Read & React
mohd shafie abdullah – April 26, 2013
“I'm thinking of deploying telescoping approach of 2 Leos and jailing technique with loose packing...”
Pakrit Jittapiromsak – April 16, 2013
“Thank you for your comment. Honestly, in my experience, if the stent(s) is(are) placed and oppose...”
Steve Dechan – April 13, 2013
“Just a question please, there are reports of instent restenosis at the distal and proximal ends o...”
wael elshawaf – April 13, 2013
“Weal EL-shawaf ,MD. Thank you for all Pr Dr how start this decision and to learn more and more ,s...”
Willem Jan van Rooij – April 5, 2013
“I am surprised by the comment of Laurent Spelle. The only thing we can learn from a case like thi...”
Carotid Baroreceptor Reaction after Stenting in 2 Locations of Carotid Bulb Lesions of Different Embryologic Origin
American Journal of Neuroradiology by
- Authors: DC Suh, JL Kim, EH Kim, JK Kim, JH Shin, DH Hyun, HY Lee, DH Lee, JS Kim.
- Reference: AJNR Am J Neuroradiol 2012 33: 977-981
- Published: 2012 January
- Link: Access the abstract here
The authors did a prospective analysis of carotid baroreceptor reaction (BR) after stent placements in 95 patients with atherosclerotic carotid stenoses. The BR was specifically defined as periprocedural hypotension (systolic BP<90 mmHg), bradycardia (HR<50/min) or HR fluctuation (>20/min). Additionally, the BR was stratified into transient (<3hrs) and prolonged (3-24hrs). The results demonstrated different body responses in treatments of 2 different carotid bulb lesions: apex and body. The main significant information from the study is that the body lesion (which is proximal to the apical lesion) has more transient BR than the apical lesion, theoretically explainable by baroreceptor stimulation.
Nevertheless, there are some doubtful points in this article.
Table 1 and table 2 are a bit difficult to understand since the authors intended to differentiate between BR+ and BR- lesions, not between apical and body lesions. By counting overall numbers, the BR- case in transient table can be a case with BR+ in prolonged table and vise versa. There is no case overlapping between transient and prolonged BR+ (means no patient has hypotension within 3 hrs of treatment and during 3-24 hrs after treatment). Counting of the BR in this term is a spot event, not a mean value. There should be a high possibility to have this overlapped situation.
Finally, the authors tried to relate the difference between apical and body lesions with hyperperfusion syndrome which might be an overstatement. Actually, we don’t know the degree of stenosis between apical and body lesions in this study including the results of treatment in both groups (by table configuration provided in the article). The claim that there is a positive tendency of the adverse events and hyperperfusion in apical lesion could not be confirmed without showing balanced stenotic severity in between groups.