1
|
Predicting the Risk of Stroke in Chinese Internal Carotid Artery Stenosis Patients Underwent Carotid Artery Stenting: Validation and Improvement of Siena Carotid Artery Stenting Risk Score. J Stroke Cerebrovasc Dis 2019; 28:104369. [PMID: 31548086 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/18/2019] [Accepted: 08/25/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Siena carotid artery stenting (CAS) risk score is developed based on Chinese internal carotid artery (ICA) stenosis patients recruited in Italy, whether it is equally applicable in Chinese remains unknown. We aimed to investigate Siena CAS risk score value for predicting stroke risk in ICA stenosis patients underwent CAS and explore additional factors for improving accuracy of scoring system. METHODS Totally 401 patients with ICA stenosis who underwent CAS were enrolled. The clinical data (including patient characteristics, lesion features, and procedure-related features) were collected and the Siena CAS score was calculated. Stroke incidence with 30 days was documented. RESULTS The incidence of stroke was 4.5%, and the Siena CAS score in stroke patients was higher compared with nonstroke patients, further receiver operating characteristic (ROC) curve illustrated that Siena CAS score was acceptable at predicting stroke risk with area under curve (AUC) of .743 (95%CI: .638-.848). Multivariate logistic regression model revealed that Siena CAS score and current fasting-blood glucose (FBG) greater than 7.1 mmol/l independently predicted higher stroke risk; followed ROC curve disclosed that Siena CAS score combined with current FBG greater than 7.1 mmol/l was of good value in predicting stroke risk (AUC: .770 (95%CI: .677-.863)), which was numerically increased compared with Siena CAS score alone. CONCLUSIONS Siena CAS risk scoring system exhibits to be a useful tool to predict stroke risk, and the combination of Siena CAS score and current increased FBG might be a more accurate stratification for stroke risk in Chinese ICA stenosis patients after CAS.
Collapse
|
2
|
Richards CN, Schneider PA. Will mesh-covered stents help reduce stroke associated with carotid stent angioplasty? Semin Vasc Surg 2017; 30:25-30. [DOI: 10.1053/j.semvascsurg.2017.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
3
|
Zhang L, Zhao Z, Ouyang Y, Bao J, Lu Q, Feng R, Zhou J, Jing Z. Systematic Review and Meta-Analysis of Carotid Artery Stenting Versus Endarterectomy for Carotid Stenosis: A Chronological and Worldwide Study. Medicine (Baltimore) 2015; 94:e1060. [PMID: 26131824 PMCID: PMC4504641 DOI: 10.1097/md.0000000000001060] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 05/30/2015] [Accepted: 06/02/2015] [Indexed: 11/26/2022] Open
Abstract
There are disparities among the results of meta-analyses under different circumstances of carotid artery stenting (CAS) versus endarterectomy (CEA) for carotid stenosis. This study aimed to assess the efficacies of CAS and CEA for carotid stenosis at 5-year intervals and worldwide.Comparative studies simultaneously reporting CAS and CEA for carotid stenosis with at least 10 patients in each group were identified by searching PubMed and Embase in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines, and by reviewing the reference lists of retrieved articles.The studies were stratified into different subgroups according to the publication year, location in which the study was mainly performed, and randomized and nonrandomized study designs.Thirty-five comparative studies encompassing 27,525 patients were identified. The risk ratios (RRs) of stroke/death when CAS was compared with CEA within 30 d of treatment were 1.51 (95% CI 1.32-1.74, P < 0.001) for overall, 1.50 (95% CI 1.14-1.98, P = 0.004) from 2011 to 2015, 1.61 (95% CI 1.35-1.91, P < 0.001) from 2006 to 2010, 1.59 (95% CI 1.27-1.99, P < 0.001) in North America, 1.50 (95% CI 1.24-1.81, P < 0.001) in Europe, 1.63 (95% CI 1.31-2.02, P < 0.001) for randomized, and 1.44 (95% CI 1.20-1.73, P < 0.001) for nonrandomized comparative studies. CEA decreased the risks of transient ischemic attack at 30 d (RR: 2.07, 95% CI 1.50-2.85, P < 0.001) and restenosis at 1-year (RR: 1.97, 95% CI 1.28-3.05, P = 0.002). Data from follow-up showed that the RRs of stroke/death were 0.74 (95% CI 0.55-0.99, P = 0.04) at 1 year, 1.24 (95% CI 1.04-1.46, P = 0.01) at 4 year, and 2.27 (95% CI 1.39-3.71, P = 0.001) at 10 year. This systematic review, compared with those of other meta-analyses, included all available comparative studies and analyzed them at 5-year intervals, in different continents, and under different study designs. Current evidence suggests that the efficacy of CEA is superior to CAS for freedom from stroke/death within 30 d, especially from 2006 to 2015, in North America and Europe. Meanwhile, the superiority was also observed for restenosis at 1-year, transient ischemic attack within 30 d, and stroke/death at 4- and 10-year follow-ups.
