1. Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting: Results From a National Prospective Multicenter Study
- Author
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González-García, Alejandro, Moniche, Francisco, Escudero-Martínez, Irene, Mancha, Fernando, Tomasello, Alejandro, Ribó, Marc, Delgado-Acosta, Fernando, Ochoa, Juan José, Heras, José A. de las, López-Mesonero, L., González-Delgado, Montserrat, Murias, Eduardo, Gil, Joaquín, Gil, Rosario, Zamarro, Joaquín, Parrilla, Guillermo, Mosteiro, Sonia, Fernández-Couto, María Dolores, Fernández de Alarcón, Luis, Ramírez-Moreno, José M., Luna, Alain, Gil, Alberto, González-Mandly, Andrés, Caniego, José Luis, Zapata-Wainberg, Gustavo, García, Ernesto, Alcázar, Pedro P., Ortega, Joaquín, Arenillas, Juan F., Algaba, Pilar, Zapata‐Arriaza, Elena, Alcalde-López, Jesús, Albóniga-Chindurza, Asier de, Instituto de Salud Carlos III, Abbott Fund, Grifols, and Red Temática de Investigación Cooperativa en Enfermedades Cardiovasculares (España)
- Subjects
integumentary system ,Hyperperfusion ,hemic and lymphatic diseases ,Stent ,cardiovascular diseases ,equipment and supplies ,skin and connective tissue diseases ,Carotid - Abstract
[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., This study was supported by a Spanish grant from the Instituto de Salud Carlos III (ISCIII-FIS IP14/00971, 2014–2017). The ITRIBIS project has the registration number REGPOT-2013-1. Cooperative Cerebrovascular Disease Research Network (INVICTUS+) (RD16/0019/0015). Dr. Mancha is supported by a Río Hortega contract (CM16/00015). Abbott and Grifols have partial financial supported the conduction of the HISPANIAS project but had no role in the design of the study, interpretation of the data, or manuscript approval.
- Published
- 2019