Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting
| Autor: | Pilar Algaba, Sonia Mosteiro, Alain Luna, Ernesto García, Luis López-Mesonero, José A. de las Heras, Alberto Gil, Alejandro Tomasello, Irene Escudero-Martínez, José M. Ramírez-Moreno, G. Parrilla, Gustavo Zapata-Wainberg, Juán José Ochoa, Elena Zapata-Arriaza, Fernando Delgado-Acosta, Rosario Gil, Aurelio Cayuela, María Dolores Fernández-Couto, Montserrat González-Delgado, José Luis Caniego, Pedro P. Alcázar, Joaquín Ortega, Asier de Albóniga-Chindurza, J. Zamarro, Francisco Moniche, Joaquín Gil, Eduardo Murias, Marc Ribó, Joan Montaner, Alejandro González García, Andrés González-Mandly, Juan F. Arenillas, Luis Fernández de Alarcón, Fernando Mancha, Jesús Alcalde-López |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
integumentary system business.industry medicine.medical_treatment Area under the curve Stent Odds ratio 030204 cardiovascular system & hematology medicine.disease Confidence interval 03 medical and health sciences 0302 clinical medicine Level of consciousness Internal medicine Angioplasty medicine 030212 general & internal medicine Carotid stenting Cardiology and Cardiovascular Medicine business Kidney disease |
| Zdroj: | JACC: Cardiovascular Interventions. 12:873-882 |
| ISSN: | 1936-8798 |
| DOI: | 10.1016/j.jcin.2019.01.247 |
| Popis: | Objectives The aim of the HISPANIAS (HyperperfusIon Syndrome Post-carotid ANgIoplasty And Stenting) study was to define CHS rates and develop a clinical predictive model for cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS). Background CHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain. Methods The HISPANIAS study was a national prospective multicenter study with 14 recruiting hospitals. CHS was classified as mild (headache only) and moderate-severe (seizure, impaired level of consciousness, or development of focal neurological signs). Results A total of 757 CAS procedures were performed. CHS occurred in 22 (2.9%) patients, in which 16 (2.1%) had moderate-severe CHS and 6 (0.8%) had mild CHS (only headache). The rate of hemorrhages was 0.7% and was associated with high mortality (20%). Pre-operative predictors of moderate-severe CHS in multivariate analysis were female sex (odds ratio [OR]: 3.24; 95% confidence interval [CI]: 1.11 to 9.47; p = 0.03), older patients (OR: 1.09; 95% CI: 1.01 to 1.17; p = 0.02), left carotid artery treated (OR: 4.13; 95% CI: 1.11 to 15.40; p = 0.03), and chronic renal failure (OR: 6.29; 95% CI: 1.75 to 22.57; p = 0.005). The area under the curve of this clinical and radiological model was 0.86 (95% CI: 0.81 to 0.92; p = 0.001). Conclusions The rate of CHS in the HISPANIAS study was 2.9%, with moderate-severe CHS of 2.1%. CHS was independently associated with female sex, older age, history of chronic kidney disease, and a treated left carotid artery. Although further investigations are needed, the authors propose a model to identify high-risk patients and develop strategies to decrease CHS morbidity and mortality in the future. |
| Databáze: | OpenAIRE |
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