title: Cerebral intolerance during flow arrested carotid angioplasty.
abstract: BACKGROUND
  The use of flow arrest as a means of providing cerebral protection during carotid angioplasty offers the advantages of improved efficiency of debris removal and the ability to provide protection under unfavorable (tortuous) anatomic circumstances. However, in contrast to the filtration methods of cerebral protection, this modality requires complete interruption of antegrade carotid artery flow during balloon angioplasty and stent deployment.
  
  
  METHODS
  We report our experience with 9 patients undergoing carotid angioplasty with the Mo.Ma device, which utilizes common and external carotid artery balloon occlusion during the angioplasty procedure. We assessed the clinical outcomes and intraprocedural hemodynamic data.
  
  
  RESULTS
  The average duration of carotid occlusion was 8.3 minutes. Of the 9 patients, 2 patients (22%) experienced cerebral intolerance. No stroke occurred in this patient cohort. There appeared to be a poor relationship between procedure intolerance and the presence of significant contralateral stenosis or low carotid back pressure. Furthermore, the incidence of postangioplasty hypotension was not clearly related to cerebral intolerance.
  
  
  CONCLUSIONS
  Carotid angioplasty with stenting can be safely conducted with flow arrest as an alternative to filter-type cerebral protection devices. However, because cerebral intolerance is not an infrequent occurrence with this approach, clinicians must be cognizant of management strategies for transient cerebral intolerance.
authors.affiliation: Division of Vascular Surgery, Hartford Hospital, Hartford, CT, USA.
authors.forename: Myron
authors.initials: M
authors.lastname: St Louis
authors.forename: Brian D
authors.initials: BD
authors.lastname: Park
authors.forename: Michael
authors.initials: M
authors.lastname: Dahn
authors.forename: Patricia
authors.initials: P
authors.lastname: Bozeman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation; D017536:Carotid Artery, Common / Q000503:physiopathology*; D002342:Carotid Artery, External / Q000503:physiopathology*; D016893:Carotid Stenosis / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation; D005260:Female; D006429:Hemiplegia / Q000209:etiology*; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012039:Regional Blood Flow; D012640:Seizures / Q000209:etiology*; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome