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Dinç Y, Oğuz Akarsu E, Hakyemez B, Bakar M. Evaluation of Risk Factors Associated with Stroke Recurrence in Patients with Minor Ischemic Stroke. TURKISH JOURNAL OF NEUROLOGY 2022. [DOI: 10.4274/tnd.2021.17992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Shchehlov DV, Svyrydiuk OY, Vyval MB, Sydorenko OF, Nosenko NM, Gudym MS. Simultaneous bilateral angioplasty and stenting for carotid stenosis - a single center experience. J Med Life 2022; 15:252-257. [PMID: 35419100 PMCID: PMC8999088 DOI: 10.25122/jml-2021-0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
Abstract
Carotid artery stenosis is responsible for up to 12% of all ischemic strokes. The prevalence of bilateral carotid artery stenosis is nearly 8–39% among patients with stroke, and its management is still controversial. This study aimed to report the treatment results of bilateral carotid artery stenosis with simultaneous bilateral angioplasty and stenting (sbCAS) in a single institution during the last 10 years. 315 patients underwent carotid stenting in the Scientific-Practical Center of Endovascular Neuroradiology, NAMS of Ukraine during 2010–2020. 39 (12.4%) patients (mean age 57.9±2.1 – 28 men) underwent sbCAS. Primary clinical endpoints (stroke, myocardial infarction, or death) and secondary endpoints (hemodynamic depression (HD) – hypotension (<90 mmHg) or bradycardia (<60 bpm) and hyperperfusion syndrome (HPS) were evaluated. All sbCAS were technically successful, and a reduction of stenosis was noted in each case. There were two periprocedural neurological complications, one transient ischemic attack (TIA), and one minor stroke with the Modified Rankin Scale (mRS) – 3 at discharge. No myocardial infarction (MI) or death during hospitalization was noted. 28 patients (71.8%) had HD, and 2 (5.1%) had HPS. All patients except those with periprocedural stroke were discharged or transferred to another hospital without neurological deterioration. sbCAS is an effective and relatively safe procedure for carefully selected patients with bilateral carotid stenosis. Patients with bilateral carotid stenosis should be carefully examined, and the best treatment strategy should be assessed using a multidisciplinary approach taking into account the possibility of sbCAS.
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Affiliation(s)
- Dmytro Viktorovych Shchehlov
- State Organization Scientific-Practical Center of Endovascular Neuroradiology, National Academy of Medical Sciences of Ukraine (NAMS), Kyiv, Ukraine
| | - Oleg Yevgenovych Svyrydiuk
- State Organization Scientific-Practical Center of Endovascular Neuroradiology, National Academy of Medical Sciences of Ukraine (NAMS), Kyiv, Ukraine
| | - Mykola Bohdanovych Vyval
- State Organization Scientific-Practical Center of Endovascular Neuroradiology, National Academy of Medical Sciences of Ukraine (NAMS), Kyiv, Ukraine,Corresponding Author: Mykola Bohdanovych Vyval, State Organization Scientific-Practical Center of Endovascular Neuroradiology, National Academy of Medical Sciences of Ukraine (NAMS), Kyiv, Ukraine. E-mail:
| | - Olena Fedorivna Sydorenko
- State Organization Scientific-Practical Center of Endovascular Neuroradiology, National Academy of Medical Sciences of Ukraine (NAMS), Kyiv, Ukraine
| | - Nataliia Mykolayivna Nosenko
- State Organization Scientific-Practical Center of Endovascular Neuroradiology, National Academy of Medical Sciences of Ukraine (NAMS), Kyiv, Ukraine
| | - Maxym Stepanovych Gudym
- State Organization Scientific-Practical Center of Endovascular Neuroradiology, National Academy of Medical Sciences of Ukraine (NAMS), Kyiv, Ukraine
