Abstract
Background: Staged angioplasty (SAP) for cervical carotid artery stenosis is useful in preventing cerebral hyperperfusion syndrome (CHS) following a carotid revascularization procedure. However, expansion failure due to elastic recoil (ER) occurs often. Herein, we investigated the frequency and clinical significance of ER.
Methods: Among the 49 SAP cases, the extent of ER was quantitatively defined as a minimal lumen diameter (MLD) loss of >10% between the time immediately after the angioplasty and 15 minutes later. A relationship between ER and restenosis (NASCET ≥70%) during CAS as a second-stage surgical option and severe ER (>30% indicating restenosis) and its risk factors were also evaluated.
Results: The MLD improved from 0.7±0.3 mm before performing angioplasty to 2±0.5 mm after the angioplasty. ER was recognized in 41 cases (84%), with 5 cases eventually requiring urgent CAS. On the third postoperative day, urgent CAS was required in one case due to the deterioration of hemiparesis. However, CHS did not occur in all cases. The lumen loss was significantly associated with restenosis progression in 7 cases (p=0.01). Regarding severe ER (lumen loss >30%) in 28 cases (57%), patients aged >75 years (p=0.01), eccentric stenosis (p=0.02), and vessel calcification angle >180° (p=0.04) were found to be statistically significant risk factors.
Conclusions: Restenosis due to ER tends to occur in elderly patients with eccentric calcified stenosis. In such cases, surgeons should perform CAS as early as possible.
