1
|
Rots ML, Meershoek AJ, Bonati LH, den Ruijter HM, de Borst GJ. Editor's Choice – Predictors of New Ischaemic Brain Lesions on Diffusion Weighted Imaging After Carotid Stenting and Endarterectomy: A Systematic Review. Eur J Vasc Endovasc Surg 2019; 58:163-174. [DOI: 10.1016/j.ejvs.2019.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/09/2019] [Accepted: 04/14/2019] [Indexed: 12/16/2022]
|
2
|
Traenka C, Engelter ST, Brown MM, Dobson J, Frost C, Bonati LH. Silent brain infarcts on diffusion-weighted imaging after carotid revascularisation: A surrogate outcome measure for procedural stroke? A systematic review and meta-analysis. Eur Stroke J 2019; 4:127-143. [PMID: 31259261 DOI: 10.1177/2396987318824491] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/20/2018] [Indexed: 12/13/2022] Open
Abstract
Aim To investigate whether lesions on diffusion-weighted imaging (DWI+) after carotid artery stenting (CAS) or endarterectomy (CEA) might provide a surrogate outcome measure for procedural stroke. Materials and Methods Systematic MedLine® database search with selection of all studies published up to the end of 2016 in which DWI scans were obtained before and within seven days after CAS or CEA. The correlation between the underlying log odds of stroke and of DWI+ across all treatment groups (i.e. CAS or CEA groups) from included studies was estimated using a bivariate random effects logistic regression model. Relative risks of DWI+ and stroke in studies comparing CAS vs. CEA were estimated using fixed-effect Mantel-Haenszel models. Results We included data of 4871 CAS and 2099 CEA procedures (85 studies). Across all treatment groups (CAS and CEA), the log odds for DWI+ was significantly associated with the log odds for clinically manifest stroke (correlation coefficient 0.61 (95% CI 0.27 to 0.87), p = 0.0012). Across all carotid artery stenting groups, the correlation coefficient was 0.19 (p = 0.074). There were too few CEA groups to reliably estimate a correlation coefficient in this subset alone. In 19 studies comparing CAS vs. CEA, the relative risks (95% confidence intervals) of DWI+ and stroke were 3.83 (3.17-4.63, p < 0.00001) and 2.38 (1.44-3.94, p = 0.0007), respectively. Discussion This systematic meta-analysis demonstrates a correlation between the occurrence of silent brain infarcts on diffusion-weighted imaging and the risk of clinically manifest stroke in carotid revascularisation procedures. Conclusion Our findings strengthen the evidence base for the use of DWI as a surrogate outcome measure for procedural stroke in carotid revascularisation procedures. Further randomised studies comparing treatment effects on DWI lesions and clinical stroke are needed to fully establish surrogacy.
Collapse
Affiliation(s)
- Christopher Traenka
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.,Neurorehabilitation Unit, University of Basel and University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Basel, Switzerland
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.,Neurorehabilitation Unit, University of Basel and University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Basel, Switzerland
| | - Martin M Brown
- Stroke Research Group, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, London, UK
| | - Joanna Dobson
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Frost
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Leo H Bonati
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.,Stroke Research Group, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, London, UK
| |
Collapse
|
3
|
Cremonesi A, Gieowarsingh S, Castriota F. Carotid Artery Angioplasty and Stenting. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
4
|
White CJ, Ramee SR, Collins TJ, Jenkins JS, Reilly JP, Patel RAG. Carotid artery stenting: patient, lesion, and procedural characteristics that increase procedural complications. Catheter Cardiovasc Interv 2013; 82:715-26. [PMID: 23630062 DOI: 10.1002/ccd.24984] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/12/2013] [Accepted: 04/21/2013] [Indexed: 11/05/2022]
Abstract
From the earliest experiences with carotid artery stenting (CAS) presumptive high risk features have included thrombus-containing lesions, heavily calcified lesions, very tortuous vessels, and near occlusions. In addition patients have been routinely excluded from CAS trials if they have contra-indications to dual antiplatelet therapy (aspirin and thienopyridines), a history of bleeding complications and severe peripheral arterial disease (PAD) making femoral artery vascular access difficult. Variables that increase the risk of CAS complications can be attributed to patient characteristics, anatomic or lesion features, and procedural factors. Clinical features such as older age (≥80 years), decreased cerebral reserve (dementia, multiple prior strokes, or intracranial microangiopathy) and angiographic characteristics such as excessive tortuosity (more than two 90° bends within 5 cm of the target lesion) and heavy calcification (concentric calcification ≥ 3 mm in width) have been associated with increased CAS complications. Other high risk CAS features include those that prolong catheter or guide wire manipulation in the aortic arch, make crossing a carotid stenosis more difficult, decrease the likelihood of successful deployment or retrieval of an embolic protection device (EPD), or make stent delivery or placement more difficult. Procedure volume for the operator and the catheterization laboratory team are critical elements in reducing the risk of the procedure. In this article, we help CAS operators better understand procedure risk to allow more intelligent case selection, further improving the outcomes of this emerging procedure.