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Prevalence and Clinical Predictors of Intracranial Hemorrhage Following Carotid Artery Stenting for Symptomatic Severe Carotid Stenosis. World Neurosurg 2021; 155:e353-e361. [PMID: 34419661 DOI: 10.1016/j.wneu.2021.08.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/12/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Hyperperfusion-induced intracranial hemorrhage (HICH) is the most frequent cause of death following carotid artery stenting (CAS). This study aimed to identify the presence of HICH after CAS and evaluate demographic and clinical variables associated with HICH. METHODS We retrospectively reviewed clinical data of 446 consecutive patients with symptomatic severe carotid stenosis treated with CAS between November 2011 and August 2018. Good collateral compensation was defined as patency of the anterior communicating artery with well-developed bilateral A1 segments with or without posterior communicating arteries, according to the classification of Katano et al. Univariate and multivariate analyses were performed to determine whether there was a correlation between demographic and clinical variables and development of HICH. RESULTS Stent placement was successful in all patients. Of 446 patients, 14 had HICH (3.14%); 1 of 14 (7.14%) patients displayed 80%-90% stenosis, and 13 patients had stenosis ≥90%. Thirteen patients (92.86%) had poor collateral circulation compensation. Two patients (14.3%) died despite rescue efforts. Age (≥70 years), degree of carotid artery stenosis (≥90%), and poor compensation of collateral circulation were associated with a higher frequency of HICH after CAS. Severe carotid artery stenosis (≥90%) was independently associated with HICH after stenting (odds ratio 13.633, P = 0.014). CONCLUSIONS The incidence rate of HICH was 3.14%. Patients with severe carotid artery stenosis (≥90%) are at high risk for developing HICH after CAS. Further investigations are needed to better describe the contribution of other risk factors, including poor compensation of collateral circulation (especially anterior circulation).
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Lu N, Li H, Xu YL. Use of Weighted Performance Goals in Prospective Single-Arm Clinical Studies Designed to Assess the Safety and Effectiveness of Medical Devices. Stat Biopharm Res 2020. [DOI: 10.1080/19466315.2020.1799853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Nelson Lu
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD
| | - Heng Li
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD
| | - Yun-Ling Xu
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD
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Oshita J, Sakamoto S, Okazaki T, Ishii D, Kurisu K. Safety of simultaneous bilateral carotid artery stenting for bilateral carotid artery stenosis. Interv Neuroradiol 2020; 26:19-25. [PMID: 31423862 PMCID: PMC6997998 DOI: 10.1177/1591019919869478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 07/17/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Bilateral carotid artery stenting (BCAS) is often performed in two stages (staged BCAS) but it is also an option to be performed in one stage (simultaneous BCAS). To confirm the safety of simultaneous BCAS, we retrospectively analyzed perioperative and postoperative course of simultaneous BCAS compared with staged BCAS. MATERIALS AND METHODS Patients with symptomatic stenosis of ≥50% or asymptomatic stenosis of ≥80% of bilateral carotid arteries underwent BCAS. Procedure time, symptomatic ischemic complications, presence/absence of high-intensity spots on postoperative diffusion-weighted image, duration of postoperative hospital stays and 30 days outcome of patients performed with simultaneous BCAS (group A, 8 patients with 16 stenotic lesions (8 procedures)) were compared with those of staged BCAS (group B, 4 patients with 8 stenotic lesions (8 procedures)). RESULTS In groups A and B, procedure time was 146.0 ± 53.8 and 103.5 ± 39.4 min; intraoperative hypotension was observed in 62.5% and 50.0%; postoperative hypotension occurred in 37.5% and 50.0%; diffusion-weighted image showed high-intensity spots in 37.5% and 12.5%; and duration of postoperative hospital stays was 5.1 ± 1.8 and 5.3 ± 2.3 days. No patients suffered symptomatic ischemic complications. In simultaneous BCAS, there was a tendency that procedure time was longer and high-intensity spots on postoperative diffusion-weighted image was more frequent, but there was no increase in symptomatic ischemic complications and duration of hospital stays compared to staged BCAS. CONCLUSIONS Safety of simultaneous BCAS may not be inferior to staged BCAS. In terms of duration of hospital stays, simultaneous BCAS can be superior to staged BCAS for patients with bilateral carotid artery stenosis.
