Original title: Predictors of Carotid Occlusion Intolerance During Proximal Protected Carotid Artery Stenting. Reference: Giuseppe Giugliano et al. J Am Coll Cardiol Intv 2014, Epub ahead of print.
Proximal endovascular occlusion devices (PEO) have been proved particularly effective and safe for proximal protected carotid stenting procedures. However, endovascular occlusion can expose the ipsilateral hemisphere to hypoperfusion and produce transient neurological symptoms.
Between March 2010 and 2012, 605 consecutive patients undergoing proximal protected carotid stenting in one center were included in this trial (Mo.Ma, Medtronic Inc., Santa Rosa, California). In order to identify independent predictors of carotid occlusion intolerance, multivariate logistic regression model was developed that included all clinical, angiographic and procedural characteristics of patients.
Compared to the asymptomatic subjects, those who presented intolerance had a lower occlusion pressure (42.3 ± 12.7 vs. 61.9 ± 15.4 mmHg; p< 0.001).
The most powerful independent predictor of proximal protection intolerance was occlusion pressure, with best cutoff being ≤40 mmHg (sensitivity 68.5%, specificity 93.3%). The best clinical predictor was the presence of collateral internal carotid artery occlusion (OR 3.1, IC 95% 1.5 a 6.2).
Conclusion
Transient neurological symptoms can occur in one third of patients undergoing proximal protected carotid stenting. Contralateral Carotid occlusion and a ≤ 40 mmHg occlusion pressure are the best predictors.
Editorial Comment
Proximal occlusion intolerance has not been associated to peri procedural events and symptoms completely resolve within the first 20 minutes after flow restoration. Most of the times symptoms start after stenting (during post dilation or aspiration) therefore it is possible to finish procedure under protection. Only 1% of cases started with symptoms immediately after balloon inflation, in these cases the balloon may be deflated and the system may be used as a sheath guide filtered catheterization.
SOLACI