Collapse
Affiliation(s)
- Christopher J White
- Department of Cardiovascular Diseases, Ochsner Clinical School of the University of Queensland, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana, 70121
| | | | | | | | | | | |
Collapse
|
5
|
Choi JH, Park HS, Kim DH, Cha JK, Huh JT, Kang M. Direct Relationship between Angiographic Characteristics of Carotid Atherosclerotic Plaque and Filling Defect in the Cerebral Protection Filters : Based on the Conventional Angiography. J Korean Neurosurg Soc 2013; 54:93-9. [PMID: 24175022 PMCID: PMC3809450 DOI: 10.3340/jkns.2013.54.2.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 06/17/2013] [Accepted: 08/05/2013] [Indexed: 11/27/2022] Open
Abstract
Objective Neurologic complications during carotid artery stenting (CAS) are usually associated with distal embolic event. These embolic incident during CAS are highly associated with the carotid plaque instability. The current study was undertaken to identify the angiographic characteristics of carotid plaque vulnerability, which was represented as filling defect in the cerebral protection filters during CAS. Methods A total of 107 patients underwent CAS with use of a distal protection filter. Angiographic carotid plaque surface morphology was classified as smooth, irregular, and ulcerated. To determine predictable factors of filling defect in the protection filters, 11 variables were retrospectively analyzed which might influence filling defect in the protection filters during CAS. Results Filling defects during CAS were presented in the 33 cerebral protection filters. In multivariate analysis, angiographic ulceration [odds ratio (OR), 6.60; 95% confidence interval (CI) : 2.24, 19.4; p=0.001], higher stenosis degree (OR, 1.06; 95% CI : 1.00, 1.12; p=0.039), and coexistent thrombus (OR, 7.58; 95% CI : 1.69, 34.05; p=0.08) were highly associated with filling defect in the cerebral protection devices during CAS. Among several variables, angiographic surface ulceration was the only significant factor associated with flow stagnation during CAS (OR, 4.11; 95% CI : 1.33, 12.72; p=0.014). Conclusion Plaque surface morphology on carotid angiography can be a highly sensitive marker of plaque instability during CAS. The independent risk factors for filling defect in the filter devices during CAS were plaque ulceration, stenosis degree, and coexistent thrombus.
Collapse
Affiliation(s)
- Jae-Hyung Choi
- Department of Neurosurgery, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University, Busan, Korea
| | - Hyun-Seok Park
- Department of Neurosurgery, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University, Busan, Korea
| | - Dae-Hyun Kim
- Department of Neurology, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University, Busan, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University, Busan, Korea
| | - Jae-Taeck Huh
- Department of Neurosurgery, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University, Busan, Korea
| | - Myongjin Kang
- Department of Diagnostic Radiology, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University, Busan, Korea
| |
Collapse
|
6
|
Cremonesi A, Gieowarsingh S, de Campos Martins EC, Castriota F. Carotid Artery Angioplasty and Stenting. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
7
|
Roffi M, Mukherjee D. Current role of emboli protection devices in percutaneous coronary and vascular interventions. Am Heart J 2009; 157:263-70. [PMID: 19185632 DOI: 10.1016/j.ahj.2008.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 09/11/2008] [Indexed: 11/17/2022]
Abstract
After the observation that distal embolization is a frequent complication of coronary and vascular interventions, mechanical emboli protection devices (EPD) have been developed and tested in different vascular territories. The most frequently used device type incorporates a guidewire with a filter that is placed distal to the target lesion, unfolded, and then retrieved at the end of the procedure. Alternative approaches are based on transient flow obstruction using proximal or distal balloon occlusion. The procedure is then performed under flow reversal or flow arrest and the blood column is evacuated prior to restoration of flow. The efficacy of EPD in reducing major adverse cardiac events among patients undergoing percutaneous intervention of aortocoronary bypass grafts has been demonstrated in a randomized trial. In the acute myocardial infarction setting, EPD failed to improve outcomes. Although randomized data in carotid artery stenting are lacking, a broad, but not unanimous, consensus supports the use of these devices. While a small randomized trial showed disappointing results of emboli protection in renal stenting, no data are available for lower extremity interventions.
