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Lungu CN, Creteanu A, Mehedinti MC. Endovascular Drug Delivery. Life (Basel) 2024; 14:451. [PMID: 38672722 PMCID: PMC11051410 DOI: 10.3390/life14040451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Drug-eluting stents (DES) and balloons revolutionize atherosclerosis treatment by targeting hyperplastic tissue responses through effective local drug delivery strategies. This review examines approved and emerging endovascular devices, discussing drug release mechanisms and their impacts on arterial drug distribution. It emphasizes the crucial role of drug delivery in modern cardiovascular care and highlights how device technologies influence vascular behavior based on lesion morphology. The future holds promise for lesion-specific treatments, particularly in the superficial femoral artery, with recent CE-marked devices showing encouraging results. Exciting strategies and new patents focus on local drug delivery to prevent restenosis, shaping the future of interventional outcomes. In summary, as we navigate the ever-evolving landscape of cardiovascular intervention, it becomes increasingly evident that the future lies in tailoring treatments to the specific characteristics of each lesion. By leveraging cutting-edge technologies and harnessing the potential of localized drug delivery, we stand poised to usher in a new era of precision medicine in vascular intervention.
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Affiliation(s)
- Claudiu N. Lungu
- Department of Functional and Morphological Science, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania;
| | - Andreea Creteanu
- Department of Pharmaceutical Technology, University of Medicine and Pharmacy Grigore T Popa, 700115 Iași, Romania
| | - Mihaela C. Mehedinti
- Department of Functional and Morphological Science, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania;
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Panthofer AM, Yi JA, Chiou AC, Matsumura JS. Acute ischemia secondary to popliteal artery stent fracture and embolization. J Vasc Surg Cases Innov Tech 2023; 9:101143. [PMID: 37799850 PMCID: PMC10547732 DOI: 10.1016/j.jvscit.2023.101143] [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: 12/27/2022] [Accepted: 02/14/2023] [Indexed: 10/07/2023] Open
Abstract
Femoropopliteal disease comprises more than one half of lesions in peripheral vascular disease. The treatment modalities for stenosis or occlusion of this anatomic region include femoropopliteal bypass and percutaneous transluminal angioplasty with or without stenting. Our patient developed acute leg ischemia 3 years after stenting, secondary to stent fracture, with distal embolization of stent fragments. Using mechanical thromboembolectomy and superficial femoral artery to below-the-knee popliteal in situ saphenous vein bypass, we were able to restore perfusion to the limb and retrieve fragments of the fractured stent.
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Affiliation(s)
- Annalise M. Panthofer
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jeniann A. Yi
- Division of Vascular Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Jon S. Matsumura
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Ma W, Cheng Z, Chen X, Huang C, Yu G, Chen G. Multiphase Flow Hemodynamic Evaluation of Vertebral Artery Stenosis Lesions and Plaque Stability. Biomed Mater Eng 2023; 34:247-260. [PMID: 36245366 DOI: 10.3233/bme-221436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Atherosclerosis is one of the main causes of vertebral artery stenosis, which reduces blood supply to the posterior circulation, resulting in cerebral infarction or death. OBJECTIVE To investigate stenosis rates and locations on the development of vertebral artery plaques. METHODS Stenosis models with varying degrees and positions of stenosis were established. The stenosis area was comprehensively analyzed using multiphase flow numerical simulation. Wall shear stress (WSS), blood flow velocity, and red blood cell (RBC) volume fraction were calculated. RESULTS Blood flow velocity in 30-70% stenosis of each segment tended to increase significantly higher than normal. Downstream of 50% stenosis exhibited turbulent flow; downstream of 70% displayed reflux. Severe stenosis increases the WSS and distribution area. The mixed area of high and low WSS appeared downstream of the stenosis. The RBC volume fraction at the stenosis increased (maximum value: 0.487 at 70% stenosis in the V4), which was 1.08 times the normal volume fraction. Turbulent and backflow regions exhibited complex RBC volume fraction distributions. CONCLUSION Flow velocity, WSS, and RBC volume fraction at the stenosis increase with stenosis severity, increasing plaque shedding. Narrow downstream spoiler and reflux areas possess low WSS and high erythrocyte volume fractions, accelerating plaque growth.
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Affiliation(s)
- Wei Ma
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
| | - Zhiguo Cheng
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
| | - Xiaoqin Chen
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
| | - Chengdu Huang
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
| | - Guanghao Yu
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
| | - Guangxin Chen
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
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Ichikawa T, Yasuda R, Yamamoto A, Nishikawa H, Fujimoto M, Miura Y, Toma N, Suzuki H. Folding Deformation of Open-Cell Stents in Carotid Artery Stenting: Report of Three Cases and Review of Literature. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 16:570-575. [PMID: 37501740 PMCID: PMC10370877 DOI: 10.5797/jnet.cr.2022-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/02/2022] [Indexed: 07/29/2023]
Abstract
Objective We describe 3 cases with folding deformation of a PRECISE (Cordis, Miami, FL, USA) stent in carotid artery stenting (CAS). Case Presentations The 3 cases with cervical carotid stenosis consisted of 3 males around 80 years old and included 2 symptomatic lesions. During CAS, distal embolic protection was established using a Mo.Ma (Medtronic, Minneapolis, MN, USA) along with a filter device in 2 cases and an Optimo (Tokai Medical Products, Aichi, Japan) along with a filter device in 1 case. For the filter device, either FilterWire EZ (Boston Scientific, Natick, MA, USA) or Spider FX (Covidien, Irvine, CA, USA) was employed. In all cases, a PRECISE stent was deployed after pre-dilation performed using a percutaneous transluminal angioplasty (PTA) balloon with the diameter of 2.5 to 3 mm. Post-dilation was performed after the stent deployment using a PTA balloon whose diameter was about 80% of that of the normal distal internal carotid artery. In all cases, cone-beam CT taken after the deployment of a stent showed folding deformation of the stent. In 2 cases, heavily calcified plaque hampered self-expansion of the stent, which resulted in the stent deformation. On the other hand, in the remaining 1 case, a distal shaft of the Mo.Ma caused the stent deformation, which was likely accelerated by head rotation and cervical compression that was performed to resolve difficulties for a filter retrieval device to pass through the stent, and post-dilation after the stenting. Conclusion Heavily calcified plaque and a distal shaft of a Mo.Ma would result in stent deformation.
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Affiliation(s)
- Tomonori Ichikawa
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Ryuta Yasuda
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Atsushi Yamamoto
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hirofumi Nishikawa
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masashi Fujimoto
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yoichi Miura
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Naoki Toma
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Assessing the Suitability of the Carotid Bifurcation for Stenting: Anatomic and Morphologic Considerations. J Vasc Surg 2021; 74:2087-2095. [PMID: 34175382 DOI: 10.1016/j.jvs.2021.05.048] [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: 11/05/2020] [Accepted: 05/04/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Over the years where stents have been used to treat carotid lesions, a great deal has been learned about which anatomical characteristics lead to adverse outcomes. This review summarizes the anatomic and morphologic characteristics of the carotid vasculature that can help guide patient selection and clinical decision-making. METHODS Each of the carotid artery anatomy and lesion characteristics that are relevant to carotid stenting are described in detail. These are accompanied with evidence-based outcomes and results. RESULTS Data on the prevalence of carotid artery lesions that are unsuitable for stenting are summarized and the implications of these data for practice are discussed, especially as they pertain to transcarotid artery revascularization. CONCLUSIONS CAS can be viable option for carotid revascularization, but the lesion must be acceptable and safe for stent placement. There should be thorough assessment to rule out the presence of severe tortuosity, long-segment disease, severe calcification (circumferential or exophytic), mobile-plaque, swollen ICA sign, and carotid diameters outside the acceptable range. In carefully chosen lesions with the absence of the unfavorable characteristics described-TCAR may offer improved periprocedural success, and CAS may attain better long-term durability.
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Marlevi D, Edelman ER. Vascular Lesion-Specific Drug Delivery Systems: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:2413-2431. [PMID: 33985687 PMCID: PMC8238531 DOI: 10.1016/j.jacc.2021.03.307] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/08/2021] [Accepted: 03/21/2021] [Indexed: 01/15/2023]
Abstract
Drug delivery is central to modern cardiovascular care, where drug-eluting stents, bioresorbable scaffolds, and drug-coated balloons all aim to restore perfusion while inhibiting exuberant healing. The promise and enthusiasm of these devices has in some cases exceeded demonstration of efficacy and even understanding of driving mechanisms. The authors review the means of drug delivery in each device, outlining how the technologies affect vascular behavior. They focus on how drug retention and response are governed by lesion morphology: lipid displacing drug-specific binding sites, calcium inhibiting diffusion, blocking thrombi or promoting luminal washout, and vascular healing steering hyperplastic developments. In this regard, the authors outline the fundamental impact of vascular structure on drug delivery and review the development of contemporary and future devices for coronary and peripheral intervention. They look toward a future where incorporating information on lesion distribution is central to therapeutic success and envision a transition toward lesion-specific treatment for improved interventional outcomes.
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Affiliation(s)
- David Marlevi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Fuse Y, Tajima H, Nakamura S, Kurimoto F, Watanabe K. Prevention of Stroke with Closed-Cell Stent-in-Stent for Carotid Artery Stenosis Due to Stent Fracture. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:52-55. [PMID: 37502023 PMCID: PMC10370623 DOI: 10.5797/jnet.cr.2020-0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/31/2021] [Indexed: 07/29/2023]
Abstract
Objective Stent fracture is a risk factor for stroke. It has not been fully elucidated whether stent-in-stent procedures can effectively treat stent fractures. Case Presentation An 80-year-old man underwent carotid artery stenting (CAS) with an open-cell stent to treat asymptomatic right internal carotid artery (ICA) stenosis. Type III stent fracture occurred during CAS. Six months later, in-stent stenosis progressed on DSA. Repeat CAS with a closed-cell stent was performed. CT showed expansion of the narrowed lumen. The patient remained stroke-free and carotid artery restenosis did not occur for 3 years postoperatively. Conclusion Repeat CAS with a closed-cell stent is a viable treatment option for stent fracture.
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Affiliation(s)
- Yutaro Fuse
- Department of Neurosurgery, Handa City Hospital, Handa, Aichi, Japan
| | - Hayato Tajima
- Department of Neurosurgery, Handa City Hospital, Handa, Aichi, Japan
| | | | - Futoshi Kurimoto
- Department of Neurosurgery, Handa City Hospital, Handa, Aichi, Japan
| | - Kazuhiko Watanabe
- Department of Neurosurgery, Handa City Hospital, Handa, Aichi, Japan
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Failed carotid artery stenting followed by successful surgical intervention: Case report. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:259-262. [PMID: 34104521 PMCID: PMC8167460 DOI: 10.5606/tgkdc.dergisi.2021.21207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/06/2021] [Indexed: 11/29/2022]
Abstract
A 56-year-old female patient with significant carotid stenoses with circumferential plaques, causing localized vascular narrowing, was inappropriately indicated for carotid artery stenting. After placement of a distal embolic protection device in the left internal carotid artery, a stent was inserted; however, it could not be fully deployed due to the rigid, severely calcified vascular walls. The various endovascular attempts to recapture the protection device were futile and, eventually, led to fracture of the guidewire of the device and it remained entrapped together with the stent. Emergency carotid arteriotomy with extirpation of the stent and embolic protection device via carotid thromboendarterectomy was performed. In conclusion, the proper patient selection for carotid artery stenting is of utmost importance.
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Ezura M, Kimura N, Sakata H, Ishida T, Inoue T, Uenohara H. Carotid Artery Stenting Using Balloon-Expandable Coronary Stent: Intentional Use for Staged Angioplasty. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 15:621-628. [PMID: 37501748 PMCID: PMC10370791 DOI: 10.5797/jnet.tn.2020-0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/05/2020] [Indexed: 07/29/2023]
Abstract
Objective We report carotid artery stenting (CAS) using balloon-expandable coronary (BECo) stent. The materials in this study consist of 15 cases of high-grade stenosis in internal carotid artery (ICA) in which self-expanding carotid (SECa) stent was not utilized. There were two groups why BECo stent was used instead of SECa stent: alternative group and intentional group. The alternative group was subdivided into two groups: access difficulty of guiding catheter and access difficulty of SECa stent. Case Presentation The alternative group included 11 cases (access difficulty of guiding catheter in 10 and access difficulty of SECa stent in 1), and the intentional group included 4 cases. There were four cases using transbrachial approach. All the intentional group cases were the first stage of staged angioplasty (SAP). The second stage of SAP was PTA in two and SECa stent over the BECo stent in two. There was no complication related to CAS. Conclusion CAS using BECo stent is one of the choices for the first stage of SAP, if stent placement instead of PTA is required at the first stage. It is also the useful alternative for the patient having difficulty of SECa stent.
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Affiliation(s)
- Masayuki Ezura
- Department of Neurosurgery, NHO Sendai Medical Center, Sendai, Miyagi, Japan
| | - Naoto Kimura
- Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | - Hiroyuki Sakata
- Department of Neurosurgery, NHO Sendai Medical Center, Sendai, Miyagi, Japan
| | - Tomohisa Ishida
- Department of Neurosurgery, NHO Sendai Medical Center, Sendai, Miyagi, Japan
| | - Takashi Inoue
- Department of Neurosurgery, NHO Sendai Medical Center, Sendai, Miyagi, Japan
| | - Hiroshi Uenohara
- Department of Neurosurgery, NHO Sendai Medical Center, Sendai, Miyagi, Japan
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Silva DA, de Aguiar GB, Jory M, Conti MLM, Veiga JCE. "Whiplash" cervical trauma with fracture and migration of carotid stent fragments. Surg Neurol Int 2020; 11:329. [PMID: 33194263 PMCID: PMC7656007 DOI: 10.25259/sni_550_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background: Angioplasty using a carotid stent is a treatment modality for carotid stenosis, with results similar to those obtained with endarterectomy, as demonstrated by important studies. The increasing use of this procedure has also led to a larger number of reports of complications, stent fractures among those. Stent fracture is a rare manifestation and hence needs further studying so that its actual prevalence can be determined, as well as its associated risk factors and proper clinical management. The current study reports the case of a patient who had previously undergone angioplasty with a carotid stent and, after an automobile accident, presented with a stent fracture and distal embolization of fragments thereof with neurological manifestation. Case Description: A male patient, 40 years old, presented with a history of previously stent carotid angioplasty. He had been involved in an automobile accident and suffered a stent fracture with distal fragment migration. As he was an asymptomatic patient (NIHSS 0, Rankin zero), we opted for a conservative treatment with oral anticoagulant. Conclusion: Angioplasty is an effective treatment for extracranial atherosclerosis and, albeit rare, stent fractures can result in the migration of fragments thereof. This occurrence should be suspected in patients who have sustained severe neck injuries due to sudden deceleration and may be associated with thromboembolism.
