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Mohammadian R, Tarighatnia A, Sharifipour E, Nourizadeh E, Parvizi R, Applegate CT, Nader ND. Carotid artery stenting prior to coronary artery bypass grafting in patients with carotid stenosis: Clinical outcomes. Interv Neuroradiol 2023; 29:30-36. [PMID: 35331026 PMCID: PMC9893238 DOI: 10.1177/15910199221067665] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Management of patients undergoing coronary artery bypass grafting (CABG) with obstructive disease of the carotid arteries is still a matter of debate. We compared the results of staged carotid artery stenting (CAS) before CABG in patients with carotid lesions. MATERIALS AND METHOD Patients with significant carotid artery disease who were deemed to simultaneously suffer from an obstructive coronary artery disease requiring CABG from 2008 to 2018 were screened and enrolled in this study. We performed a staged CAS in cases with ≥60% stenosis and neurological symptoms or asymptomatic patients with ≥80% carotid artery stenosis. Patients with bilateral carotid lesions received sequential CAS within three weeks. Six weeks after the CAS procedure, all patients underwent CABG. RESULTS A total of 142 patients were included. Eighty-five of these had neurological symptoms, while the remaining 40% were asymptomatic. Thirty-one patients underwent sequential CAS for bilateral lesions. The cerebrovascular event (CVE) following CAS (3 patients) and CABG (3 patients) was 4.2%. There was only a single case of mortality in this cohort. Although it was not statistically significant, CVE after CABG was more frequent in patients with bilateral carotid disease. CONCLUSIONS Our results showed that staged CAS could be performed with minimal adverse outcomes in patients suffering from a simultaneous occlusive disease of carotids and coronary arteries before CABG. Bilateral CAS will further decrease cerebrovascular events and could be performed consequently or concomitantly.
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Affiliation(s)
- Reza Mohammadian
- Radiology Department, East Clinical University Hospital, Stradins
University, Riga, Latvia
| | - Ali Tarighatnia
- Department Interventional Radiology, Aalinasab Hospital, ISSO,
Tabriz, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qom
University of Medical Sciences, Qom, Iran
| | | | - Rezayat Parvizi
- Cardiovascular Research Center, Tabriz University of Medical
Sciences, Shahid Madani Heart Center, Tabriz, Iran
| | - Camille T. Applegate
- Jacobs School of Medicine and Biomedical
Sciences, 955 Main Street, Buffalo, NY 14203, USA
| | - Nader D. Nader
- Dept. of Anesthesiology & Surgery, Jacobs School of Medicine and Biomedical
Sciences, UB-Gateway Building, 77 Goodell Street, Suite 550, Buffalo, NY
14203
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2
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El-Sudany AH, Georgy SS, Zaki AS, Bedros RY, El-Bassiouny A. Non-protected carotid artery stenting for symptomatic carotid stenosis in low resource settings. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00330-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The use of a distal cerebral protection device during extracranial carotid artery stenting is still a matter of debate. The aim of this work was to evaluate the safety of performing carotid artery stenting procedure without the use of cerebral protection device in patients with symptomatic carotid stenosis. A retrospective study was performed during the period from September 2015 till March 2020 including 91 patients with symptomatic carotid artery stenosis. All patients were treated with a single stent type (Wall stent® - Boston scientific) without the use of cerebral protection device. Pre- and post-procedural clinical assessment with the national institute of health stroke scale (NIHSS). Post procedure brain diffusion-weighted magnetic resonance imaging (DW-MRI) if clinically indicated within 24 h was used to determine periprocedural cerebral embolization.
Results
A low complication rate was found as only one case (1%) showed mild deterioration in NIHSS and new acute cerebral emboli were detected with brain DW-MRI.
Conclusion
Carotid artery stenting can be performed safely without the use of cerebral protection device.
