Be careful out there.
Re-Inflating Balloon After Carotid
Stenting Appears to Double Risk of Stroke, Death
After reviewing outcomes from thousands of cases, researchers report
that patients with blocked neck arteries who undergo carotid stenting to
prop open the narrowed blood vessels fare decidedly worse if their
surgeons re-inflate a tiny balloon in the vessel after the mesh stent is
in place.
Although the overall risk of stroke and death is low in patients who
undergo carotid stenting, the common practice of “ballooning” the vessel
after the wire mesh is inserted can double the risk of death and stroke
during or shortly after the procedure
The findings are published online in the Journal of Vascular Surgery.
“Ballooning after placing the stent appears to cause the very
complication it's intended to prevent,” said senior author Mahmoud
Malas, MD, Johns Hopkins University School of Medicine, Baltimore,
Maryland. “Surgeons should avoid doing it. Period.”
For the current study, the researchers analysed stroke and death risk
in more than 3,700 patients aged 19 to 89 years who had carotid
stenting between 2005 and 2014 in hospitals across the United States and
whose outcomes were reported in the Vascular Quality Initiative, a
national repository of vascular surgery outcomes.
One group of patients had pre-stent ballooning only, another was
treated with post-stent ballooning only, and a third group had the
combination technique involving balloon use both before and after stent
placement.
While the overall risk of stroke and death was relatively low -- 2.4%
of patients had a stroke within 30 days of treatment and <1% died --
those treated with combination pre and post-stent ballooning were twice
as likely to suffer a stroke or die. Those who had post-stent
ballooning alone also had an elevated risk but in the final analysis,
the difference did not reach statistical significance.
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