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Affiliation(s)
- Danilo Almeida Silva
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Guilherme Brasileiro de Aguiar
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Maurício Jory
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Mario Luiz Marques Conti
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - José Carlos Esteves Veiga
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
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Hüttl AB, Hüttl A, Vértes M, Nguyen DT, Bérczi Á, Hüttl K, Dósa E. The presence of long and heavily calcified lesions predisposes for fracture in patients undergoing stenting of the first part of the subclavian artery. J Vasc Surg 2019; 70:1146-1154.e1. [PMID: 30926275 DOI: 10.1016/j.jvs.2019.01.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/08/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prevalence and risk factors of subclavian artery stent fractures and to investigate their impact on in-stent restenosis development. METHODS One hundred eight patients (65 females; median age, 58.3 years [interquartile range, 53.4-65.5 years]) with steno-occlusive disease of the first part of the subclavian artery who underwent stenting (N = 108 stents; balloon-expandable, 83.3%; self-expandable, 16.7%) between 2005 and 2015 and returned for a fluoroscopic examination of the implanted stents in 2017 were included in our study. Fractures were type I (single strut fracture), type II (multiple strut fractures without deformation), type III (multiple strut fractures with deformation), type IV (multiple strut fractures with acquired transection but without gap), or type V (multiple strut fractures with acquired transection with gap in the stent body). Stent patency was monitored by duplex ultrasound imaging. The Mann-Whitney U and Fisher's exact tests; Kaplan-Meier, receiver operating characteristic, and logistic regression analyses; as well as a log-rank test were used as statistical methods. RESULTS The median follow-up was 73.8 months (interquartile range, 35.6-104.2 months). Thirty-eight fractures (35.2%) were detected; fractures were type I in 13, type II in 12, type III in 6, type IV in 4, and type V in 3 cases. Multivariable logistic regression analysis revealed the presence of long (≥20 mm) lesions (odds ratio, 3.3; 95% confidence interval, 1.3-8.4; P = .012) and heavy calcification (odds ratio, 4.7; 95% confidence interval, 1.7-12.7; P = .002) to be significant independent predictors of stent fracture. The primary patency rates were significantly worse (P = .035) in patients with stent fracture compared with those without stent fracture. CONCLUSIONS Stent fractures frequently occur. Patients with long and/or heavily calcified lesions require closer follow-up.
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Affiliation(s)
| | - Artúr Hüttl
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Miklós Vértes
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dat Tin Nguyen
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ákos Bérczi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Kálmán Hüttl
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Edit Dósa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
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Tan D, Crockett MT, Chiu AHY. Delayed tine Displacement of a CASPER Carotid Artery Stent due to Styloid Process Compression. Clin Neuroradiol 2019; 29:567-569. [PMID: 30715555 DOI: 10.1007/s00062-019-00761-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/16/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Daren Tan
- Neurological Intervention & Imaging Service of WA [NIISwa], SCGH, RPH & FSH, Department of Health, Level 1, G Block, Hospital Ave, Nedlands, 6009, WA, Australia.
| | - Matthew Thomas Crockett
- Neurological Intervention & Imaging Service of WA [NIISwa], SCGH, RPH & FSH, Department of Health, Level 1, G Block, Hospital Ave, Nedlands, 6009, WA, Australia
| | - Albert Ho Yuen Chiu
- Neurological Intervention & Imaging Service of WA [NIISwa], SCGH, RPH & FSH, Department of Health, Level 1, G Block, Hospital Ave, Nedlands, 6009, WA, Australia
- UWA Medical School, Division of Medicine, University of Western Australia, 6009, Crawley, WA, Australia
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Arai S, Ikeda H, Kawamo M, Kamiya Y, Mizutani T. Surgical Rescue Retrieval of a Filter Protection Device in Carotid Artery Stenting with Stent Deformation: Case Report and Literature Review. World Neurosurg 2018; 122:215-219. [PMID: 30415040 DOI: 10.1016/j.wneu.2018.10.214] [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: 09/09/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the development of neuroendovascular treatment, device-related complications requiring surgical procedures remain. We report a case requiring surgical retrieval of a filter protection device in carotid artery stenting (CAS) with an open-cell stent, due to stent deformation, and review past reports on CAS in which surgical retrieval of devices was required. CASE DESCRIPTION An 82-year-old man underwent CAS for symptomatic right internal carotid artery stenosis with severe calcification and tortuosity. Immediately after placement of the open-cell stent, stent deformation was detected and the filter protection device could not be retrieved. All noninvasive device retrieval attempts failed, and the device was ultimately retrieved surgically. After surgery, right cerebral infarction progressed increased, but no permanent deficit was observed. CONCLUSIONS As the treatment of cerebrovascular disease shifts from surgical to endovascular approaches, surgeons must be familiar with devices and techniques to manage complications of neuroendovascular treatment.
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Affiliation(s)
- Shintaro Arai
- Department of Neurosurgery, Showa University School of Medicine, Shinagawa, Tokyo, Japan; Department of Neurosurgery, Showa University, Koto-Toyosu Hospital, Tokyo, Japan.
| | - Hisato Ikeda
- Department of Neurosurgery, Showa University, Koto-Toyosu Hospital, Tokyo, Japan
| | - Michiari Kawamo
- Department of Neurosurgery, Showa University, Koto-Toyosu Hospital, Tokyo, Japan
| | - Yuki Kamiya
- Department of Neurology, Showa University, Koto-Toyosu Hospital, Tokyo, Japan
| | - Tohru Mizutani
- Department of Neurosurgery, Showa University School of Medicine, Shinagawa, Tokyo, Japan
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Millet JD, Cavallo JJ, Scoutt LM, Gunabushanam G. Sonographic Evaluation of Complications of Extracranial Carotid Artery Interventions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:769-781. [PMID: 28877355 DOI: 10.1002/jum.14376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 06/07/2023]
Abstract
Carotid endarterectomy and carotid artery stenting are among the most common peripheral vascular procedures performed worldwide. Sonography is the initial and often only imaging modality used in the evaluation of iatrogenic carotid arterial injuries. This pictorial essay provides an overview of the clinical and sonographic findings of complications after interventions in the extracranial carotid arteries, including dissection, fluid collections, pseudoaneurysm, thrombosis, thromboembolism, restenosis, and stent deformation. Grayscale, color, and pulsed Doppler imaging findings are reviewed, and correlations with computed tomography, magnetic resonance imaging, and angiography are provided.
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Affiliation(s)
- John D Millet
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Joseph J Cavallo
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Leslie M Scoutt
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gowthaman Gunabushanam
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
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Naeem AH, Al-Rumaihi G, Namavarian A, Sharma M, Boulton M. Balloon Angioplasty for In-Stent Restenosis Resulting in Carotid Stent Fracture: Literature Review of Stent-in-Stent Technique as a Viable Therapeutic Option. World Neurosurg 2017; 101:818.e1-818.e6. [DOI: 10.1016/j.wneu.2017.01.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/28/2017] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
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16
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Simgen A, Ley D, Roth C, Cattaneo GFM, Mühl-Benninghaus R, Müller A, Körner H, Kim YJ, Scheller B, Reith W, Yilmaz U. Evaluation of occurring complications after flow diverter treatment of elastase-induced aneurysm in rabbits using micro-CT and MRI at 9.4 T. Neuroradiology 2016; 58:987-996. [DOI: 10.1007/s00234-016-1730-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/12/2016] [Indexed: 12/22/2022]
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17
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Abstract
Eagle syndrome is a rare condition resulting from elongation of the temporal styloid process or calcification of its associated stylohyoid ligaments. Although usually presenting with pain or odynophagia, Eagle syndrome has been reported to cause a multitude of neurologic symptoms or vascular complications, some of which can be life-threatening. We present a case in which an endovascularly placed internal carotid artery stent in close proximity to a calcified stylohyoid ligament resulted in stent fracture with subsequent stent and vessel occlusion. We review and discuss the presentation, diagnosis, etiology, complications and treatment options of the syndrome.
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Affiliation(s)
- Jeffrey D Hooker
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - David A Joyner
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Edward P Farley
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Majid Khan
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA
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18
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Barrett H, Cunnane E, Kavanagh E, Walsh M. On the effect of calcification volume and configuration on the mechanical behaviour of carotid plaque tissue. J Mech Behav Biomed Mater 2016; 56:45-56. [DOI: 10.1016/j.jmbbm.2015.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/02/2015] [Accepted: 11/04/2015] [Indexed: 12/15/2022]
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19
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Structural Mechanics Predictions Relating to Clinical Coronary Stent Fracture in a 5 Year Period in FDA MAUDE Database. Ann Biomed Eng 2015; 44:391-403. [PMID: 26467552 DOI: 10.1007/s10439-015-1476-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022]
Abstract
Endovascular stents are the mainstay of interventional cardiovascular medicine. Technological advances have reduced biological and clinical complications but not mechanical failure. Stent strut fracture is increasingly recognized as of paramount clinical importance. Though consensus reigns that fractures can result from material fatigue, how fracture is induced and the mechanisms underlying its clinical sequelae remain ill-defined. In this study, strut fractures were identified in the prospectively maintained Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience Database (MAUDE), covering years 2006-2011, and differentiated based on specific coronary artery implantation site and device configuration. These data, and knowledge of the extent of dynamic arterial deformations obtained from patient CT images and published data, were used to define boundary conditions for 3D finite element models incorporating multimodal, multi-cycle deformation. The structural response for a range of stent designs and configurations was predicted by computational models and included estimation of maximum principal, minimum principal and equivalent plastic strains. Fatigue assessment was performed with Goodman diagrams and safe/unsafe regions defined for different stent designs. Von Mises stress and maximum principal strain increased with multimodal, fully reversed deformation. Spatial maps of unsafe locations corresponded to the identified locations of fracture in different coronary arteries in the clinical database. These findings, for the first time, provide insight into a potential link between patient adverse events and computational modeling of stent deformation. Understanding of the mechanical forces imposed under different implantation conditions may assist in rational design and optimal placement of these devices.
