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Intolerance to occlusion during carotid artery stenting with proximal protection: causes, mechanisms, treatment and prevention.
Montorsi, Piero; Mancini, Elisabetta; Galli, Stefano; Teruzzi, Giovanni; Caputi, Luigi; Ferrari, Cristina; Troiano, Sarah; Olivares, Paolo; Ravagnani, Paolo M; Trabattoni, Daniela.
Afiliación
  • Montorsi P; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy - piero.montorsi@ccfm.it.
  • Mancini E; Centro Cardiologico Monzino IRCCS, Milan, Italy - piero.montorsi@ccfm.it.
  • Galli S; Centro Cardiologico Monzino IRCCS, Milan, Italy.
  • Teruzzi G; Centro Cardiologico Monzino IRCCS, Milan, Italy.
  • Caputi L; Centro Cardiologico Monzino IRCCS, Milan, Italy.
  • Ferrari C; Division of Neurology, ASST Crema, Crema, Cremona, Italy.
  • Troiano S; Centro Cardiologico Monzino IRCCS, Milan, Italy.
  • Olivares P; Centro Cardiologico Monzino IRCCS, Milan, Italy.
  • Ravagnani PM; Centro Cardiologico Monzino IRCCS, Milan, Italy.
  • Trabattoni D; Centro Cardiologico Monzino IRCCS, Milan, Italy.
Minerva Cardiol Angiol ; 70(6): 751-764, 2022 Dec.
Article en En | MEDLINE | ID: mdl-36700670
Periprocedural cerebral microembolization is the most important complication of carotid artery stenting. Among several variables that play a role to reduce this risk, brain protection (proximal vs. distal) plays a pivot role. Data are accumulating in favor of a better performance of proximal vs. distal especially in symptomatic patients and high-risk carotid plaques. A prerequisite for the technique to be safe and effective is the presence of a valid intracranial collateral circulation to compensate for the target vessel hemisphere avoiding patient intolerance. This complication may occur either soon after the common carotid balloon occlusion or slowly developing during the procedure peaking at the stent post-dilation step. While Willis' circle anatomic variants are the most frequent cause of acute intolerance, a mix of anatomic, hemodynamic and patient cerebral condition play a role for the late developing form. Prevention is the best treatment of intolerance through a pre- and procedural imaging with different techniques (CT angiography, NMR angiography, transcranial Doppler assessment, digital subtraction angiography and back pressure monitoring).
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estenosis Carotídea Tipo de estudio: Etiology_studies Límite: Humans Idioma: En Revista: Minerva Cardiol Angiol Año: 2022 Tipo del documento: Article Pais de publicación: Italia

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estenosis Carotídea Tipo de estudio: Etiology_studies Límite: Humans Idioma: En Revista: Minerva Cardiol Angiol Año: 2022 Tipo del documento: Article Pais de publicación: Italia