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3
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Garriboli L, Pruner G, Miccoli T, Recchia A, Tamellini P, Jannello AM. Carotid Artery Stenting Without Embolic Protection Device: A Single-Center Experience. J Endovasc Ther 2018; 26:121-127. [PMID: 30514133 DOI: 10.1177/1526602818816656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of carotid artery stenting (CAS) performed without an embolic protection device (EPD) in a selected group of asymptomatic patients with primary internal carotid artery (ICA) stenosis or restenosis after carotid endarterectomy (CEA). MATERIALS AND METHODS Between May 2015 and May 2018, 77 patients (mean age 77 years; 60 men) underwent CAS without any embolic protection device. Forty-seven (61%) patients had primary ICA stenosis and were excluded from CEA because of high surgical risk; the other 30 (39%) patients had post-CEA restenosis (n=26) or a distal ICA flap after eversion CEA (n=4). The mean ICA stenosis was 82%. All procedures were performed from a femoral artery access. Pre- and/or postdilation were used in 64 patients. The primary outcome was the incidence of major complications (death, stroke, or myocardial infarction) during the procedure and within 30 days; the secondary outcome was the incidence of restenosis in follow-up. RESULTS No relevant bradycardia was encountered during CAS. The combined rate of stroke, death, or myocardial infarction at 30 days was 1.3%. The single stroke patient recovered fully after 2 months. Over a follow-up that ranged to 3 years (mean 24±18 months), no further neurological events were recorded. One (1.3%) patient had a >70% restenosis after 6 months; the lesion was dilated, successfully restoring the lumen contour. CONCLUSION In our series, endovascular treatment of carotid stenosis without the use of protection devices in patients with primary stenosis or postsurgical restenosis can achieve satisfactory safety and efficacy outcomes. The choice of performing CAS without using EPDs should follow a tailored approach based on the appropriate patient anatomy and specific clinical parameters to minimize neurological complications.
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Affiliation(s)
- Luca Garriboli
- 1 Department of Vascular and Endovascular Surgery, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | - Gianguido Pruner
- 1 Department of Vascular and Endovascular Surgery, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | - Tommaso Miccoli
- 1 Department of Vascular and Endovascular Surgery, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | - Andrea Recchia
- 1 Department of Vascular and Endovascular Surgery, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | - Paolo Tamellini
- 1 Department of Vascular and Endovascular Surgery, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | - Antonio Maria Jannello
- 1 Department of Vascular and Endovascular Surgery, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
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Mohammadian R, Sharifipour E, Taheraghdam A, Mansourizadeh R, Altafi D, Fattahzadeh G, Sariaslani P, Yousefshahi P, Ebrahimzadeh K, Vahedian M, Golzari SEJ. Efficacy of carotid artery stenting on stroke prevention of octogenarians. Clin Neurol Neurosurg 2018; 173:187-193. [PMID: 30165319 DOI: 10.1016/j.clineuro.2018.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/15/2018] [Accepted: 08/20/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Octogenarians account for a third of ischemic stroke (IS) patients and applying endovascular carotid artery stenting (CAS), as a secondary prevention, in these patients is challenging. The aim of this study was to evaluate peri-procedural and long term clinical and angiographic impact of CAS on octogenarians. PATIENTS AND METHODS In a prospective study, 102 patients aged over 80 years old with symptomatic internal carotid artery (ICA) stenosis presenting by non-disabling IS or transient ischemic attack and having undergone CAS were evaluated prospectively from January 2012 to July 2016. All patients received standard stroke care during the study follow up period. Peri-procedural complication, cerebrovascular accidents, restenosis in target vessel and mortality rate were recorded and the collected data were analyzed to evaluate safety and durability of CAS in octogenarians. RESULTS 48 (47.06%) males and 54 (52.9%) females with the mean age of 83.39 ± 2.53 (range, 80-88) years were followed in a mean period of 24.5 ± 14.1 months (6-50 months). Success rate of CAS was 100%; whereas, the peri-procedural complication rate was 5.8% (only one patient experienced acute ischemic stroke during the procedure). Restenosis and recurrent cerebrovascular accidents were observed in 3.9% and 9.8% of the cases, respectively. Recurrent cerebrovascular accident leading to death was seen in 2.9% of the cases. The median patient event-free survival was 20 months. CONCLUSION Endovascular CAS seems to be a safe and durable method for secondary prevention in ischemic stroke following symptomatic carotid artery stenosis in octogenarians.