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20
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van de Weijer M, Vonken E, de Vries JP, Moll F, Vos J, de Borst G. Technical and Clinical Success and Long-Term Durability of Endovascular Treatment for Atherosclerotic Aortic Arch Branch Origin Obstruction: Evaluation of 144 Procedures. Eur J Vasc Endovasc Surg 2015; 50:13-20. [DOI: 10.1016/j.ejvs.2015.03.058] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/27/2015] [Indexed: 11/16/2022]
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21
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Seo KD, Lee KY, Kim BM, Suh SH. Delayed cerebral infarction due to stent folding deformation following carotid artery stenting. Korean J Radiol 2014; 15:858-61. [PMID: 25469100 PMCID: PMC4248644 DOI: 10.3348/kjr.2014.15.6.858] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/09/2014] [Indexed: 11/15/2022] Open
Abstract
We report a case of delayed cerebral infarction due to stent longitudinal folding deformation following carotid artery stenting using a self-expandable stent with an open-cell design. The stented segment of the left common carotid artery was divided into two different lumens by this folding deformation, and the separated lumens became restricted with in-stent thrombosis. Although no established method of managing this rare complication exists, a conservative approach was taken with administration of anticoagulant and dual antiplatelet therapy. No neurological symptoms were observed during several months of clinical follow-up after discharge.
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Affiliation(s)
- Kwon-Duk Seo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea
| | - Kyung-Yul Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea. ; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul 135-720, Korea
| | - Byung Moon Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Sang Hyun Suh
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul 135-720, Korea. ; Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea
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22
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Millet JD, Stilp E, Kirsch JD, Gunabushanam G, Mena C, Pollak J, Scoutt LM. Carotid stent deformation: sonographic findings and CT correlation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:313-317. [PMID: 24926493 DOI: 10.1002/jcu.22108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Carotid artery dissection is a rare but potentially serious complication of endovascular procedures in the carotid arteries. Stent deformation or incomplete expansion may occur following endovascular repair of an iatrogenic carotid artery dissection and may mimic stent fracture. We report an unusual case of deformation of a common carotid artery open cell design stent following endovascular repair of an iatrogenic dissection, which resulted in persistent blood flow between the stent and the wall of the common carotid artery. Sonographic features are described and correlation with intravascular ultrasound and CT is provided.
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23
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Sirignano P, Setacci F, Galzerano G, de Donato G, Setacci C. Carotid false aneurysm after carotid stent fracture: report of a surgical solution. Vascular 2014; 23:105-10. [PMID: 24788063 DOI: 10.1177/1708538114532924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stent fracture has been well documented in the Literature and in the majority of cases arises from the exposition of the stent to unfavourable stresses and biomechanical forces. We report a case of carotid false aneurysm after stent placement for post-surgery restenosis. Stent fracture is a clinical reality that sometimes should be considered prior to stent deployment and may require monitoring or treatment after occurrence.
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Affiliation(s)
- Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery and Neurological Sciences, School of Medicine, University of Siena, Siena, Italy
| | - Francesco Setacci
- Department of Surgery "P. Valdoni", School of Medicine, "Sapienza" University of Rome, Italy
| | - Giuseppe Galzerano
- Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery and Neurological Sciences, School of Medicine, University of Siena, Siena, Italy
| | - Gianmarco de Donato
- Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery and Neurological Sciences, School of Medicine, University of Siena, Siena, Italy
| | - Carlo Setacci
- Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery and Neurological Sciences, School of Medicine, University of Siena, Siena, Italy
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24
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High frequency of brachiocephalic trunk stent fractures does not impair clinical outcome. J Vasc Surg 2014; 59:781-5. [DOI: 10.1016/j.jvs.2013.09.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 09/19/2013] [Accepted: 09/19/2013] [Indexed: 11/18/2022]
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25
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Complications and Solutions with Carotid Stenting. Interv Cardiol Clin 2014; 3:105-113. [PMID: 28582146 DOI: 10.1016/j.iccl.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Complications of carotid stenting can be classified as neurologic, cardiovascular, death, carotid, access site, device malfunctions, and general and late complications. The risk of most complications is related to readily identifiable patient and anatomic factors. Management and outcome of complications require immediate recognition and a team-based approach to patient care.