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Affiliation(s)
- Jumpei Oshita
- Department of Neurosurgery, Graduate School of
Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of
Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of
Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Daizo Ishii
- Department of Neurosurgery, Graduate School of
Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of
Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Zhu Z, Yu W. Update in the treatment of extracranial atherosclerotic disease for stroke prevention. Stroke Vasc Neurol 2019; 5:65-70. [PMID: 32411410 PMCID: PMC7213501 DOI: 10.1136/svn-2019-000261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/10/2019] [Accepted: 10/28/2019] [Indexed: 01/03/2023] Open
Abstract
Stroke is a leading cause of adult mortality and disability worldwide. Extracranial atherosclerotic disease (ECAD), primarily, carotid artery stenosis, accounts for approximately 18%–25% of ischaemic stroke. Recent advances in neuroimaging, medical therapy and interventional management have led to A significant reduction of stroke from carotid artery stenosis. The current treatment of ECAD includes optimal medical therapy, carotid endarterectomy (CEA) and carotid artery stenting (CAS). The selection of treatments depends on symptomatic status, severity of stenosis, individual factors, efficacy and risk of complications. The aim of this paper is to review current evidence and guidelines on the management of carotid artery stenosis, including the comparison of medical and interventional therapy (CAS and CEA), as well as future directions.
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Affiliation(s)
- Zhu Zhu
- Department of Neurology, University of California Irvine, Irvine, California, USA.,Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Wengui Yu
- Department of Neurology, University of California Irvine, Irvine, California, USA
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Dong H, Chen Y, Jiang X, Zou Y, Che W, Xiong H, Xu B, Yang Y, Gao R. Safety and feasibility of simultaneous endovascular therapy for supra-arch multivessel stenosis in 256 Chinese patients. Catheter Cardiovasc Interv 2019; 93:846-850. [PMID: 30569666 DOI: 10.1002/ccd.28031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/02/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate the safety and feasibility of simultaneous endovascular therapy for supra-arch multivessel stenosis. BACKGROUND Limited data are currently available on simultaneous intervention for supra-arch multivessel stenosis because of concerns regarding the high incidence of procedure-related complications. METHODS From January 2005 to December 2012, the clinical data of 256 consecutive inpatients who underwent simultaneous intervention for supra-arch multivessel stenosis were retrospectively analyzed. The primary end point was a composite of any type of stroke or neurological death within 30 days. RESULTS In total, 535 supra-arch vessels underwent endovascular therapy. In total, 234, 21, and 1 patient underwent simultaneous intervention of 2, 3, and 4 supra-arch vessels, respectively. The lesions involved only the anterior circulation in 40.2% (103/256), only the posterior circulation in 10.5% (27/256), and the combined circulations in 49.2% (126/256) patients. The overall procedural success rate was 99.6% (533/535). The incidence of the primary end point was 3.5%. According to the lesion location, the incidence of the primary end point was 3.9% (4/103), 0% (0/27), and 4.0% (5/126) in the patients who underwent endovascular treatment for the anterior circulation alone, posterior circulation alone, and combined circulations, respectively. According to the number of supra-arch lesions, the incidence of the primary end point was 3.4% (8/234), 4.8% (1/21), and 0% (0/1) in the patients who underwent simultaneous intervention of 2, 3, and 4 vessels, respectively. CONCLUSIONS The study showed that simultaneous intervention for supra-arch multivessel stenosis was safe and technically feasible.
