CEREBRAL HEMODYNAMICS AND EMBOLIZATION DURING CAROTID ANGIOPLASTY IN HIGH-RISK PATIENTS

Background Patients with symptomatic internal carotid artery (ICA) ste nosis greater than 70 per cent in association with a contralateral ICA occlusion may have an increased risk of stroke following carotid enda rterectomy. Such patients might benefit from the theoretically shorter ischaemic time offered by carotid angioplasty and stenting. Methods N ine patients who underwent carotid angioplasty and stenting were monit ored using near infrared spectroscopy, continuous jugular venous oxime try and transcranial Doppler ultrasonography to detect both haemodynam ic ischaemia and embolic events. Results Significant ischaemia occurre d in four of the nine patients once the stenosis had been crossed by t he guidewire (spectroscopy and oximetry). Inflation of the angioplasty balloon resulted in a brief period of ischaemia and showers of emboli in all patients (ultrasonography) and this persisted for more than 3 min after balloon deflation in three patients. One patient had a major disabling stroke due to ICA thrombosis. Conclusion Angioplasty and st enting in these high-risk patients may not confer any advantage over c onventional surgery in terms of both haemodynamic ischaemia and emboli zation.