Catheter-based neurosalvage for acute embolic complication during carotid intervention

Mao Shin Lin, Ying Hsien Chen, Chi Chao Chao, Cheng Hsin Lin, Hung Yuan Li, Chia Lun Chao, Ming Fong Chen, Hsien Li Kao

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)308-313
Number of pages6
JournalJournal of Vascular Surgery
Volume52
Issue number2
DOIs
Publication statusPublished - Aug 2010

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Catheters
Nervous System
Balloon Angioplasty
Craniotomy
Nitroglycerin
Internal Carotid Artery
Embolism
Carotid Arteries
Stents
Heparin
Myocardial Infarction
Hemorrhage
Injections
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Catheter-based neurosalvage for acute embolic complication during carotid intervention. / Lin, Mao Shin; Chen, Ying Hsien; Chao, Chi Chao; Lin, Cheng Hsin; Li, Hung Yuan; Chao, Chia Lun; Chen, Ming Fong; Kao, Hsien Li.

In: Journal of Vascular Surgery, Vol. 52, No. 2, 08.2010, p. 308-313.

Research output: Contribution to journalArticle

Lin, Mao Shin ; Chen, Ying Hsien ; Chao, Chi Chao ; Lin, Cheng Hsin ; Li, Hung Yuan ; Chao, Chia Lun ; Chen, Ming Fong ; Kao, Hsien Li. / Catheter-based neurosalvage for acute embolic complication during carotid intervention. In: Journal of Vascular Surgery. 2010 ; Vol. 52, No. 2. pp. 308-313.
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abstract = "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.",
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