Periprocedural Monitoring with Regional Cerebral Oxygen Saturation in Carotid Artery Stenting

Abstract

Hemodynamic instability during and after carotid artery stenting (CAS) may reduce cerebral blood flow (CBF), leading to cerebral ischemia. To investigate changes in CBF in the periprocedural period, we continuously recorded the regional cerebral oxygen saturation (rSO2) using near-infrared spectroscopy.

In 46 consecutive patients with carotid artery stenosis, rSO2 was continuously recorded during and after CAS. In addition, the patients underwent SPECT to evaluate a change in CBF on the next day after CAS.

Introprocedural bradycardia (heart rate <50 bpm) occurred in 21 patients (46%) including one transient cardiac arrest. Intraprocedural hypotension (systolic blood pressure <80 mmHg) occurred in 18 patients (39%), and 16 of them showed prolonged hypotension. The rSO2 in patients with bradycardia/hypotension during CAS was significantly less than that in patients without them (p<0.01). Moreover, the SPECT on the next day after CAS demonstrated that the ipsilateral CBF in patients with bradycardia/hypotension during CAS significantly more than that in patients without them (p<0.05).

Intraprocedural hemodynamic instability resulted in a significant decrease in rSO2, leading to a possible severe cerebral ischemia. In addition, intraprocedural bradycardia/hypotension might be related with postprodedural hyperperfusion, causing the morbidity and mortality after CAS.

Keywords

carotid artery stenting bradycardia hypotension oxygen saturation

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References

Qureshi

Kirmani

: Carotid angioplasty with or without stent placement versus carotid endarterectomy for treatment of carotid stenosis: A meta-analysis. Neurosurgery 56: 1171–1179, 2005.

Brooks

McClure

: Carotid angioplasty and stenting versus carotid endarterectomy for treatment of asymptomatic carotid stenosis: A randomized trial in a community hospital. Neurosurgery 54: 318–324, 2004.

Yadav

Wholey

: Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators: Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351: 1493–1501, 2004.

Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS) Investigators: Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): A randomised trial. Lancet 357: 1729–1737, 2001.

Nano

Dalainas

: Ballooning-induced bradycardia during carotid stenting in primary stenosis and restenosis. Neuroradiology 2006 May 3

Gupta

Abou-Chebl

: Rate, predictors, and consequences of hemodynamic depression after carotid artery stenting. J Am Coll Cardiol 47: 1538–1543, 2006.

Nagata

Kazekawa

: Hemodynamic stability under general anesthesia in carotid artery stenting. Radiat Med 23: 427–431, 2005.

Bush

Lin

: Reevaluation of temporary transvenous cardiac pacemaker usage during carotid angioplasty and stenting: A safe and valuable adjunct. Vasc Endovascular Surg 38: 229–235, 2004.

Mlekusch

Schillinger

: Hypotension and bradycardia after elective carotid stenting: Frequency and risk factors. J Endovasc Ther 10: 851–859; 2003.

10.

Harrop

Sharan

: Prevention of carotid angioplasty-induced bradycardia and hypotension with temporary venous pacemakers. Neurosurgery 49: 814–820, 2001.

11.

Qureshi

Luft

: Frequency and determinants of postprocedural hemodynamic instability after carotid angioplasty and stenting. Stroke 30: 2086–2093, 1999.

12.

Edmonds

Jr Ganzel

: Cerebral oximetry for cardiac and vascular surgery. Semin Cardiothorac Vasc Anesth 8: 147–166, 2004.

13.

Kim

Ward

: Estimation of jugular venous O2 saturation from cerebral oximetry or arterial O2 saturation during isocapnic hypoxia. J Clin Monit Comput 16: 191–199, 2000.

14.

Niizuma

Kamii

: Usefulness of regional cerebral oxygen saturation monitoring in balloon test occlusion. No Shinkei Geka 34: 695–702, 2006.

15.

Ogasawara

Konno

: Transcranial regional cerebral oxygen saturation monitoring during carotid endarterectomy as a predictor of postoperative hyperperfusion. Neurosurgery 53: 309–314, 2003.

16.

Henry

Gopalakrishnan

: Bilateral carotid angioplasty and stenting. Catheter Cardiovasc Interv 64: 275–282, 2005.

17.

Meyers

Higashida

: Cerebral hyperperfusion syndrome after percutaneous transluminal stenting of the craniocervical arteries. Neurosurgery 47: 335–343, 2000.