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26
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Wróbel W, Lesiak M, Sinkiewicz A. Fracture of a carotid stent and restenosis of common carotid artery. Arch Med Sci 2013; 9:953-6. [PMID: 24273584 PMCID: PMC3832815 DOI: 10.5114/aoms.2013.33178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 06/18/2011] [Accepted: 08/29/2011] [Indexed: 11/28/2022] Open
Affiliation(s)
- Wojciech Wróbel
- 2 Department and Clinic of Cardiology, Dr. J. Biziel Memorial University Hospital No. 2, Bydgoszcz, Poland
| | - Maciej Lesiak
- 1 Clinic of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Sinkiewicz
- Department of Phoniatry and Voice Rehabilitation, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
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27
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Al-Natour M, Renno A, El-Fedaly M, Abbas J, Nazzal M. Stent fracture in the brachiocephalic trunk. Vascular 2013; 21:261-5. [DOI: 10.1177/1708538113478775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stents are commonly used as a tool for revascularization of different vascular beds in the body. However, many pitfalls have been reported with their use, such as thrombosis, migration, restenosis or fractures. The latter have been strongly correlated to in-stent restenosis with long-term follow-up. We report a rare case of an early stent fracture in the brachiocephalic trunk with in-stent restenosis and recurrence of symptoms. To our knowledge there has been only one case report of a delayed brachiocephalic stent fracture in the English literature. We believe that our case is the first report of an early stent fracture in the brachiocephalic trunk.
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Affiliation(s)
- M Al-Natour
- Division of Vascular and Endovascular Surgery, The University of Toledo Medical Center, Toledo, OH, USA
| | - A Renno
- Division of Vascular and Endovascular Surgery, The University of Toledo Medical Center, Toledo, OH, USA
| | - M El-Fedaly
- Division of Vascular and Endovascular Surgery, The University of Toledo Medical Center, Toledo, OH, USA
| | - J Abbas
- Division of Vascular and Endovascular Surgery, The University of Toledo Medical Center, Toledo, OH, USA
| | - M Nazzal
- Division of Vascular and Endovascular Surgery, The University of Toledo Medical Center, Toledo, OH, USA
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28
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Mwipatayi BP, Leong BDK, Hockley J, Vijayan V. The pitfalls of femoropopliteal stenting trials. J Endovasc Ther 2013; 19:596-8. [PMID: 23046323 DOI: 10.1583/jevt-12-3898c.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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29
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Nolz R, Wibmer A, Beitzke D, Gentzsch S, Willfort-Ehringer A, Lammer J, Thurnher M, Schoder M. Carotid artery stenting and follow-up: Value of 64-MSCT angiography as complementary imaging method to color-coded duplex sonography. Eur J Radiol 2012; 81:89-94. [DOI: 10.1016/j.ejrad.2010.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 12/01/2010] [Accepted: 12/02/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Richard Nolz
- Department of Radiology, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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30
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Hynes BG, Ruggiero NJ, Hirsch JA, Rosenfield K. Carotid stent fracture and restenosis management. Vasc Med 2011; 16:436-42. [DOI: 10.1177/1358863x11422563] [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
We report an unusual case of asymptomatic accelerated right carotid artery in-stent restenosis in a patient referred for revascularization of a de novo stenosis of her left internal carotid artery.
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Affiliation(s)
- Brian G Hynes
- Section of Vascular Medicine and Peripheral Intervention, Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Nicholas J Ruggiero
- Section of Vascular Medicine and Peripheral Intervention, Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua A Hirsch
- Department of Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth Rosenfield
- Section of Vascular Medicine and Peripheral Intervention, Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
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31
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Abstract
The role of carotid artery stenting (CAS) as an alternative to carotid endarterectomy for the treatment of extracranial carotid occlusive disease for stroke prevention continues to evolve. Although technical and device refinements aimed at making CAS safer continue to this day, safety as measured by 30-day and 1-year outcomes has been the primary recipient of regulatory and practice attention. Relatively less emphasis has been placed on the incidence of recurrent stenosis after CAS and the efficacy of CAS in late stroke prevention. Data on late outcomes of CAS, including factors of potential influence, have been emerging and are addressed in this review.
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32
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Chang CK, Huded CP, Nolan BW, Powell RJ. Prevalence and clinical significance of stent fracture and deformation following carotid artery stenting. J Vasc Surg 2011; 54:685-90. [DOI: 10.1016/j.jvs.2011.03.257] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 03/03/2011] [Accepted: 03/12/2011] [Indexed: 10/17/2022]
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33
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Garcia-Toca M, Rodriguez HE, Naughton PA, Keeling A, Phade SV, Morasch MD, Kibbe MR, Eskandari MK. Are Carotid Stent Fractures Clinically Significant? Cardiovasc Intervent Radiol 2011; 35:263-7. [DOI: 10.1007/s00270-011-0149-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 02/25/2011] [Indexed: 11/28/2022]
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34
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Symptomatic Vertebral Artery Stent Fracture: A Case Report. J Vasc Interv Radiol 2010; 21:1751-4. [DOI: 10.1016/j.jvir.2010.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 05/13/2010] [Accepted: 07/08/2010] [Indexed: 11/18/2022] Open
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35
