CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Chakravarti, S.
Right arrow Articles by Zhang, W
Right arrow Search for Related Content
PubMed
Right arrow Articles by Chakravarti, S.
Right arrow Articles by Zhang, W
Canadian Journal of Anesthesia 54:44024 (2007)
© Canadian Anesthesiologists' Society, 2007

Monday June 25; 1230 - 1400

44024 - CAROTID ARTERY ANGIOPLASTY AND STENTING:ANESTHETIC IMPLICATIONS

Sucharita Chakravarti1, Sucharita Chakravarti2, Pirjo Manninen3 and W Zhang4

1 Dept of Anesthesia, Toronto Western Hospital, Toronto, ON, Canada
2 Dept of Anesthesia, Toronto Western Hospital
3 Dept of Anesthesia, Toronto Western Hospital
4 Toronto Western Hospital

Abstract

INTRODUCTION: Patients with carotid artery occlusive disease frequently have other co morbidities, especially cardiac disease. A newer option for treatment is carotid angioplasty and stenting (CAS), which has been shown to result in lower incidence of stroke and myocardial infraction, but may have a high incidence of hemodynamic changes during the procedure. (1,2) We reviewed the anesthetic management and the incidence of cardiovascular and other complications during and after treatment with CAS.

METHODS: After ethics board approval, medical records of all patients who had CAS over an 18-month period were reviewed. Data collected included demographics, preoperative co morbidities, anesthetic management and the incidence of complications during and post CAS.

RESULTS: 29 patients were reviewed; mean age (±SD) was 71±11 yr, weight 76± 11 kg, 16 male, 13 female and median ASA 3 (range 2–4). 21 patients (72%) presented with TIA, remainder with stroke. Pre-procedure medical co morbidities were: coronary artery disease 31%, hypertension 55%, diabetes 27% and peripheral vascular disease 6%. Anesthesia was conscious sedation in 27 patients (propofol 86±94mg (n=23), fentanyl 102±85µg (n=23), midazolam 2.4±1.4mg (n=25). Two patients had general anesthesia as they also planned treatment of intracranial lesions. Monitoring included ECG, non-invasive blood pressure, PETCO2, and SpO2. A defibrillator/pacemaker was present in the room for all patients but not attached to any patient. Prophylactic vagolytic agents were used in 72%, (glycopyrrolate 0.29±0.1mg (n=20) and atropine 0.6mg (n=1). There were no incidences of myocardial ischemia. One patient developed hyperperfusion syndrome post procedure. Complications are shown in Table.


Figure 1
View larger version (34K):
[in this window]
[in a new window]

  		Complications and treatment

 
CONCLUSIONS: Conscious sedation was an effective technique of anesthesia allowing for rapid diagnosis and treatment of a neurological problem in 2 patients. The incidence of bradycardia has been shown to be decreased with use of prophylactic vagolytic agents (2) however we found an incidence of 6.9% despite administration of a prophylactic vagolytic agent (atropine in one patient and glycopyrrolate in other). Blood pressure changes were more frequent during (17%) and after (24%) the procedure requiring treatment. This warrants continuous careful monitoring of patients.

REFERENCES:

1 N Engl J Med 2004;351:1493[Abstract/Free Full Text]

2 Am J of Cardiol, 1998;82:1077[Medline]






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2007 by the Canadian Anesthesiologists' Society.