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Affiliation(s)
- Reza Mohammadian
- Institute of Neuroradiology University Hospital of Zurich, Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center of Qom University of Medical Sciences, Iran.
| | | | - Reza Mansourizadeh
- Institute of Neuroradiology University Hospital of Zurich, Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Davar Altafi
- Neurologist, Ardebil University of Medical Sciences, Iran
| | | | | | | | | | - Mostafa Vahedian
- Clinical Research and Development Center (CRDC), Qom University of Medical Sciences, Qom, Iran
| | - Samad E J Golzari
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Road Traffic Injury Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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5
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Abreu P, Nogueira J, Rodrigues FB, Nascimento A, Carvalho M, Marreiros A, Nzwalo H. Intracerebral hemorrhage as a manifestation of cerebral hyperperfusion syndrome after carotid revascularization: systematic review and meta-analysis. Acta Neurochir (Wien) 2017; 159:2089-2097. [PMID: 28916863 DOI: 10.1007/s00701-017-3328-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 09/05/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) in the context of cerebral hyperperfusion syndrome (CHS) is an uncommon but potentially lethal complication after carotid revascularization for carotid occlusive disease. Information about its incidence, risk factors and fatality is scarce. Therefore, we aimed to perform a systematic review and meta-analysis focusing on the incidence, risk factors and outcomes of ICH in the context of CHS after carotid revascularization. METHODS We searched the PubMed and EBSCO hosts for all studies published in English about CHS in the context of carotid revascularization. Two reviewers independently assessed each study for eligibility based on predefined criteria. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the PROSPERO register was made (register no. CRD42016033190), including the pre-specified protocol. RESULTS Forty-one studies involving 28,956 participants were deemed eligible and included in our analysis. The overall quality of the included studies was fair. The pooled frequency of ICH in the context of CHS was 38% (95% CI: 26% to 51%, I2 = 84%, 24 studies), and the pooled case fatality of ICH after CHS was 51% (95% CI: 32% to 71%, I2 = 77%, 17 studies). When comparing carotid angioplasty with stenting (CAS) with carotid endarterectomy (CEA), post-procedural ICH in the context of CHS was less frequent in CEA. ICH following CHS occurred less often in large series and was rare in asymptomatic patients. The most common risk factors were periprocedural hypertension and ipsilateral severe stenosis. CONCLUSIONS ICH as a manifestation of CHS is rare, more frequent after CAS and associated with poor prognosis. Periprocedural control of hypertension can reduce its occurrence.
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Affiliation(s)
- Pedro Abreu
- Department of Biomedical Sciences and Medicine, University of Algarve, Campus da Penha, 8005-139, Faro, Portugal
| | - Jerina Nogueira
- Department of Biomedical Sciences and Medicine, University of Algarve, Campus da Penha, 8005-139, Faro, Portugal
| | - Filipe Brogueira Rodrigues
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Huntington's Disease Centre, Institute of Neurology, University College London, London, UK
| | - Ana Nascimento
- Department of Neurology, Centro Hospitalar do Algarve, Faro, Portugal
| | - Mariana Carvalho
- Department of Neurology, Centro Hospitalar do Algarve, Faro, Portugal
| | - Ana Marreiros
- Department of Biomedical Sciences and Medicine, University of Algarve, Campus da Penha, 8005-139, Faro, Portugal
| | - Hipólito Nzwalo
- Department of Biomedical Sciences and Medicine, University of Algarve, Campus da Penha, 8005-139, Faro, Portugal.
