22. European Stroke Conference 338 Vascular surgery and neurosurgery CEREBRAL HEMODYNAMICS MEASURED BY TRANSCRANIAL DOPPLER AND RET-ROGRADE CAROTID STUMP PRESSURE IN CAROTID ENDARTERECTOMY. L. Benavente1, S. Calleja2, M. Rico3, M. Para4, M. Suárez5, R. Álvarez6, J. Pascual7 Hospital Universitario Central de Asturias, Oviedo, SPAIN1, Hospital Universitario Central de Asturias, Oviedo, SPAIN2, Hospital Universitario Central de Asturias, Oviedo, SPAIN3, Hospi-tal Universitario Central de Asturias, Oviedo, SPAIN4, Hospital Universitario Central de Asturias, Oviedo, SPAIN5, Hospital Universitario Central de Asturias, Oviedo, SPAIN6, Hospital Universitario Central de Asturias, Oviedo, SPAIN7 BACKGROUND. The retrograde pressure (RetP) in clamped carotid is a safety measure very employed in carotid endarterectomy (CEA). Over a certain value, for which there is no universal agreement, the cerebral blood flow is enough to ensure an adequate brain perfusion. Our aim is to study the relationship between the RetP with the hemodynamic values registered during the CEA monitoring. METHODS. Observational prospective study of 25 patients underwent to CEA (steno-sis ≥70%). We included demographic data, treatments, vascular studies, clamping time, RetP, and hemodynamic changes during the procedure. RESULTS. Patients were mostly men (≥80%). There were a lot of asymptomatic stenosis (48%), come from Vascular Surgery Department consultation. Shunt was employed in only one patient. The RetP was inversely associated to the initial MV (mean velocity) (CCP=-0.578; p<0.01) and the final MV (CCP=-0.540; p=0.01) measured in the MCA (middle cerebral artery). So then, the RetP was lower in case of higher MV scores. A hypothesis is set out to explain this fact, as this behaviour in blood flow would be justified through the Venturi Effect. In this way, the flow is faster through the MCA –mainly coming from the ACA (anterior ce-rebral artery) across the ACoA (anterior communicating artery)-, while the pressure will be lower in the system. This entails a sucking effect and consequently less pressure in the clamped carotid. CONCLUSIONS. The TCD monitoring is able to allow relevant information about the intraopera-tive security in the CEA. Although a high RetP in the stump carotid is considered a safety measure to the CEA, it seems to be associated to a more uncertain cerebral blood flow. So, this classical safe-ty value might be questionable. 464 © 2013 S. Karger AG, Basel Scientific Programme 339 Vascular surgery and neurosurgery Carotid Artery Stenting in Patients with Near Occlusion: A Single-center Experience S. Son1, D.S. Choi2, S.K. Kim3, H. Kang4, K.J. Park5, N.C. Choi6, O.Y. Kwon7, B.H. Lim8 Department of Neurology, Gyeongsang National University School of Medicine, Jinju, SOUTH KOREA1, Department of Radiology, Gyeongsang National University School of Medicine, Jinju, SOUTH KOREA2, Department of Neurology, Gyeongsang National University School of Medi-cine, Jinju, SOUTH KOREA3, Department of Neurology, Gyeongsang National University School of Medicine, Jinju, SOUTH KOREA4, Department of Neurology, Gyeongsang National Universi-ty School of Medicine, Jinju, SOUTH KOREA5, Department of Neurology, Gyeongsang National University School of Medicine, Jinju, SOUTH KOREA6, Department of Neurology, Gyeongsang National University School of Medicine, Jinju, SOUTH KOREA7, Department of Neurology, Gyeo-ngsang National University School of Medicine, Jinju, SOUTH KOREA8 Background: The optimal management strategy for carotid artery near occlusion is still controver-sial. Nevertheless, prior studies about carotid artery stenting in patients with near occlusion reported both technically and clinically inspiring results. We analyzed our experience of carotid artery stent-ing in patients with near occlusion. Methods: We performed 24 carotid artery stenting procedures in 24 patients with near occlusion be-tween January 2010 and July 2012. The patient group comprised 20 men (83.3%) and four women (16.7%) with a mean age of 69.5 years (range, 53–85 years). Eighteen patients had prior stroke or transient ischemic attack (75%), and six patients were asymptomatic (25%). Results: Successful stent insertion was achieved in 23 of 24 patients (95.8%). Cerebral hyperperfu-sion syndrome and post-procedural vascular events occurred in four patients, and all of these devel-oped within 24 hours after the procedure (17.4%; two: hyperperfusion syndrome, two: acute myo-cardial infarction). The mean follow-up period after carotid artery stenting was 16.7 +/- 9.2 months (range, 6–32 months). No stroke related to carotid artery stenting or significant restenosis of the in-serted stent developed during the follow-up period. Conclusions: Carotid artery stenting in patients with near occlusion seems to be a technically feasi-ble and effective method to prevent stroke recurrence. But hyperperfusion syndrome and post-proce-dural vascular event rates may be high, as shown in this study.
Karger_ESC London_2013
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