Korean Circ J.  2018 Mar;48(3):217-226. 10.4070/kcj.2017.0031.

Low Common Carotid Artery Systolic Occlusion Pressure and Symptomatic Carotid Artery Stenosis Are Associated with Development of Neurologic Intolerance during Proximal Protected Carotid Artery Stenting

• Kwon HJ
• Park JH
• Lee JH
• Jeong HS
• Song HJ
• Kim J
• Kim M
• Kwon IS
• Seong IW

• KMID: 2406925
• DOI: http://doi.org/10.4070/kcj.2017.0031

Abstract

BACKGROUND AND OBJECTIVES
Neurologic intolerance (NI) is defined as the occurrence of neurological symptoms during carotid artery stenting (CAS). Because NI is inevitable problem, it may be helpful to anticipate its occurrence. So, we studied factors associated with NI during proximal protected CAS.
METHODS
We retrospectively analyzed all consecutive patients underwent proximal protected CAS from August 2012 to January 2017.
RESULTS
We included total 123 patients (109 males, 72±8 years old). The total procedure time was 43±12 minutes, and mean occlusion time was 4.8±1.2 minutes. We divided CAS patients into 2 groups according to presence of NI; neurologic tolerance (NT; n=74, 60%) and NI (n=49, 40%) groups. After the univariate analysis, symptomatic carotid artery stenosis (p = 0.003), absence of anterior communicating artery (p = 0.015) and low common carotid artery occlusion pressure (CCAOP, p < 0.001) were associated with NI. After the multivariate analysis, NI was significantly associated with symptomatic carotid artery stenosis (odds ratio [OR], 5.549; p = 0.014) and systolic CCAOP≤42 mmHg (OR, 6.461; p < 0.001). In NI group, 43 patients (88%) recovered right after the balloon deflation and 2 patients were normalized within 2 hours. However, 1 had major stroke and 3 had minor strokes in 4 patients with persistent NI ≥24 hours.
CONCLUSIONS
About 40% showed NI during the CAS. Most of them (88%, 43 of 49 patients) recovered after the balloon deflation, but stroke incidence was significantly higher in NI group. Symptomatic carotid artery stenosis and systolic CCAOP ≤42 mmHg were significantly associated with the development of NI during proximal protected CAS.

Keyword

Carotid stenosis; Stent; Neurologic symptoms; Embolic protection devices

MeSH Terms

Arteries
Carotid Arteries*
Carotid Artery, Common*
Carotid Stenosis*
Embolic Protection Devices
Humans
Incidence
Male
Multivariate Analysis
Neurologic Manifestations
Retrospective Studies
Stents*
Stroke

Figure

• 

  Figure 1 Graphic illustration and case examples of the CCAOP measurement. CCAOP was measured immediately after expansion of the proximal balloon of the MO.MA catheter after the insertion into the CCA (A and B). Femoral arterial pressure was measured by the blood pressure measured from the distal aorta through a 25-cm-long sheath inserted into the femoral artery (B). These 2 pressure tracings were monitored throughout the procedure simultaneously. A patient with CCAOP of 70/50 mmHg had no change in consciousness throughout the procedure (C). However, a patient with low CCAOP (24/16 mmHg) and poor pulse pressure had transient NI during the procedure (D). CCA = common carotid artery; CCAOP = common carotid artery occlusion pressure; FA pr. = femoral artery pressure; NI = neurologic intolerance.

• 

  Figure 2 Study scheme. CAS = carotid artery stenting; CCA = common carotid artery; ECA = external carotid artery; NI = neurologic intolerance; NT = neurologic tolerance.

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