Collapse
Affiliation(s)
- Lei Zhang
- From the Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China (LZ, ZZ, YO, JB, QL, RF, ZJ); and Department of Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China (JZ)
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Paraskevas KI, Moore WS, Veith FJ. Commentary: carotid artery stenting: still not as cost-effective as carotid endarterectomy, but the contest continues. J Endovasc Ther 2014; 21:303-5. [PMID: 24754291 DOI: 10.1583/13-4549c.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kosmas I Paraskevas
- 1 Department of Vascular Surgery, Larissa University Hospital, Larissa, Greece
| | | | | |
Collapse
|
5
|
Staubach S, Hein-Rothweiler R, Hochadel M, Segerer M, Zahn R, Jung J, Rieß G, Seggewiß H, Schneider A, Fürste T, Gottkehaskamp C, Mudra H. Predictors of minor versus major stroke during carotid artery stenting: results from the carotid artery stenting (CAS) registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK). Clin Res Cardiol 2014; 103:345-51. [DOI: 10.1007/s00392-013-0657-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022]
|
6
|
Spacek M, Veselka J. Carotid artery stenting - current status of the procedure. Arch Med Sci 2013; 9:1028-34. [PMID: 24482646 PMCID: PMC3902709 DOI: 10.5114/aoms.2013.39216] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 12/29/2012] [Accepted: 02/07/2013] [Indexed: 11/17/2022] Open
Abstract
Surgical carotid endarterectomy (CEA) was long considered the standard approach for the treatment of atherosclerotic carotid artery disease. This was based on results of several randomized trials demonstrating its effectiveness over the best medical therapy. In the past two decades, patients identified high-risk for surgery were offered carotid artery stenting (CAS) as a less invasive option. Despite its initial limitations, CAS has evolved into an elaborate method currently considered to be equivalent and in selected patients even preferable to CEA. However, outcomes of both procedures are highly operator dependent and a simple stratifying method to prioritize CAS, CEA or medical therapy only has not yet been proposed. In addition, recently published randomized trials highlighted the importance of proper patient selection and rigorous training contributing to low absolute rates of (procedural) adverse events. This review discusses the history and evidence for carotid revascularization and briefly presents technical aspects and innovations in CAS.
Collapse
Affiliation(s)
- Miloslav Spacek
- Department of Cardiology, Cardiovascular Center, University Hospital Motol, 2 Medical School, Charles University, Prague, Czech Republic
| | - Josef Veselka
- Department of Cardiology, Cardiovascular Center, University Hospital Motol, 2 Medical School, Charles University, Prague, Czech Republic
| |
Collapse
|
7
|
Dumont TM, Mokin M, Wach MM, Drummond PS, Siddiqui AH, Levy EI, Hopkins LN. Understanding risk factors for perioperative ischemic events with carotid stenting: is patient age over 80 years or is unfavorable arch anatomy to blame? J Neurointerv Surg 2013; 6:219-24. [DOI: 10.1136/neurintsurg-2013-010721] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
8
|
Barbiero G, Cognolato D, Casarin A, Stramanà R, Galzignan E, Guarise A. Carotid artery stenting in difficult aortic arch anatomy with or without a new dedicated guiding catheter: preliminary experience. Eur Radiol 2012. [DOI: 10.1007/s00330-012-2708-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
9
|
Reichmann BL, van Lammeren GW, Moll FL, de Borst GJ. Is age of 80 years a threshold for carotid revascularization? Curr Cardiol Rev 2012; 7:15-21. [PMID: 22294970 PMCID: PMC3131710 DOI: 10.2174/157340311795677716] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 10/16/2010] [Accepted: 01/07/2011] [Indexed: 11/22/2022] Open
Abstract