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6
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Petr O, Brinjikji W, Murad MH, Glodny B, Lanzino G. Selective-versus-Standard Poststent Dilation for Carotid Artery Disease: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2017; 38:999-1005. [PMID: 28302610 DOI: 10.3174/ajnr.a5103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/12/2016] [Indexed: 11/07/2022]
Abstract
BACKROUND The safety and efficacy of standard poststent angioplasty in patients undergoing carotid artery stent placement have not been well-established. PURPOSE We conducted a systematic review of the literature to evaluate the safety and efficacy of carotid artery stent placement and analyzed outcomes of standard-versus-selective poststent angioplasty. DATA SOURCES A systematic search of MEDLINE, EMBASE, Scopus, and the Web of Science was performed for studies published between January 2000 and January 2015. STUDY SELECTION We included studies with >30 patients describing standard or selective poststent angioplasty during carotid artery stent placement. DATA ANALYSIS A random-effects meta-analysis was used to pool the following outcomes: periprocedural stroke/TIA, procedure-related neurologic/cardiovascular morbidity/mortality, bradycardia/hypotension, long-term stroke at last follow-up, long-term primary patency, and technical success. DATA SYNTHESIS We included 87 studies with 19,684 patients with 20,378 carotid artery stenoses. There was no difference in clinical (P = .49) or angiographic outcomes (P = .93) in carotid artery stent placement treatment with selective or standard poststent balloon angioplasty. Both selective and standard poststent angioplasty groups had a very high technical success of >98% and a low procedure-related mortality of 0.9%. There were no significant differences between both groups in the incidence of restenosis (P = .93) or procedure-related complications (P = .37). LIMITATIONS No comparison to a patient group without poststent dilation could be performed. CONCLUSIONS Our meta-analysis demonstrated no significant difference in angiographic and clinical outcomes among series that performed standard poststent angioplasty and those that performed poststent angioplasty in only select patients.
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Affiliation(s)
- O Petr
- From the Departments of Neurologic Surgery (O.P., G.L.) .,Neurosurgery (O.P.), Medical University Innsbruck, Innsbruck, Austria
| | | | - M H Murad
- Division of Preventive Medicine (M.H.M.), Mayo Clinic, Rochester, Minnesota
| | | | - G Lanzino
- From the Departments of Neurologic Surgery (O.P., G.L.).,Radiology (W.B., G.L.)
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7
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Borhani Haghighi A, Yousefi S, Bahramali E, Kokabi S, Heydari ST, Shariat A, Nikseresht A, Ashjazadeh N, Izadi S, Petramfar P, Poursadegh M, Rahimi Jaberi A, Emami S, Agheli H, Nemati R, Yaghoubi E, Abdi MH, Panahandeh M, Heydari M, Safari A, Basir M, Cruz-Flores S, Edgell R. Demographic and Technical Risk Factors of 30-Day Stroke, Myocardial Infarction, and/or Death in Standard- and High-Risk Patients Who Underwent Carotid Angioplasty and Stenting. INTERVENTIONAL NEUROLOGY 2015; 3:165-73. [PMID: 26279663 DOI: 10.1159/000430923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Carotid angioplasty and stenting (CAS) is an accepted treatment to prevent stroke in patients with carotid artery stenosis. The purpose of this study is to identify risk factors for major complications after CAS. MATERIALS AND METHODS This is a prospective study that was conducted at Shiraz University of Medical Sciences in southern Iran from March 2011 to June 2014. Consecutive patients undergoing CAS were enrolled. Both standard- and high-risk patients for endarterectomy were enrolled. Demographic data, atherosclerotic risk factors, site of stenosis, degree of stenosis, and data regarding technical factors were recorded. Thirty-day stroke, myocardial infarction, and/or death were considered as the composite primary outcomes of the study. RESULTS A total of 251 patients were recruited (mean age: 71.1 ± 9.6 years; male: 65.3%). Of these, 178 (70.9%) were symptomatic, 73 (29.1%) were diabetic, 129 (51.4%) were hyperlipidemic, 165 (65.7%) were hypertensive, and 62 (24.7%) patients were smokers. CAS was performed for left internal carotid artery (ICA) in 113 (45.4%) patients. Fourteen (5.6%) patients had sequential bilateral stenting. Mean stenosis of operated ICA was 80.2 ± 13.8%. An embolic protection device was used in 203 (96.2%) patients. Pre- and postdilation were performed in 39 (18.5%) and 182 (86.3%) patients, respectively. Composite outcomes were observed in 3.6% of patients (3.2% stroke, 0% myocardial infarction, and 1.2% death). Left-sided lesions and the presence of diabetes mellitus were significantly associated with poor short-term outcome (p = 0.025 and p = 0.020, respectively). CONCLUSION There was a higher risk of short-term major complications in diabetic patients and for left carotid artery intervention.
