Carotid artery stenting complications [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Carotid artery stenting complications ======

see [[Hemodynamic depression]].


The potential procedural and peri-procedural complications that may be related to carotid angioplasty and stenting may be categorised as minor or major complications:

A - Minor complications

[[Carotid artery spasm]]

Sustained hypotension / bradycardia

Carotid artery dissection

Contrast encephalopathy (very rare)

Minor embolic neurological events (TIAs)

B - Major complications

Major embolic stroke

[[Retinal artery occlusion]]

[[Intracranial hemorrhage]]

[[Hyperperfusion syndrome]]

Carotid perforation (very rare)

Acute stent thrombosis (very rare)

Complications at the site of the vascular access.


----


The increase in the number of [[carotid artery stenting]] (CAS) [[procedure]]s has necessitated critical appraisal of procedural [[outcome]]s and patterns of utilization including [[cost]] [[analysis]]. 

Badheka et al. queried the [[Healthcare Cost]] and Utilization Project's [[Nationwide Inpatient Sample]] from 2006 to 2010 using the [[International Classification of Diseases]], Ninth Revision, procedure code of 00.63 for CAS. Hierarchical mixed-effects models were generated to identify the independent multivariate predictors of in-[[Hospital mortality]], procedural complications, LOS, and cost of hospitalization. A total of 13,564 CAS procedures (weighted n = 67,344) were analyzed. The overall postprocedural [[mortality]] was low at 0.5%, whereas the complication rate was 8%, both of which remained relatively steady over the time frame of the study. Greater postoperative mortality and [[complication]]s were noted in symptomatic patients, women, and those with greater burden of baseline co-morbidities. A greater operator volume was associated with a lower rate of postoperative mortality and complications, as well as shorter LOS and lesser hospitalization costs. In conclusion, the postprocedural mortality after CAS has remained low over the recent years. Operator volume is an important predictor of postprocedural outcomes and resource utilization
((Badheka AO, Chothani A, Panaich SS, Mehta K, Patel NJ, Deshmukh A, Singh V,
Arora S, Patel N, Grover P, Shah N, Savani CN, Patel A, Panchal V, Brown M, Kaki 
A, Kondur A, Mohamad T, Elder M, Grines C, Schreiber T. Impact of symptoms,
gender, co-morbidities, and operator volume on outcome of carotid artery stenting
(from the Nationwide Inpatient Sample [2006 to 2010]). Am J Cardiol. 2014 Sep
15;114(6):933-41. doi: 10.1016/j.amjcard.2014.06.030. Epub 2014 Jul 3. PubMed
PMID: 25208563.
)).



Perioperative incidence of stroke (0.9%), myocardial infarction MI (0.6%), and death (1.1%)
((Dumont TM, Wach MM, Mokin M, Sorkin GC, Snyder KV, Hopkins LN, Levy EI,
Siddiqui AH. Perioperative complications after carotid artery stenting: a
contemporary experience from the university at buffalo neuroendovascular surgery 
team. Neurosurgery. 2013 Oct;73(4):689-93; discussion 693-4. doi:
10.1227/NEU.0000000000000077. PubMed PMID: 23842555.)). 

Adding a distal filter and blood aspiration to flow reversal during CAS could provide effective distal embolic protection
((Sakamoto S, Kiura Y, Okazaki T, Shinagawa K, Ichinose N, Shibukawa M, Orita Y,
Shimonaga K, Kajihara Y, Kurisu K. Usefulness of dual protection combined with
blood aspiration for distal embolic protection during carotid artery stenting.
Acta Neurochir (Wien). 2015 Mar;157(3):371-7. doi: 10.1007/s00701-014-2311-6.
Epub 2014 Dec 30. PubMed PMID: 25547718.
)).

The [[radial artery]] is an effective and safe method in [[stenting]] of carotid arteries. In patients with high risk of haemorrhagic complications from the side of the vascular approach and with difficult anatomy of the [[aortic arch]] and its branches, hampering catheterization of the [[carotid artery]] via the [[femoral artery approach]], the [[radial artery]] may be considered as an advantageous site of access
((Shchanitsyn IN, Sharafutdinov MR, Iakubov RA, Larin IV. [Transradial approach 
in carotid stenting]. Angiol Sosud Khir. 2018;24(2):114-122. Russian. PubMed
PMID: 29924782.
)).