Background and purpose: Carotid Angioplasty and Stenting (CAS) has emerged as an alternative to Carotid Endarterectomy (CEA) in treatment of carotid stenotic disease. With increasing life expectancy clinicians are more often confronted with patients of higher age. Octogenarians were often excluded from randomized trials comparing CAS to CEA because they were considered high-risk for revascularization. Conflicting results on the peri-procedural outcome of carotid revascularization in these patients have been reported. In order to objectively evaluate whether age above 80 years should be an upper limit for indicating carotid revascularization we systematically reviewed the currently available literature. Methods: Literature was systematically reviewed between January 2000 and June 2010 using Pubmed and Embase, to identify all relevant studies concerning CAS and CEA in octogenarians. Inclusion criteria were 1) reporting outcome on either CEA or CAS; and 2) data subanalysis on treatment outcome by age. The 30-day Major Adverse Event (MAE) rate (disabling stroke, myocardial infarction or death) was extracted as well as demographic features of included patients. Results: After exclusion of 23 articles, 46 studies were included in this review, 18 involving CAS and 28 involving CEA. A total of 2.963 CAS patients and 14.365 CEA patients with an age >80 years were reviewed. The MAE rate was 6.9% (range 1.6 - 24.0%) following CAS and 4.2% (range 0 – 8.8%) following CEA. A separate analysis in this review included the results of one major registry 140.376 patients) analyzing CEA in octogenarians only reporting on 30-day mortality and not on neurological or cardiac adverse events. When these data were included the MAE following CEA is 2.4% (range 0 – 8.8%) Conclusions: MAE rates after CEA in octogenarians are comparable with the results of large randomized trials in younger patients. Higher complication rates are described for CAS in octogenarians. In general, age > 80 years is not an absolute cut off point to exclude patients from carotid surgery. In our opinion, CEA should remain the golden standard in the treatment of significant carotid artery stenoses, even in the very elderly.
Collapse
|
10
|
Kasivisvanathan V, Thapar A, Davies KJ, Dharmarajah B, Shalhoub J, Davies AH. Periprocedural outcomes after surgical revascularization and stenting for postradiotherapy carotid stenosis. J Vasc Surg 2012; 56:1143-52.e2. [PMID: 22819749 DOI: 10.1016/j.jvs.2012.04.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/08/2012] [Accepted: 04/09/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Treatment of head and neck malignancy commonly involves radiotherapy, which is associated with the development of carotid artery stenosis. There is little evidence to guide clinicians on how to intervene in significant postradiotherapy carotid stenosis. This systematic review collated data pertaining to perioperative outcomes of carotid artery surgery and carotid stenting in postradiotherapy carotid stenosis to aid the clinical decision-making process. METHODS A systematic review of the literature, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines, was performed. We screened 575 articles related to carotid artery surgery or stenting in postradiotherapy carotid stenosis, from which 21 studies were included for quantitative analysis. The primary outcome was stroke or death ≤ 30 days of the procedure. Secondary outcomes included cranial nerve injury, restenosis, stroke, and death at >30 days. RESULTS Nine publications recorded 211 surgical procedures in 179 patients. In symptomatic patients, the 30-day mortality rate was 2.6% and the stroke or death rate was 2.7%. In asymptomatic patients, the 30-day mortality rate was 0% and the stroke or death rate was 1.1%. Permanent cranial nerve palsy was experienced by 0.6% of patients. Twelve publications recorded 510 carotid artery stenting procedures in 482 patients. In symptomatic patients, the 30-day mortality rate was 5.1%, and the stroke or death rate was 5.1%. In asymptomatic patients, the 30-day mortality rate was 1.4%, and the stroke or death rate was 2.1%. There was no statistically significant difference in 30-day stroke or death rate between surgical revascularization and carotid artery stenting in all (odds ratio [OR], 0.54; 95% confidence interval [CI] 0.17-1.70; P = .43), symptomatic (OR, 0.52; 95% CI, 0.14-1.98; P = .38), or asymptomatic patients (OR, 0.55; 95% CI, 0.06-5.42; P = .99). CONCLUSIONS The published outcomes from high-volume centers demonstrate that surgical revascularization and stenting are both technically feasible in postradiotherapy carotid stenosis and have similar safety profiles to nonirradiated necks. Radiation should therefore not be considered a contraindication to surgical intervention.