Collapse
|
8
|
Gröschel K, Schnaudigel S, Ernemann U, Wasser K, Kastrup A. Size Matters! Stent-Length Is Associated With Thrombembolic Complications After Carotid Artery Stenting. Stroke 2008; 39:e131-2; author reply e133. [DOI: 10.1161/strokeaha.108.522219] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Klaus Gröschel
- Department of Neurology, University of Göttingen, Göttingen, Germany, Department of General Neurology, Center of Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Sonja Schnaudigel
- Department of Neurology, University of Göttingen, Göttingen, Germany
| | - Ulrike Ernemann
- Department of Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Katrin Wasser
- Department of Neurology, University of Göttingen, Göttingen, Germany
| | - Andreas Kastrup
- Department of Neurology, University of Göttingen, Göttingen, Germany, Department of General Neurology, Center of Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| |
Collapse
|
9
|
Cappendijk VC, Kessels AG, Heeneman S, Cleutjens KB, Schurink GWH, Welten RJ, Mess WH, van Suylen RJ, Leiner T, Daemen MJ, van Engelshoven JM, Kooi ME. Comparison of lipid-rich necrotic core size in symptomatic and asymptomatic carotid atherosclerotic plaque: Initial results. J Magn Reson Imaging 2008; 27:1356-61. [DOI: 10.1002/jmri.21359] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
10
|
Cappendijk VC, Heeneman S, Kessels AG, Cleutjens KB, Schurink GWH, Welten RJ, Mess WH, van Suylen RJ, Leiner T, Daemen MJ, van Engelshoven JM, Kooi ME. Comparison of single-sequence T1w TFE MRI with multisequence MRI for the quantification of lipid-rich necrotic core in atherosclerotic plaque. J Magn Reson Imaging 2008; 27:1347-55. [DOI: 10.1002/jmri.21360] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
11
|
Carotid angioplasty and stenting, success relies on appropriate patient selection. J Vasc Surg 2008; 47:946-51. [DOI: 10.1016/j.jvs.2007.12.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 12/04/2007] [Accepted: 12/20/2007] [Indexed: 11/19/2022]
|
12
|
Retrieval of the Protection Filter with a Soft Coaxial Catheter After Carotid Stenting. Cardiovasc Intervent Radiol 2008; 32:136-8. [DOI: 10.1007/s00270-008-9349-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2007] [Revised: 03/04/2008] [Accepted: 03/13/2008] [Indexed: 11/26/2022]
|
13
|
Schnaudigel S, Gröschel K, Pilgram SM, Kastrup A. New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke 2008; 39:1911-9. [PMID: 18388346 DOI: 10.1161/strokeaha.107.500603] [Citation(s) in RCA: 210] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Against the background of a relatively low rate of clinical events during carotid angioplasty and stenting (CAS) or carotid endarterectomy (CEA), diffusion-weighted imaging (DWI) is increasingly being used to compare the incidence of new ischemic lesions after both procedures. In addition, DWI may also provide a means of defining the role of different CAS techniques on this adverse outcome. Therefore, we performed a PubMed search and systematically analyzed all peer-reviewed studies published between January 1990 and June 2007 reporting on the occurrence of new DWI lesions after CAS or CEA. Summary of Review- In 32 studies comprising 1363 CAS and 754 CEA procedures, the incidence of any new DWI lesion was significantly higher after CAS (37%) than after CEA (10%) (P<0.01). Similar results were obtained in a meta-analysis focusing on those studies directly comparing the incidence of new DWI lesions after either CEA or CAS (OR, 6.1; 95% CI, 4.19 to 8.87; P<0.01). The use of cerebral protection devices (33% vs 45% without; P<0.01) and closed-cell designed stents during CAS (31% vs 51% with open-cell stents; P<0.01), as well as selective versus routine shunt usage during CEA (6% vs 16%; P<0.01) significantly reduced the incidence of new ipsilateral DWI lesions. CONCLUSIONS New DWI lesions occur more frequently after CAS than after CEA. However, technical advances mainly in the field of endovascular therapy potentially reduce the incidence of these adverse ischemic events. In this scenario, DWI appears to be an ideal tool to compare and further improve both techniques.
