Abstract
Balloon protection effectively prevents distal embolism during carotid artery stenting (CAS). However, some patients have occlusion intolerance to transient balloon-induced ischemia and can develop secondary perioperative ischemic complications. We conducted this study to identify factors that can predict ischemic intolerance. We analyzed 58 patients undergoing CAS in which double balloon protection was used. Seven patients (12.1%) had ischemic intolerance. These patients had a significantly lower stenosis rate (p＝0.0255), poor collateral flow (p=0.0001), and pooling appearance of the contrast medium in the ipsilateral internal carotid artery during test proximal balloon occlusion (P＝0.0086).
We conclude that preoperative assessment of collateral flow and intraoperative assessment of flow pattern during the proximal test occlusion are useful predictors of ischemic intolerance. These findings may be useful when choosing the protection devices during CAS or determining whether a shunt system should be used during carotid endarterectomy.