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Affiliation(s)
- Hui Dong
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiongjing Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yubao Zou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wuqiang Che
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Hongliang Xiong
- Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Lai Z, Guo Z, Shao J, Chen Y, Liu X, Liu B, Qiu C. A systematic review and meta-analysis of results of simultaneous bilateral carotid artery stenting. J Vasc Surg 2018; 69:1633-1642.e5. [PMID: 30578074 DOI: 10.1016/j.jvs.2018.09.033] [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] [Received: 02/17/2018] [Accepted: 09/04/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although staged procedures to treat bilateral carotid artery stenosis are mainstream, a growing number of articles on simultaneous bilateral carotid artery stenting (SBCAS) have been published. Thus, this meta-analysis was performed to evaluate the efficacy and safety of SBCAS. METHODS The PubMed and Embase databases were searched to identify all studies reporting SBCAS from January 1, 2000, to October 1, 2017. Patients' characteristics, comorbidities, technical success, deaths, and complications were collected and analyzed. Forest plots were drawn with either a random-effects model or fixed-effects model according to their heterogeneities. Publication biases were tested by funnel plots and linear regression test. RESULTS Overall, 333 patients with bilateral carotid stenosis in 10 retrospective studies were enrolled in this meta-analysis. The mean age was 67.4 years; 75% of the patients were male, and 85.6% of them were symptomatic. The mean severity of stenosis was 82.1%. The overall technical success rate reached 99.38% (95% confidence interval [CI], 96.58%-100.00%). The pooled incidences of periprocedural complications were as follows: hemodynamic depression, 46.12% (95% CI, 33.16%-59.35%); hyperperfusion syndrome, 3.33% (95% CI, 1.66%-5.55%); stroke, 3.20% (95% CI, 1.59%-5.36%); myocardial infarction (MI), 0.60% (95% CI, 0.00%-1.43%); and death, 1.20% (95% CI, 0.03%-2.38%). The occurrence of a periprocedural primary end point, defined as a combination of any stroke, MI, and death, affected 4.28% (95% CI, 2.37%-6.71%) of patients. For long-term patency, there were too few follow-up results available to evaluate. CONCLUSIONS Except for hyperperfusion syndrome, all other periprocedural complications including hemodynamic depression, stroke, and MI were comparable with the literature reporting unilateral carotid artery stenting. However, the analysis was based on retrospective studies. Further studies, including prospective and randomized controlled studies, are needed to confirm these results.
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Affiliation(s)
- Zhichao Lai
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Zhiwei Guo
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yu Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xiu Liu
- General Surgery, Puren Hospital of Beijing, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China.
| | - Chenyang Qiu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
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Jiang XJ, Dong H, Peng M, Zou YB, Song L, Xu B, Zhang HM, Wu HY, Zhou XL, Yang YJ, Gao RL. Simultaneous Bilateral vs Unilateral Carotid Artery Stenting: 30-Day and 1-Year Results. J Endovasc Ther 2016; 23:258-66. [PMID: 26823486 DOI: 10.1177/1526602815626900] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate clinical outcomes of simultaneous bilateral carotid artery stenting (sbCAS) compared with unilateral CAS (uCAS). METHODS The database in our institution was queried to identify all patients treated with CAS from January 2005 to December 2012. In this time frame, 120 (18.8%) patients (mean age 64.9 ± 7.7 years; 96 men) underwent sbCAS and 517 (81.2%) patients (mean age 65.7 ± 7.7 years; 421 men) received uCAS. The primary endpoint was the composite of stroke, myocardial infarction, or death within 30 days or any ipsilateral stroke within 1 year. RESULTS There was no significant difference in the rates of the primary endpoint between the sbCAS and uCAS groups (6.7% vs 4.6%, p=0.358). The rates of the primary endpoint among symptomatic patients was 8.0% in the sbCAS group and 5.0% in the uCAS group (p=0.299) and 3.1% and 4.0%, respectively (p=0.821) among asymptomatic patients. During the 30-day periprocedural period, the rates of the primary endpoint did not differ significantly between the sbCAS and uCAS groups among all patients (5.8% vs 4.4%, p=0.479), symptomatic patients (6.8% vs 5.0%, p=0.594), or asymptomatic patients (3.1% vs 3.5%, p>0.999). After this period, the incidences of any ipsilateral stroke were similarly low (0.8% and 0.2%, respectively; p=0.342). CONCLUSION The study showed that simultaneous bilateral CAS had no more adverse events than unilateral CAS during the periprocedural period or within 1 year. This 1-stage strategy may become a valuable alternative in the treatment of patients with severe bilateral carotid stenosis.
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Affiliation(s)
- Xiong-Jing Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Dong
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Peng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu-Bao Zou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui-Min Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hai-Ying Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xian-Liang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Jin Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Run-Lin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kim A, Kwon TW, Han Y, Kwon SU, Kwon H, Noh M, Cho YP. Clinical outcomes of staged bilateral carotid endarterectomy for bilateral carotid artery stenosis. Ann Surg Treat Res 2015; 89:261-7. [PMID: 26576406 PMCID: PMC4644907 DOI: 10.4174/astr.2015.89.5.261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/16/2015] [Accepted: 07/24/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This retrospective cohort study aimed to determine the clinical outcomes of staged bilateral carotid endarterectomy (CEA) for bilateral internal carotid artery (ICA) stenosis performed with a short interval between the primary and secondary CEA procedures. METHODS In our institution, 574 consecutive patients underwent CEA between September 2007 and August 2014. Bilateral significant ICA stenosis was identified in 43 patients (7.5%) who underwent staged bilateral CEA within 30 days or less. Patients with unilateral CEA and staged bilateral CEA were compared in terms of CEA outcomes. The primary endpoint was the composite of any stroke, myocardial infarction, or death during the periprocedural period or ipsilateral stroke within 3 years after the CEA. RESULTS Staged bilateral CEA was not associated with ipsilateral stroke (P = 0.178) during postoperative follow-up. The two groups did not differ in terms of estimated 3-year primary endpoint rates (2.8% vs. 4.7%, P = 0.456) or ipsilateral stroke-free (P = 0.225), any stroke-free (P = 0.326), or overall (P = 0.739) survival rates. CONCLUSION Patients with bilateral significant ICA stenosis can undergo staged bilateral CEA within 30 days or less with outcomes that compare favorably with those of patients undergoing unilateral CEA.
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Affiliation(s)
- Amy Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Won Kwon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youngjin Han
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyunwook Kwon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Minsu Noh
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Pil Cho
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Liu B, Wei W, Wang Y, Yang X, Yue S, Zhang J. Treatment Strategy for Bilateral Severe Carotid Artery Stenosis: One Center's Experience. World Neurosurg 2015; 84:820-5. [PMID: 25871783 DOI: 10.1016/j.wneu.2015.03.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 03/28/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe 1 center's experience using carotid artery stenting (CAS) or carotid endarterectomy (CEA) as a treatment strategy in patients with bilateral carotid artery stenosis. METHODS Patients with severe carotid artery stenosis, including bilateral carotid artery stenosis, treated by CEA or CAS during the period 2008-2013 were reviewed retrospectively. The selection of treatment depended on the individual patient's medical comorbidities, neurologic condition, and clinical and anatomic arterial factors. The main adverse events included death from any cause, major stroke within 30 days, and death between 30 days and 1 year later from the treated carotid artery or ipsilateral major stroke. RESULTS There were 27 patients with bilateral carotid artery stenosis treated, including 11 patients with bilateral CEA, 9 patients with CEA on one side and CAS on the other side, and 7 patients with bilateral CAS. Of patients with unilateral carotid artery stenosis, 69 were treated with CEA, and 75 were treated with CAS. The incidence of main adverse events for the bilateral patients was 7.4%, similar to the unilateral patients undergoing CEA and CAS (8.7% and 6.7%, respectively). Restenosis occurred in 4 treated carotid arteries in bilateral patients within 1 year (4 of 54 [7.4%]); this was not significantly different from unilateral patients undergoing CEA and CAS (4 of 69 [5.8%] and 6 of 75 [8.0%], respectively). Local complications were not more frequent in bilateral patients. CONCLUSIONS Good outcomes can be achieved in patients with bilateral carotid artery stenosis when treatment selection is based on each individual patient's clinical characteristics and with a proper combination of staged CEA and CAS.
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Affiliation(s)
- Bing Liu
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.
| | - Wei Wei
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Yongli Wang
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xinyu Yang
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Shuyuan Yue
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
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Buratti L, Balucani C, Viticchi G, Falsetti L, Altamura C, Avitabile E, Provinciali L, Vernieri F, Silvestrini M. Cognitive deterioration in bilateral asymptomatic severe carotid stenosis. Stroke 2014; 45:2072-7. [PMID: 24903984 DOI: 10.1161/strokeaha.114.005645] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE This study aimed to monitor cognitive performance during a 3-year period in subjects with bilateral asymptomatic severe internal carotid artery stenosis and to explore the role of cerebral hemodynamics and atherosclerotic disease in the development of cognitive dysfunction. METHODS One hundred fifty-nine subjects with bilateral asymptomatic severe internal carotid artery stenosis were included and prospectively evaluated for a 3-year period. At entry, demographics, vascular risk profile, and pharmacological treatments were defined. Cognitive status was evaluated using the Mini-Mental State Examination at baseline and at follow-up. Cerebral hemodynamics was assessed by transcranial Doppler-based breath-holding index test. As a measure of the extent of systemic atherosclerotic disease, common carotid artery intima-media thickness was measured. A cutoff for pathological values was set at 0.69 for breath-holding index and 1.0 mm for intima-media thickness. RESULTS The risk of decreasing in Mini-Mental State Examination score increased progressively from patients with bilaterally normal to those with unilaterally abnormal breath-holding index, reaching the highest probability in patients with bilaterally abnormal breath-holding index (P<0.0001). Pathological values of intima-media thickness did not influence the risk of Mini-Mental State Examination score change. CONCLUSIONS Our findings suggest that patients with asymptomatic bilateral severe internal carotid artery stenosis may be at risk of developing cognitive impairment. The evaluation of the hemodynamic status, besides providing insights about the possible mechanism behind the cognitive dysfunction present in carotid atherosclerotic disease, may be of help for the individuation of subjects deserving earlier and more aggressive treatments.