Collapse
Affiliation(s)
- Veeru Kasivisvanathan
- Academic Section of Vascular Surgery, Imperial College London, Charing Cross Hospital, London, United Kingdom.
| | | | | | | | | | | |
Collapse
|
11
|
Fokkema M, den Hartog AG, Bots ML, van der Tweel I, Moll FL, de Borst GJ. Stenting Versus Surgery in Patients With Carotid Stenosis After Previous Cervical Radiation Therapy. Stroke 2012; 43:793-801. [DOI: 10.1161/strokeaha.111.633743] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Margriet Fokkema
- From the Department of Vascular Surgery (M.F., A.G.d.H., F.L.M., G.J.d.B.) and the Julius Center for Health Sciences and Primary Care (M.L.B., I.v.d.T.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne G. den Hartog
- From the Department of Vascular Surgery (M.F., A.G.d.H., F.L.M., G.J.d.B.) and the Julius Center for Health Sciences and Primary Care (M.L.B., I.v.d.T.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel L. Bots
- From the Department of Vascular Surgery (M.F., A.G.d.H., F.L.M., G.J.d.B.) and the Julius Center for Health Sciences and Primary Care (M.L.B., I.v.d.T.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ingeborg van der Tweel
- From the Department of Vascular Surgery (M.F., A.G.d.H., F.L.M., G.J.d.B.) and the Julius Center for Health Sciences and Primary Care (M.L.B., I.v.d.T.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frans L. Moll
- From the Department of Vascular Surgery (M.F., A.G.d.H., F.L.M., G.J.d.B.) and the Julius Center for Health Sciences and Primary Care (M.L.B., I.v.d.T.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert Jan de Borst
- From the Department of Vascular Surgery (M.F., A.G.d.H., F.L.M., G.J.d.B.) and the Julius Center for Health Sciences and Primary Care (M.L.B., I.v.d.T.), University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
12
|
Solomon B, Berland T, Cayne N, Rockman C, Veith FJ, Maldonado T. The Coronary Technique for Complex Carotid Artery Stenting in the Setting of Complex Aortic Arch Anatomy. Vasc Endovascular Surg 2010; 44:572-5. [DOI: 10.1177/1538574410375125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Carotid artery stenting (CAS) remains a viable option for treating carotid artery lesions in high surgical risk patients. We retrospectively reviewed our experience in performing CAS in patients with complex aortic arch anatomy. The ‘‘coronary technique’’ uses an AL1 guiding catheter to engage the origin of the common carotid artery permitting delivery of protection device and stent. In total, 12 patients had complex arch anatomy which precluded access using the standard technique as determined on preoperative imaging. A total of 8 patients with such anatomy underwent femoral artery catheterization with placement of an Amplatz AL1 guide catheter into the common carotid artery. All were able to be successfully treated, with no dissection, neurovascular deficit, or other major complication. Based on this case series, we describe the coronary technique as a safe and viable method for CAS in the setting of complex anatomy which might otherwise preclude CAS.
Collapse
Affiliation(s)
- B. Solomon
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA
| | - T. Berland
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA
| | - N. Cayne
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA
| | - C. Rockman
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA
| | - FJ Veith
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA
| | - T. Maldonado
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA,
| |
Collapse
|
13
|
Setacci C, Chisci E, Setacci F, Iacoponi F, de Donato G, Rossi A. Siena Carotid Artery Stenting Score. Stroke 2010; 41:1259-65. [DOI: 10.1161/strokeaha.110.578583] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carlo Setacci
- From Department of Surgery, Vascular, and Endovascular Surgery Unit (C.S., E.C., F.S., G.d.D.), University of Siena, Siena, Italy; Department of Biomedical Sciences (F.I.), Applied Biology Section, University of Siena, Siena, Italy; Department of Neurological, Neurosurgical, and Behaviour Sciences (A.R.), University of Siena, Siena, Italy
| | - Emiliano Chisci
- From Department of Surgery, Vascular, and Endovascular Surgery Unit (C.S., E.C., F.S., G.d.D.), University of Siena, Siena, Italy; Department of Biomedical Sciences (F.I.), Applied Biology Section, University of Siena, Siena, Italy; Department of Neurological, Neurosurgical, and Behaviour Sciences (A.R.), University of Siena, Siena, Italy
| | - Francesco Setacci
- From Department of Surgery, Vascular, and Endovascular Surgery Unit (C.S., E.C., F.S., G.d.D.), University of Siena, Siena, Italy; Department of Biomedical Sciences (F.I.), Applied Biology Section, University of Siena, Siena, Italy; Department of Neurological, Neurosurgical, and Behaviour Sciences (A.R.), University of Siena, Siena, Italy