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Affiliation(s)
- Afshin Borhani Haghighi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Samaneh Yousefi
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Ehsan Bahramali
- Cardiology Department, Faculty of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Safoora Kokabi
- Transgenic Technology Research Center, Shiraz University of Medical Sciences, Fasa, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Shiraz University of Medical Sciences, Fasa, Iran
| | - Abdolhamid Shariat
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Alireza Nikseresht
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Nahid Ashjazadeh
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Sadegh Izadi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Peyman Petramfar
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Maryam Poursadegh
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Abbas Rahimi Jaberi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Sajjad Emami
- Department of Neurology, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Hamid Agheli
- Shahidzadeh Hospital, Behbahan, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Reza Nemati
- Department of Neurology, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ehsan Yaghoubi
- Department of Neurology, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mohammad Hosein Abdi
- Motaharri Hospital, Marvdasht, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Majid Panahandeh
- Ordibehesht Hospital, Shiraz, Fasa University of Medical Sciences, Fasa, Iran
| | - Moslem Heydari
- Department of Neurology, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Anahid Safari
- Department of Pharmacology, Kazeroon Azad University, Kazeroon, Iran
| | - Marziyeh Basir
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | | | - Randal Edgell
- Department of Neurology, Saint Louis University, Saint Louis, Mo., USA ; Department of Psychiatry, Saint Louis University, Saint Louis, Mo., USA
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8
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Hopf-Jensen S, Marques L, Preiß M, Müller-Hülsbeck S. Initial Clinical Experience With the Micromesh Roadsaver Carotid Artery Stent for the Treatment of Patients With Symptomatic Carotid Artery Disease. J Endovasc Ther 2015; 22:220-5. [PMID: 25809366 DOI: 10.1177/1526602815576337] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To assess the effectiveness, technical aspects, handling, and safety of the micromesh Roadsaver Carotid Artery Stent in the treatment of atherosclerotic carotid artery stenosis and tandem lesions in ischemic stroke patients. Methods: Seven patients (5 men; mean age 75±11.4 years, range 53–86) suffering from symptomatic internal carotid artery (ICA) stenosis (mean 76% diameter reduction) were treated with the dual layer closed-cell stent without embolic protection. Postdilation was performed in 6 of 7 patients. Two patients were treated in the context of ischemic stroke and concurrent middle cerebral artery occlusion. Mean National Institutes of Health Stroke Scale score at admission was 12.8±5. Results: All devices were deployed satisfactorily. One wall-adherent thromboembolus in a proximal ICA was covered with the Roadsaver stent in a tandem lesion setting. The modified Rankin Scale (mRS) declined from 3.7±0.7 to 2.4±0.8 in hospital, showing an improvement in clinical symptoms. No complications were detected during or after the procedure. The 30-day mRS was 1.7±1.1. At 6 months, ultrasound examination demonstrated patency of stents and the external carotid arteries. Conclusion: The Roadsaver double layer micromesh stent seems to be safe and effective in the treatment of extracranial ICA stenosis and in the context of tandem lesions in ischemic stroke. Further studies with larger populations are warranted.