Collapse
Affiliation(s)
- Sonja Schnaudigel
- Department of Neurology, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | | | | | | |
Collapse
|
14
|
Sayeed S, Stanziale SF, Wholey MH, Makaroun MS. Angiographic lesion characteristics can predict adverse outcomes after carotid artery stenting. J Vasc Surg 2008; 47:81-7. [DOI: 10.1016/j.jvs.2007.09.047] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 09/12/2007] [Accepted: 09/23/2007] [Indexed: 10/22/2022]
|
15
|
Kim SJ, Roh HG, Jeon P, Kim KH, Lee KH, Byun HS, Moon WJ, Kim GM, Kim YW, Kim DI. Cerebral ischemia detected with diffusion-weighted MR imaging after protected carotid artery stenting: comparison of distal balloon and filter device. Korean J Radiol 2007; 8:276-85. [PMID: 17673838 PMCID: PMC2627162 DOI: 10.3348/kjr.2007.8.4.276] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study was to examine the incidence of ischemia during protected carotid artery stenting (CAS) as well as to compare the protective efficacy of the balloon and filter devices on diffusion-weighted MR imaging (DWI). Materials and Methods Seventy-one consecutive protected CAS procedures in 70 patients with a severe (> 70%) or symptomatic moderate (> 50%) carotid artery stenosis were examined. A balloon device (PercuSurge GuardWire) and a filter device (FilterWire EX/EZ, Emboshield) was used in 33 cases (CAS-B group) and 38 cases (CAS-F group) to prevent distal embolization, respectively. All the patients underwent DWI within seven days before and after the procedures. The number of new cerebral ischemic lesions on the post-procedural DWI were counted and divided into ipsilateral and contralateral lesions according to the relationship with the stenting side. Results New cerebral ischemic lesions were detected in 13 (39.4%) out of the 33 CAS-Bs and in 15 (39.5%) out of the 38 CAS-Fs. The mean number of total, ipsilateral and contralateral new cerebral ischemic lesion was 2.39, 1.67 and 0.73 in the CAS-B group and 2.11, 1.32 and 0.79 in the CAS-F group, respectively. No statistical differences were found between the two groups (p = 0.96, 0.74 and 0.65, respectively). The embolic complications encountered included two retinal infarctions and one hemiparesis in the CAS-B group (9.09%), and one retinal infarction, one hemiparesis and one ataxia in the CAS-F group (7.89%). There was a similar incidence of embolic complications in the two groups (p = 1.00). Conclusion The type of distal protection device used such as a balloon and filter does not affect the incidence of cerebral embolization after protected CAS.
Collapse
Affiliation(s)
- Suk Jung Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stroke and Neurovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University Hospital, Seoul, Korea
| | - Pyoung Jeon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stroke and Neurovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Ha Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stroke and Neurovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Ho Lee
- Stroke and Neurovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Sik Byun
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stroke and Neurovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University Hospital, Seoul, Korea
| | - Gyeong-Moon Kim
- Stroke and Neurovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
16
|
Criado E, Fontcuberta J, Orgaz A, Flores A, Doblas M. Transcervical carotid stenting with carotid artery flow reversal: 3-year follow-up of 103 stents. J Vasc Surg 2007; 46:864-9. [DOI: 10.1016/j.jvs.2007.07.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 07/03/2007] [Accepted: 07/18/2007] [Indexed: 11/30/2022]
|