| | - Francesca Iacoponi
- From Department of Surgery, Vascular, and Endovascular Surgery Unit (C.S., E.C., F.S., G.d.D.), University of Siena, Siena, Italy; Department of Biomedical Sciences (F.I.), Applied Biology Section, University of Siena, Siena, Italy; Department of Neurological, Neurosurgical, and Behaviour Sciences (A.R.), University of Siena, Siena, Italy
| | - Gianmarco de Donato
- From Department of Surgery, Vascular, and Endovascular Surgery Unit (C.S., E.C., F.S., G.d.D.), University of Siena, Siena, Italy; Department of Biomedical Sciences (F.I.), Applied Biology Section, University of Siena, Siena, Italy; Department of Neurological, Neurosurgical, and Behaviour Sciences (A.R.), University of Siena, Siena, Italy
| | - Alessandro Rossi
- From Department of Surgery, Vascular, and Endovascular Surgery Unit (C.S., E.C., F.S., G.d.D.), University of Siena, Siena, Italy; Department of Biomedical Sciences (F.I.), Applied Biology Section, University of Siena, Siena, Italy; Department of Neurological, Neurosurgical, and Behaviour Sciences (A.R.), University of Siena, Siena, Italy
| |
Collapse
|
14
|
Abstract
Treatment of high-grade symptomatic carotid stenosis via carotid endarterectomy has been shown to be superior to medical management alone in several studies. Carotid angioplasty and stenting (CAS) has emerged as an alternative approach to endarterectomy to reduce the associated perioperative risks. Several anatomic and physiologic factors that increase the risk of stroke and/or death associated with endarterectomy have been identified. The alternative approach of CAS has been found to be noninferior to endarterectomy for high surgical risk patients with severe symptomatic carotid stenosis and the use of this procedure is supported by the current widely accepted guidelines. In patients with standard surgical risk, the differential benefit of CAS compared with endarterectomy is not clear. Several advantages of CAS have been identified in previous studies in selected patients. The results of CAS will undoubtedly continue to improve with advances in device designs, technological expertise, and appropriate patient selection.
Collapse
|
15
|
Tips and techniques in carotid artery stenting. J Vasc Surg 2009; 50:216-20. [DOI: 10.1016/j.jvs.2009.01.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Revised: 01/13/2009] [Accepted: 01/13/2009] [Indexed: 11/23/2022]
|
16
|
Abstract
In 2008 we witnessed a rapid advancement in stent technology, which is reflected in the high number of case reports, publications of case series, and randomized trials. Stents not only served for a combined intrasaccular and extrasaccular treatment of challenging aneurysms but also assisted the revascularization in acute and chronic ischemic conditions of the neurovascular system. Although a self-expanding nitinol semiopen cell stent is currently used for intracranial occlusive disease, a new retrievable closed-cell designed stent is widely used for aneurysms because of its easy delivery through a microcatheter in frequently tortuous head and neck as well as cerebrovascular circulation (
Figure 1
). However, despite numerous publications in the field, the widespread acceptance of the use of stents to routinely treat carotid stenosis awaits the results of the multicenter randomized clinical trials that should be available in 2009. The role of interventional neuroradiology in the treatment of acute ischemic stroke continues to expand and excite interest.
Figure 1.
Intracranial nitinol self-expanding stents used for endovascular treatment of aneurysm in conjunction with coil embolization. A, Closed cell design with flaring ends (Enterprise VRD; Codman Neurovascular, Raynham, MA). B, Semiopen cell design (Neuroform; Boston Scientific, Natick, MA).
Collapse
Affiliation(s)
- Ajay K. Wakhloo
- From Department of Radiology (A.K.W., M.J.D.), University of Massachusetts, Worcester, Mass; Institute of Neurology (M.M.B.), National Hospital, London, UK
| | - Michael J. Deleo
- From Department of Radiology (A.K.W., M.J.D.), University of Massachusetts, Worcester, Mass; Institute of Neurology (M.M.B.), National Hospital, London, UK
| | - Martin M. Brown
- From Department of Radiology (A.K.W., M.J.D.), University of Massachusetts, Worcester, Mass; Institute of Neurology (M.M.B.), National Hospital, London, UK
| |
Collapse
|
17
|
Howell GM, Makaroun MS, Chaer RA. Current Management of Extracranial Carotid Occlusive Disease. J Am Coll Surg 2009; 208:442-53. [DOI: 10.1016/j.jamcollsurg.2008.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 11/21/2008] [Accepted: 12/04/2008] [Indexed: 11/30/2022]
|