlusion balloon deflation. The mean time to spontaneous recovery of full neurologic function was 8 minutes (range 4-15 minutes). The mean subsequent procedure duration was 11.9 minutes (range 6-21 minutes). No recurrence of neurologic symptoms occurred when the occlusion balloon was reinflated. All 10 patients underwent successful CAS without occlusion, dissection, cerebrovascular accident, or death. Ischemic preconditioning can be used to enable CAS with embolic protection in patients who cannot tolerate initial interruption of antegrade cerebral perfusion by PercuSurge occlusion.
authors.affiliation: Division of Vascular Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA. peter.faries@mountsinai.org
authors.forename: Peter L
authors.initials: PL
authors.lastname: Faries
authors.forename: Brian
authors.initials: B
authors.lastname: DeRubertis
authors.forename: Susan
authors.initials: S
authors.lastname: Trocciola
authors.forename: John
authors.initials: J
authors.lastname: Karwowski
authors.forename: K Craig
authors.initials: KC
authors.lastname: Kent
authors.forename: Rabih A
authors.initials: RA
authors.lastname: Chaer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D002545:Brain Ischemia / Q000209:etiology / Q000628:therapy; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D003097:Collateral Circulation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome