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Original Research

Open Access

Can we predict complications after elective carotid artery angioplasty and stenting with a simple Valsalva test?

  • VIKTOR ŠVIGELJ1
  • MATJAŽ ŠINKOVEC2
  • VIKTOR AVBELJ3
  • ROMAN TROBEC3

1Department of Vascular Neurology and Neurological Intensive Care, Neurological Intensive Care Unit, Division of Neurology, University Medical Centre Ljubljana

2Department of Cardiology, Division of Internal Medicine, University Medical Centre Ljubljana

3Department of Communication Systems, Jozef Stefan Institute, Ljubljana

DOI: 10.22514/SV101.042015.4 Vol.10,Issue 1,April 2015 pp.93-102

Published: 30 April 2015

*Corresponding Author(s): VIKTOR ŠVIGELJ E-mail: viktor.svigelj@kclj.si

Abstract

Objectives. Arterial baroreflex plays a key role in short-term blood pressure balancing. It can also be quantified noninvasively with baroreceptor sensitivity during Valsalva manoeuver. The aim of the study was to evaluate the role of Valsalva manoeuver as a potential marker of possible autonomic dysfunction in patients after carotid artery angioplasty and stenting.

Materials and methods. We evaluated dynamic changes of blood pressure during Valsalva manoeuver (Valsalva ratio, adrenergic baroreceptor sensitivity) in 22 patients (11 male; 63.2 ± 6.7 years) with symptomatic, unilateral internal carotid artery stenosis, and compared results with age and sex matched control subjects.

Results. Valsalva ratio between baseline and post-procedural day (1.26 ± 0.13 vs 1.46 ± 0.31; p=0.002) was the only statistically significant parameter. All other tests (also between the study and the control group), cardiovagal and adrenergic, revealed no significant differences.

Conclusion. We were not able to show that Valsalva manoeuver, as a simple, non-invasive and easy to perform test, could reliably confirm patients who are at a risk for postprocedural complications. It seems that most of the compensatory mechanisms, occurring after a revascularisation procedure, remain largely unclarified.

Keywords

carotid stenosis, angioplasty, Valsalva manoeuver, baroreceptor sensitivity, Valsalva ratio

Cite and Share

VIKTOR ŠVIGELJ,MATJAŽ ŠINKOVEC,VIKTOR AVBELJ,ROMAN TROBEC. Can we predict complications after elective carotid artery angioplasty and stenting with a simple Valsalva test?. Signa Vitae. 2015. 10(1);93-102.

References

1. Brott TG, Hobson RW, Howard G, Roubin GS, Clark WM, Brooks W, et al. Stenting versus Endarterectomy for Treatment of Carotid Artery Stenosis. N Engl J Med 2010;363(1):11-23.

2. Kozar S, Jeromel M. Hyperperfusion and Intracranial Haemorrhage After Carotid Angioplasty With Stenting – Latest Review. Signa Vitae 2014;9(2):9-14.

3. Narita S, Aikawa H, Nagata S, Tsutsumi M, Nii K, Yoshida H, et al. Intraprocedural Prediction of Hemorrhagic Cerebral Hyperperfusion Syndrome After Carotid Artery Stenting. J Stroke Cerebrovasc Dis 2013;22(5): 615-9.

4. Coutts SB, Hill MD, Hu WY. Hyperperfusion syndrome: toward a stricter definition. Neurosurgery 2003;53:1053-8.

5. Ogasawara K, Mikami C, Inoue T, Ogawa A. Delayed cerebral hyperperfusion syndrome caused by prolonged impairment of cerebrovascular autoregulation after carotid endarterectomy: case report. Neurosurgery 2004;54:1258-62.

6. van Mook WN, Rennenberg RJ, Schurink GW, van Oostenbrugge RJ, Mess WH, Hofman PA, et al. Cerebral hyperperfusion syndrome. Lancet Neurol 2005;4:877-88.

7. Bouri S, Thapar A, Shalhoub J, Jayasooriya G, Fernando A, Franklin IJ, et al. Hypertension and the post-carotid endarterectomy cerebral Hyperperfusion Syndrome. Eur J Vasc Endovasc Surg 2011;41:229-37.

8. Canovas D, Estela J, Perendreu J, Branera J, Rovira A, Martinez M, et al. Cerebral hyperperfusion syndrome after angioplasty. In: Forbes T, editor. Angioplasty, various techniques and challenges in treatment of congenital and acquired vascular stenoses. Shangai: InTech; 2012. p. 9-40.

9. Goldberg JB, Goodney PP, Kumbhani SR, Roth RM, Powell RJ, Likosky DS. Brain Injury After Carotid Revascularisation: Outcomes, Mechanisms, and Opportunities for Improvement. Ann Vasc Surg 2011;25:270-86.

10. von Reutern GM, Goertler MW, Bornstein NM, Del Sette M, Evans DH, Hetzel A, et al. Recommendations for grading carotid stenosis by means of ultrasonic methods. Stroke 2012;43:916-21.

11. Benarroch EE, Opfer-Gehrking TL, Low PA. Use of the photoplethysmographic technique to analyze the Valsalva maneuver in normal man. Muscle & Nerve 1991;14:1165-72.

12. Denq J-C, O’Brien PC, Low PA. Normative data on phases of Valsalva maneuverer. J Clin Neurophysiol 1998;15:535-40.

13. Low PA, Tomalia VA, Park KJ. Autonomic function: some clinical aplications. J Clin Neurol 2013;9:1-8.

14. Vogel ER, Sandroni P, Low PA. Blood pressure recovery from Valsalva maneuverer in patients with autonomic failure. Neurology 2005;65:1533-7.

15. Schrezenmaier C, Singer W, Muenter Swift N, Sletten D, Tanabe J, Low PA, Adrenergic and vagal baroreflex sensitivity in autonomic failure. Arch Neurol 2007;64:381-6.

16. Novak P. Assessment of sympathetic index from Valsalva maneuverer. Neurology 2011;76:2010-6.

17. Yakhou L, Constant I, Merle JC, Laude D, Becquemin JP, Duvaldestin P. Noninvasive investigation of autonomic activity after carotid stenting or carotid endarterectomy. J Vasc Surg 2006;44:472-9.

18. Huang C-C, Wu Y-S, Chen T, Chang W-N, Du Y-C, Wu C-J, et al. Long-term effects of baroreflex function after stenting in patients with carotid artery stenosis. Auton Neurosci 2010;158:100-4.

19. Bishop VS, Haywood JR, Shade RE, Siegel M, Hamm C. Aortic baroreceptor deafferentation in the baboon. J Appl Physiol 1986;60:798-801.

20. Shade RE, Bishop VS, Haywood JR, Hamm CK. Cardiovascular and neuroendocrine responses to baroreceptor denervation in baboons. Am J Physiol 1990;258:R930-8.

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