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Affiliation(s)
- Laura Buratti
- From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.)
| | - Clotilde Balucani
- From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.)
| | - Giovanna Viticchi
- From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.)
| | - Lorenzo Falsetti
- From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.)
| | - Claudia Altamura
- From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.)
| | - Emma Avitabile
- From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.)
| | - Leandro Provinciali
- From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.)
| | - Fabrizio Vernieri
- From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.)
| | - Mauro Silvestrini
- From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.).
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Alurkar A, Karanam LSP, Nayak S, Oak S. Simultaneous bilateral carotid stenting in a series of 9 patients: a single-center experience with review of literature. J Clin Imaging Sci 2013; 2:72. [PMID: 23393629 PMCID: PMC3551520 DOI: 10.4103/2156-7514.104305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 10/16/2012] [Indexed: 11/18/2022] Open
Abstract
Objectives: Simultaneous bilateral carotid artery stenting (SBCAS) is a challenging procedure, and selection criteria play an important role in determining the final outcome. The aim of the present study was to determine the efficacy and safety of the SBCAS in a series of 9 patients with significant bilateral carotid artery disease (>50% on the symptomatic side and >60% on the asymptomatic side). Materials and Methods: The present study is a retrospective study of 9 patients from January 2005 to December 2012 in a tertiary care center. There were 8 males and 1 female in the age range 50 to 75 years and an average mean age of 63 years. Inclusion criteria of the present study were patients with bilateral internal carotid artery stenosis >50% (50 - 99%) in the symptomatic side and >60% in the asymptomatic side as seen on digital subtraction angiography (DSA). SBCAS with use of distal protection device (Spider device, ev3), to prevent intra-procedural embolic migration, was done in all the patients. Results: Technical success was achieved in all patients (100%). Post-procedural events in the form of hypotension and bradycardia occurred in 3 patients after the placement of stent on both the sides, in 2 patients after the placement of the first stent, and in 1 patient after the placement of the second stent. We did not encounter any cases of hyperperfusion, which was a concern in these patients. There were no deaths, major or minor strokes, or myocardial infarction either in the post-procedural period (up to 1 month) or on clinical follow-up 3 and 6 months post-treatment. Conclusion: SBCAS was an effective and safe alternative treatment method in a select group of patients with bilateral carotid artery disease. It can be considered as a feasible treatment option with acceptable risks.
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Affiliation(s)
- Anand Alurkar
- Department of Neurointervention, King Edward Memorial Hospital, Pune, Maharashtra, India
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Hong CT, Chan HF, Lee SP, Jang JS. Cerebral infarct in patients with bilateral high-grade internal carotid artery stenosis: analysis by diffusion-weighted imaging. Eur Neurol 2011; 65:88-93. [PMID: 21252556 DOI: 10.1159/000323514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 12/08/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bilateral high-grade internal carotid artery (ICA) stenosis is critical for brain perfusion, and mechanisms of cerebral infarct induced by bilateral high-grade ICA stenosis can be investigated by the infarct patterns on diffusion-weighted imaging (DWI). METHODS From January 2006 to October 2010, we retrospectively enrolled 21 acute infarct patients with bilateral high-grade ICA stenosis. The infarct patterns were divided into territory, cortical border-zone and internal border-zone by DWI. RESULTS The milder ICA stenosis side had a lower risk of ischemic stroke (4 of 20). None of the 8 patients with bilateral severe ICA stenosis (70-99%) suffered ischemic stroke ipsilateral to the milder ICA stenosis side. No single infarct mechanism was prominent: 10 of 21 infarcts were cortical border-zone pattern, followed by internal border-zone (7 of 21) and territory. The difference in frequency of bilateral severe ICA stenosis between the three infarct mechanisms was not significant (p = 0.856). CONCLUSIONS Cerebral infarcts occurred less frequently in the ipsilateral to milder ICA stenosis side, especially in bilateral severe ICA stenosis. The similar frequencies and hemodynamic status between the three infarct pattern groups indicated that both artery-to-artery emboli and being hemodynamically compromised contribute synergistically to bilateral ICA stenosis.
