AI Article Synopsis
- The study investigates a rare complication of carotid artery stenting (CAS), where patients experience prolonged neurological symptoms linked to fluid changes in the cerebrospinal fluid (CSF) space.
- Out of 19 patients who underwent 21 CAS procedures, 57.1% showed CSF space enhancement on imaging after the procedure, which was associated with factors like age, severity of stenosis, and acute procedural timing.
- The findings suggest that blood-brain barrier (BBB) disruption, leading to these complications, is more related to ischemic intolerance and reperfusion injury rather than sudden changes in blood flow, indicating that at-risk patients require careful monitoring to avoid serious repercussions.
Article Abstract
Purpose: A rare complication of carotid artery stenting (CAS), prolonged reversible neurological symptoms with delayed cerebrospinal fluid (CSF) space enhancement on fluid attenuated inversion recovery (FLAIR) images, is associated with blood-brain barrier (BBB) disruption. We prospectively identified patients who showed CSF space enhancement on FLAIR images.
Methods: Nineteen patients-5 acute-phase and 14 scheduled-underwent 21 CAS procedures. Balloon catheters were navigated across stenoses, angioplasty was performed using a neuroprotective balloon, and stents were placed with after dilation under distal balloon protection. CSF space hyperintensity or obscuration on FLAIR after versus before CAS indicated CSF space enhancement. Correlations with clinical factors were examined.
Results: CSF space was enhanced on FLAIR in 12 (57.1%) cases. Postprocedural CSF space enhancement was significantly related to age, stenosis rate, acute-stage procedure, and total occlusion time. All acute-stage CAS patients showed delayed enhancement. Only age was associated with delayed CSF space enhancement in scheduled CAS patients.
Conclusions: Ischemic intolerance for severe carotid artery stenosis and temporary neuroprotective balloon occlusion, causing reperfusion injury, seem to be the main factors that underlie BBB disruption with delayed CSF space enhancement shortly after CAS, rather than sudden poststenting hemodynamic change. Our results suggest that factors related to hemodynamic instability or ischemic intolerance seem to be associated with post-CAS BBB vulnerability. Patients at risk for hemodynamic instability or with ischemic intolerance, which decrease BBB integrity, require careful management to prevent intracranial hemorrhagic and other post-CAS complications.
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| http://dx.doi.org/10.1007/s00270-010-0035-4 | DOI Listing |
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