Catheter-based neurosalvage for acute embolic complication during carotid intervention

• Published in: Journal of vascular surgery 2010-08, Vol.52 (2), p.308-313
• Main Authors: Lin, Mao-Shin, MD, Chen, Ying-Hsien, MD, Chao, Chi-Chao, MD, Lin, Cheng-Hsin, MD, Li, Hung-Yuan, MD, Chao, Chia-Lun, MD, PhD, Chen, Ming-Fong, MD, PhD, Kao, Hsien-Li, MD
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Aged, 80 and over; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - instrumentation; Carotid Artery Diseases - therapy; Cerebral Angiography - methods; Cerebrovascular Circulation - drug effects; Combined Modality Therapy; Female; Fibrinolytic Agents - administration & dosage; Heparin - administration & dosage; Humans; Iatrogenic Disease; Intracranial Embolism - diagnostic imaging; Intracranial Embolism - etiology; Intracranial Embolism - physiopathology; Intracranial Embolism - therapy; Male; Microinjections; Middle Aged; Nervous System Diseases - etiology; Nervous System Diseases - therapy; Nitroglycerin - administration & dosage; Retrospective Studies; Stents; Surgery; Thrombolytic Therapy; Tissue Plasminogen Activator - administration & dosage; Tomography, X-Ray Computed; Treatment Outcome; Vasodilator Agents - administration & dosage
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2010.03.024

Objectives Iatrogenic emboli may be released during carotid intervention, causing permanent neurologic complications and catastrophic outcomes. This article reports the procedural details and clinical results of our series of neurosalvage techniques to manage thromboembolic events during carotid procedures. Methods Between March 2003 and December 2007, 342 patients (283 men, 72.1 ± 8.9 years old, 121 symptomatic) underwent percutaneous stent deployment in 407 cervical internal carotid arteries in our institution. Visible distal embolization with flow occlusion caused neurologic complications in 10 patients (2.5%), and a structured and stepwise neurosalvage approach was attempted. Results Guidewire fragmentation and microcatheter injection of heparin and nitroglycerin were performed in all 10 patients as step 1. Intra-arterial thrombolysis was given in four patients and balloon angioplasty in five, as step 2. Intracranial stenting was done in one patient as the last step. Successful angiographic recanalization (Thrombolysis in Myocardial Infarction [TIMI] grade 2-3) occurred in 9 of 10 (90%). Residual neurologic sequel was observed in five, including three patients with hemorrhage complications (1 received emergent craniotomy). There was no neurologic mortality in this series. Conclusions Acute embolic complication during carotid artery stenting can be managed by catheter-based neurosalvage with effective angiographic recanalization and marginal clinical success.