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Affiliation(s)
- Silke Hopf-Jensen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Germany
| | - Leonardo Marques
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Germany
| | - Michael Preiß
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Germany
| | - Stefan Müller-Hülsbeck
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Germany
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9
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Baldawi M, Renno A, Abbas J, Nazzal M. Carotid artery pseudoaneurysm as a complication of carotid artery stenting. Ann Vasc Surg 2014; 29:363.e1-3. [PMID: 25462542 DOI: 10.1016/j.avsg.2014.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/01/2014] [Accepted: 08/21/2014] [Indexed: 11/29/2022]
Abstract
Carotid artery stenting (CAS) has been adopted more in the treatment of carotid artery stenosis recently. The vast majority of studies about this procedure have concentrated mainly on the short- and long-term clinical complications, that is, stroke, myocardial infarction, and restenosis. However, mechanical complications including both stent fracture and carotid pseudoaneurysm are under-reported. In the present report, we present a patient with a common carotid artery psuedoaneurysm as a complication of CAS.
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Affiliation(s)
- Mustafa Baldawi
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH
| | - Anas Renno
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH
| | - Jihad Abbas
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH
| | - Munier Nazzal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH.
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10
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Jimenez-Gomez E, Cano Sánchez A, Oteros Fernández R, Valenzuela Alvarado S, Bravo-Rodriguez F, Delgado Acosta F. Unprotected carotid artery stenting in symptomatic elderly patients: a single-center experience. J Neurointerv Surg 2014; 7:341-5. [DOI: 10.1136/neurintsurg-2014-011131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/14/2014] [Indexed: 11/04/2022]
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11
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Park KY, Kim DI, Kim BM, Nam HS, Kim YD, Heo JH, Kim DJ. Incidence of embolism associated with carotid artery stenting: open-cell versus closed-cell stents. J Neurosurg 2013; 119:642-7. [PMID: 23790113 DOI: 10.3171/2013.5.jns1331] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Carotid artery stenting (CAS) can be an alternative option for carotid endarterectomy in the prevention of ischemic stroke caused by carotid artery stenosis. The purpose of this study was to evaluate the influence of stent design on the incidence of procedural and postprocedural embolism associated with CAS treatment.
Methods
Ninety-six symptomatic and asymptomatic patients, consisting of 79 males and 17 females, with moderate to severe carotid artery stenosis and a mean age of 69.0 years were treated with CAS. The stent type (48 closed-cell and 48 open-cell stents) was randomly allocated before the procedure. Imaging, procedural, and clinical outcomes were assessed and compared. The symptomatic subgroup (76 patients) was also analyzed to determine the influence of stent design on outcome.
Results
New lesions on postprocedural diffusion-weighted imaging (DWI) were significantly more frequent in the open-cell than in the closed-cell stent group (24 vs 12, respectively; p = 0.020). The 30-day clinical outcome was not different between the 2 stent groups. In the symptomatic patient group, stent design (p = 0.017, OR 4.173) and recent smoking history (p = 0.036, OR 4.755) were strong risk factors for new lesions on postprocedural DWI.
Conclusions
Stent design may have an influence on the risk of new embolism, and selecting the appropriate stent may improve outcome.
