Purpose: To investigate the possible role of stent selection and procedure-related vessel diameter changes in the development of persisting hemodynamic depression (PHD) and to demonstrate the effectiveness and safety of permanent pacemaker implantation in patients with refractory PHD.
Methods: Data from 584 procedures performed in 542 patients (398 men; mean age 67.3 years) between 2008 and 2011 using Wallstent, Precise, and Xact stents in a nonrandomized fashion were analyzed retrospectively. Cardiovascular risk factors and lesion, stent, and balloon characteristics were collected, and the pre- and postprocedure diameters of the common carotid artery (CCA) and internal carotid artery were measured. PHD was defined as any episode of hypotension (systolic blood pressure <90 mm Hg) and/or bradycardia (heart rate <60/min) lasting >6 hours. Risk factors for PHD were sought using logistic regression analyses; the results are presented as the odds ratio (OR) and 95% confidence interval (CI).
Results: The incidence of PHD was 37.0% (216/584). Refractory PHD was encountered in 9 patients; among these, 6 were successfully treated with pacemaker implantation. A history of prior ipsilateral carotid endarterectomy (OR 0.44, 95% CI 0.22 to 0.87, p=0.019) and the presence of a contralateral high-grade stenosis (OR 0.12, 95% CI 0.02 to 0.95, p=0.045) were independent protective factors, while calcification (OR 1.5, 95% CI 1.03 to 2.18, p=0.034), involvement of the carotid bulb (OR 2.56, 95% 1.62 to 4.03, p<0.001), and implantation of a nitinol stent (adjusted OR 1.62, 95% CI 1.12 to 2.34, p=0.011) were independent risk factors for developing PHD after carotid artery stenting. The ratio of the post-/preprocedure CCA diameter (p=0.002), the stent to CCA diameter ratio (p=0.009), and the presence of residual stenosis (p=0.009) were significantly higher in the PHD group.
Conclusion: Stent selection and procedure-related changes in vessel diameter may have an influence on the development of PHD. Permanent pacemaker implantation is an effective treatment option in patients with refractory PHD.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1177/1526602814566404 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Cavernous Sinus Syndrome in a Traumatic Dissecting Aneurysm of the Internal Carotid Artery.
Cureus
December 2024
Department of Ophthalmology, Hospital University Kebangsaan Malaysia, Kuala Lumpur, MYS.
We report a rare case of a missed intracavernous internal carotid artery dissecting aneurysm occurring as a complication of the base of skull fracture with severe brain injury causing acute cavernous sinus syndrome with permanent vision loss. A 31-year-old Myanmar lady had an alleged motor vehicle accident and suffered severe traumatic brain injury with multiple intracranial bleeds, multiple facial bone and base of skull fractures, and limb fractures. At one week post-trauma, she had severe right eye proptosis with vision loss, ophthalmoplegia, chemosis, and high intraocular pressure.
View Article and Find Full Text PDFRemoval of microcatheter entrapped in the middle cerebral artery in a neonate via common carotid arteriotomy.
J Vasc Surg Cases Innov Tech
February 2025
Department of Vascular Surgery, Sir Charles Gairdner Hospital, Perth, Australia.
A 2-day-old neonate was referred to the vascular surgery service owing to concerns of limb perfusion after entrapment of a microcatheter in the middle cerebral artery. The catheter was inserted via the umbilical artery to treat a vein of Galen arteriovenous malformation. This catheter inadvertently became entrapped owing to device failure, was cut at the insertion site, and left in situ for 3 months.
View Article and Find Full Text PDFManagement of Anomalous Left Vertebral Artery During Open Total Arch Replacement.
Ann Thorac Surg Short Rep
December 2024
Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School Medicine, Chicago, Illinois.
Background: An anomalous left vertebral artery (aLVA) can complicate aortic arch surgery. We examined the safety of various aLVA revascularization strategies during open total arch replacement.
Methods: We retrospectively evaluated 92 patients undergoing total arch replacement from January 2018 to May 2023 and identified 11 patients with aLVA.
CAS-OPCABG vs OPCABG-alone in patients with asymptomatic carotid Stenosis: Multi-center experience.
Int J Cardiol Heart Vasc
February 2025
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Objective: The objective was to evaluate the relationship between carotid stenting and off-pump coronary artery grafting (CAS-OPCABG) and OPCABG only in patients with asymptomatic severe carotid stenosis.
Methods: This study retrospectively included 669 patients with asymptomatic severe carotid artery stenosis who underwent OPCABG at multiple centers. After propensity score matching for baseline characteristics, the study compared two groups of patients with clinical data, early and midterm death, stroke, and myocardial infarction (MI).
Moyamoya phenomenon following clipping of intracranial aneurysm: case report.
J Surg Case Rep
January 2025
Department of Neurosurgery, The Walton Centre NHS Trust, Lower Lane, Liverpool L97LJ, United Kingdom.
Subarachnoid haemorrhage from aneurysmal rupture is a common emergency in neurosurgery. Depending on aneurysm position, morphology, size, associated clot, and symptoms, it is either managed by endovascular occlusion or by clipping. Here we report the first known case of secondary Moyamoya phenomenon following the clipping of a supraclinoid internal carotid artery Aneurysm.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!