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Titolo:
Management of neurological complications of carotid artery stenting
Autore:
Wholey, MH; Wholey, MH; Tan, WA; Toursarkissian, B; Bailey, S; Eles, G; Jarmolowski, C;
Indirizzi:
Univ Texas, Hlth Sci Ctr, Dept Cardiovasc Intervent Radiol, San Antonio, TX 78284 USA Univ Texas San Antonio TX USA 78284 ent Radiol, San Antonio, TX 78284 USA Univ Texas, Hlth Sci Ctr, Dept Vasc Surg, San Antonio, TX 78284 USA Univ Texas San Antonio TX USA 78284 Vasc Surg, San Antonio, TX 78284 USA Univ Texas, Hlth Sci Ctr, Dept Cardiol, San Antonio, TX 78284 USA Univ Texas San Antonio TX USA 78284 pt Cardiol, San Antonio, TX 78284 USA UPMC, Pittsburgh Vasc Inst, Shadyside Hosp, Pittsburgh, PA USA UPMC Pittsburgh PA USA rgh Vasc Inst, Shadyside Hosp, Pittsburgh, PA USA
Titolo Testata:
JOURNAL OF ENDOVASCULAR THERAPY
fascicolo: 4, volume: 8, anno: 2001,
pagine: 341 - 353
SICI:
1526-6028(200108)8:4<341:MONCOC>2.0.ZU;2-I
Fonte:
ISI
Lingua:
ENG
Soggetto:
ACUTE ISCHEMIC STROKE; CEREBRAL HYPERPERFUSION SYNDROME; CLINICAL-EXPERIENCE; OCCLUSIVE DISEASE; HEMORRHAGE; ENDARTERECTOMY; THROMBOLYSIS; ANGIOPLASTY; PLACEMENT; UROKINASE;
Keywords:
carotid stenosis; stroke; transient ischemic attack; thrombolysis; Palmaz stent;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
35
Recensione:
Indirizzi per estratti:
Indirizzo: Wholey, MH Univ Texas, Hlth Sci Ctr, Dept Cardiovasc Intervent Radiol, 7703 Floyd Curl Dr, San Antonio, TX 78284 USA Univ Texas 7703 Floyd Curl Dr San Antonio TX USA 78284 8284 USA
Citazione:
M.H. Wholey et al., "Management of neurological complications of carotid artery stenting", J ENDOVAS T, 8(4), 2001, pp. 341-353

Abstract

Purpose: To review the neurological complications associated with extracranial carotid artery stenting and to preliminarily assess techniques used tomanage these complications. Methods: Between April 1994 and August 2000, 450 patients (270 men; mean age 70.2 years, range 27-89) had stents implanted to treat 472 cervical carotid artery stenoses. Over half (257, 57%) of the patients were symptomatic. A variety of stents were implanted percutaneously after predilation of thelesion; a third of the patients received glycoprotein IIb/IIIa inhibitors intraprocedurally in addition to a standard oral antiplatelet regimen (aspirin and ticlopidine or clopidogrel). Occurrence and management of neurological complications within the 30-day periprocedural period were reviewed. Results: There were 14 (3.1%) transient ischemic attacks (TIAs), 10 (2.2%)minor strokes, and 3 (0.7%) major strokes. Among 6 (1.3%) procedure-related deaths, 4 had neurological causes. The total stroke and death rate was 4.2% (n=19). All the TIAs, 4 of which occurred between 1 and 14 days poststenting, were treated medically, as were the minor strokes, 3 of which occurred >24 hours after stenting. Only 2 minor stroke patients had mild residual upper extremity motor deficits. Intra-arterial thrombolytic therapy was administered in 5 cases (2 major strokes survivors and 3 patients who suffereda neurological ly-related death); occlusions were identified in the proximal middle cerebral artery (MCA) in 3 and the distal MCA in 2. Angiographic improvement was noted in 4 (80%), but only the 2 (40%) with distal MCA occlusions did well clinically. Conclusions: Neurological complications following carotid artery stenting are inevitable. The occurrence of minor strokes >24 hours following stenting may indicate a possible late embolic phenomenon, which warrants investigation. Likewise, the marginal efficacy of intra-arterial thrombolytic therapy demonstrates an inability to lyse embolic plaque and underscores the needfor effective distal protection.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 06/04/20 alle ore 20:00:55