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Affiliation(s)
- Keun Young Park
- 1Departments of Radiology and
- 3Department of Neurosurgery, National Health Insurance Corporation Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | | | | | - Hyo Suk Nam
- 2Neurology, Yonsei University College of Medicine, Seoul; and
| | - Young Dae Kim
- 2Neurology, Yonsei University College of Medicine, Seoul; and
| | - Ji Hoe Heo
- 2Neurology, Yonsei University College of Medicine, Seoul; and
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12
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Oteros R, Jimenez-Gomez E, Bravo-Rodriguez F, Ochoa JJ, Guerrero R, Delgado F. Unprotected carotid artery stenting in symptomatic patients with high-grade stenosis: results and long-term follow-up in a single-center experience. AJNR Am J Neuroradiol 2012; 33:1285-91. [PMID: 22422184 DOI: 10.3174/ajnr.a2951] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The use of cerebral protection during CAS is an extended practice. Paradoxically it is open to question because it can lead to potential embolic complications. The aim of this study was to evaluate the safety and efficacy of CASWPD in patients with severe symptomatic carotid artery stenosis. MATERIALS AND METHODS A prospective study was performed including 210 consecutive patients (201 symptomatic and 9 asymptomatic) with carotid artery stenosis >70%. All patients were treated by CASWPD. Angiographic results and neurologic complications were recorded during the procedure and within 30 days after it. All patients underwent clinical evaluation and Doppler sonography follow-up at 3, 6, and 12 months after the procedure. RESULTS Two hundred twenty carotid arteries were treated. The average degree of stenosis was 88.9%. The procedure was successfully completed in 212 (96.4%) arteries. After stent placement, 98.6% of arteries showed no residual stenosis or <30%. Balloon angioplasty dilation before stent placement was performed in 16% of cases. During the 30-day periprocedural period, there were 3 major complications (1.4%), including 1 disabling ischemic stroke, 1 acute stent thrombosis, and 1 MI. The last 2 patients died from these complications. At 1-year follow-up 24 (12.8%) restenoses, 2 new ipsilateral strokes, 1 contralateral stroke, and 5 deaths (2.7%) had occurred. None of these deaths were related to the initial stroke. CONCLUSIONS In our study, unprotected stent placement in symptomatic patients with severe carotid artery stenosis has demonstrated a low incidence of complications. We believe that this is due to the reduction of maneuvering and manipulation through the stenosis and to the protective effect of the stent placement before angioplasty balloon dilation.
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Affiliation(s)
- R Oteros
- Department of Neuroradiology, Hospital Universitario Reina Sofía, Co´rdoba, Spain.
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Long-term outcome in patients with carotid artery stenting and contralateral carotid occlusion: a single neurovascular center prospective analysis. Neuroradiology 2011; 54:965-72. [PMID: 22048419 DOI: 10.1007/s00234-011-0974-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 10/17/2011] [Indexed: 10/16/2022]
Abstract
INTRODUCTION The aim of this study was to analyze the clinical features and early and late outcome of patients treated with carotid artery stenting for carotid stenosis with occlusion of the contralateral vessel (CAS-CCO), and compare them to patients without occlusion (CAS-NO). METHODS From 1999 through 2010, 426 patients with 479 procedures were prospectively recorded, 61 patients (14.3%) CAS-CCO, and 365 patients CAS-NO. Immediate CAS complications, complications within the first 30 days and long-term complications were documented through annual clinical and ultrasonological follow-up visits. Stenosis rate was recorded. RESULTS Patients with mean age of 68.4 years, 80% men had: (1) periprocedural stroke in three cases (0.7%), (2) cumulative 30-day stroke, ischemic cardiopathy, and death in 4.2%, without differences between groups (CAS-CCO 3.3%, CAS-NO 4.4%). Mean follow-up period was 55 ± 32.78 months, median 56 months. (3) Stroke during the follow-up in 8%, without differences between CAS-CCO and CAS-NO groups (3.7% and 8.8%). (4) Myocardial infarction in 11.2% and (5) global mortality in 24.3%, without statistical differences between groups. Of the 254 cases enrolled in the restenosis analysis, 44 patients (17.3%) had restenosis of any grade during a mean follow-up period of 52 months, without statistical differences between CAS-CCO and CAS-NO groups. Only 7.5% presented restenosis ≥ 50%. Its occurrence was statistically associated with previous neck radiation. CONCLUSIONS Periprocedural risks and long-term outcomes of patients treated with CAS and presenting a contralateral carotid occlusion does not differ from regular patients treated with CAS. Based on the low stenosis rate of our study, our results do not give credit to extra surveillance measures in patients with contralateral carotid occlusion.
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