title: Prolonged carotid sinus reflex is a risk factor for contrast-induced nephropathy following carotid artery stenting.
abstract: OBJECTIVE
  Although many studies have demonstrated that CIN is associated with in-hospital and long-term mortality, the incidence of CIN following CAS is unclear. We investigated the incidence of CIN, defined as an increase from a baseline creatinine value of at least 0.5 mg/dL or 25% within 72 hours of contrast administration, and we also examined renal function in the late phase after CAS.
  
  
  METHODS
  We examined 80 patients who underwent CAS between April 2005 and December 2009. Clinical background, laboratory data, contrast volume, and clinical course were collected and analyzed.
  
  
  RESULTS
  The incidence of CIN was 8.8% (7/80), and no patients required hemodialysis. In the group that developed CIN, prolonged CSR after CAS was found in 57.1% (4/7) of cases; this incidence differed significantly (P = .001) from that in the group without development of CIN. Neither preoperative renal function, contrast volume, nor history was related to the incidence of CIN, while on multivariate analysis, prolonged CSR was found to be an independent risk factor for CIN. The incidence of elevation in creatinine values at 6 months after CAS was 8.2% (6/73). All patients who developed delayed renal impairment had pre-existing CKD; this finding differed significantly (P = .04) from that in the group without development of delayed renal impairment.
  
  
  CONCLUSIONS
  Because patients who develop prolonged CSR after CAS are at increased risk of perioperative major adverse clinical events including CIN, patients at high risk for this condition should be carefully managed to prevent increased morbidity and mortality.
authors.affiliation: Department of Neurosurgery, National Hospital Organization, Toyohashi Medical Center, Aichi, Japan. ttaka1010@gmail.com
authors.forename: T
authors.initials: T
authors.lastname: Kato
authors.forename: H
authors.initials: H
authors.lastname: Sakai
authors.forename: M
authors.initials: M
authors.lastname: Tsujimoto
authors.forename: Y
authors.initials: Y
authors.lastname: Nishimura
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000601:surgery*; D015897:Comorbidity; D003287:Contrast Media; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis* / Q000401:mortality*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007674:Kidney Diseases / Q000175:diagnosis* / Q000401:mortality*; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data
chemical_list: D003287:Contrast Media