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Affiliation(s)
- Chien-Tai Hong
- Department of Neurology, Far Eastern Memorial Hospital, Taipei, Taiwan, ROC.
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Higashida RT, Popma JJ, Apruzzese P, Zimetbaum P. Evaluation of the Medtronic Exponent Self-Expanding Carotid Stent System With the Medtronic Guardwire Temporary Occlusion and Aspiration System in the Treatment of Carotid Stenosis. Stroke 2010; 41:e102-9. [DOI: 10.1161/strokeaha.109.564161] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Randall T. Higashida
- From the Department of Radiology and Neurosurgery (R.T.H.), University of California at San Francisco Medical Center, San Francisco, Calif; Beth Israel Deaconess Medical Center (J.J.P., P.Z.), Boston, Mass; and Harvard Cardiac Research Institute (P.A.), Boston, Mass
| | - Jeffrey J. Popma
- From the Department of Radiology and Neurosurgery (R.T.H.), University of California at San Francisco Medical Center, San Francisco, Calif; Beth Israel Deaconess Medical Center (J.J.P., P.Z.), Boston, Mass; and Harvard Cardiac Research Institute (P.A.), Boston, Mass
| | - Patricia Apruzzese
- From the Department of Radiology and Neurosurgery (R.T.H.), University of California at San Francisco Medical Center, San Francisco, Calif; Beth Israel Deaconess Medical Center (J.J.P., P.Z.), Boston, Mass; and Harvard Cardiac Research Institute (P.A.), Boston, Mass
| | - Peter Zimetbaum
- From the Department of Radiology and Neurosurgery (R.T.H.), University of California at San Francisco Medical Center, San Francisco, Calif; Beth Israel Deaconess Medical Center (J.J.P., P.Z.), Boston, Mass; and Harvard Cardiac Research Institute (P.A.), Boston, Mass
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Liu S, Jung JH, Kim SM, Lim HK, Kwon HJ, Kim JK, Kim JS, Suh DC. Simultaneous bilateral carotid stenting in high-risk patients. AJNR Am J Neuroradiol 2010; 31:1113-7. [PMID: 20053810 DOI: 10.3174/ajnr.a1970] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The safety and efficacy of SBCAS have not been evaluated in detail. The purpose of our study was to evaluate the outcome after SBCAS in high-risk patients compared with unilateral stent placement. MATERIALS AND METHODS Between March 2002 and October 2008, a total of 205 consecutive high-risk patients underwent CAS at our institution. Of these patients, 30 (14.6%) underwent SBCAS (n = 24) and staged SBCAS (n = 6). Patients who underwent unilateral CAS (n = 175) during the same period served as controls. The stroke risk factors, procedural results, and outcome at 30 days and 6 months, as well as the restenosis rate at 6 months, were compared by using either the chi(2) test or the Kruskal-Wallis equality-of-populations rank test. RESULTS Our data revealed no significant differences in the stroke risk factors between the SBCAS and the control group. HPS occurred more commonly in SBCAS (ie, 16.7%, 4/24) compared with 2.9% (5/175) in the control group (P = .014). However, there was no statistical significance between 2 groups in the event rate of stroke (minor and/or major stroke), death, or restenosis at 6 months. CONCLUSIONS There was no significant difference in outcome at 6 months following stent placement between SBCAS and unilateral CAS in the high-risk patient group, even though HPS occurred more commonly after SBCAS.
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Affiliation(s)
- S Liu
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
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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).
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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
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