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Late Stent Fractures after Endoluminal Treatment of Ostial Supraaortic Trunk Arterial Occlusive Lesions. J Vasc Interv Radiol 2010; 21:1364-9. [DOI: 10.1016/j.jvir.2010.04.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 03/30/2010] [Accepted: 04/29/2010] [Indexed: 11/23/2022] Open
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36
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ADLAKHA SATJIT, SHEIKH MUJEEB, WU JASON, BURKET MARKW, PANDYA UTPAL, COLYER WILLIAM, ELTAHAWY EHAB, COOPER CHRISTOPHERJ. Stent Fracture in the Coronary and Peripheral Arteries. J Interv Cardiol 2010; 23:411-9. [DOI: 10.1111/j.1540-8183.2010.00567.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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37
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Carotid artery stent fracture identification and clinical relevance. J Vasc Surg 2010; 51:1397-405. [DOI: 10.1016/j.jvs.2010.02.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 02/01/2010] [Accepted: 02/01/2010] [Indexed: 11/19/2022]
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38
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Sfyroeras GS, Koutsiaris A, Karathanos C, Giannakopoulos A, Giannoukas AD. Clinical relevance and treatment of carotid stent fractures. J Vasc Surg 2010; 51:1280-5. [PMID: 20347546 DOI: 10.1016/j.jvs.2010.01.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 01/13/2010] [Accepted: 03/27/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To review all published reports and investigate the clinical relevance and need for treatment of carotid stent fractures. METHODS Electronic and hand-searching of the published literature and the Manufacturer and User Facility Device Experience (MAUDE) database. RESULTS Thirteen articles were published. There are 10 case reports and 3 clinical studies. There are 26 reports of fractured stents in the MAUDE database. Fifty-five cases of carotid stent fractures are reported in total. A total of 201 carotid stents were examined in the 3 studies, and the incidence of fractures was 8.9% (18/201). Fractured stents were 22 Xact, 20 Acculink, 6 Precise, 2 Exponent, 1 Nexstent, 1 Genesis, 1 Symbiot, and 2 nonspecified nitinol self-expandable stents. Twenty-seven of the treated carotid lesions were atherosclerotic, 3 restenoses after carotid endarterectomy, 2 postradiational, 1 pseudoaneurysm, and 22 lesions of unknown pathology. Calcification was reported in 15 of the 27 atherosclerotic lesions (55.5%). Time from implantation to fracture ranged from 0 days (fracture during implantation) to 37 months. In 55% of the cases, stent fracture was associated with restenosis. Six patients presented with symptoms. Treatment was reported for 32 patients: 14 patients underwent de novo stent placement, 2 balloon angioplasty, 2 carotid endarterectomy, 2 bypass graft (1 vein, 1 polytetrafluoroethylene), 1 anticoagulation, and 11 patients were followed up. CONCLUSION Carotid stent fractures are mainly reported in self-expandable nitinol stents. Plaque calcification may be a risk factor for stent fractures. No difference was observed between open and closed-cell design. Stent fractures were often associated with restenosis and usually were asymptomatic. The actual incidence, clinical relevance, and optimal treatment remain to be clarified from larger prospective studies designed to investigate the issue.
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Affiliation(s)
- Giorgos S Sfyroeras
- Department of Vascular Surgery, University Hospital of Larissa, University of Thessaly Medical School, Larissa, Greece
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39
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Carotid Stent Fracture with Recurrent High-Grade Stenosis. Ann Vasc Surg 2010; 24:254.e11-5. [DOI: 10.1016/j.avsg.2009.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 05/27/2009] [Indexed: 11/19/2022]
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40
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Kapoor B, Lockhart M, Sharma D, Maya ID. Brachiocephalic Vein Stent Fracture: Case Series and Literature Review. Semin Dial 2010; 23:110-3. [DOI: 10.1111/j.1525-139x.2009.00691.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Habib N, van der Heyden J. Acute fracture of ACCULINK carotid stent during post dilation. Catheter Cardiovasc Interv 2009; 74:1107-9. [DOI: 10.1002/ccd.22132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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42
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Affiliation(s)
- Ahmad Saad
- Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Jeffrey Pollak
- Department of Interventional Radiology, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Alan Dardik
- Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine, New Haven, CT, USA, , VA Connecticut Healthcare System, West Haven, CT, USA
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43
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Ross CB, Khoobehi A, Irwin CL, Dattilo JB, Naslund TC. Carotid Artery Stenting for Stenosis Following Cervical Radiotherapy: Report of Early Failure With Associated Stent Fracture. Vasc Endovascular Surg 2009; 43:599-605. [DOI: 10.1177/1538574409335038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Experience with carotid artery stenting (CAS) as an alternative to carotid endarterectomy (CE) for management of carotid stenosis continues to evolve. We report the case of a 64-year-old man who was treated with bilateral CAS for stenoses, which developed 7 years following thyroidectomy, neck dissection, and radiotherapy. Although long considered an ideal alternative to CE in this clinical setting, CAS in this case was complicated by multiple episodes of recurrent stenosis in his left carotid, managed by balloon angioplasty. Severe, early recurrence in his right carotid associated with a type III stent fracture was managed by CE. Close surveillance and intervention prevented neurologic morbidity. This case, combined with emerging published experience, argues for reappraisal of the general consensus that CAS is an ideal alternative to CE for radiotherapy-associated carotid stenoses.
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Affiliation(s)
| | - Ali Khoobehi
- Vanderbilt University Medical Center, Nashville, Tennessee
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44
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The use of flat panel angioCT (DynaCT) for navigation through a deformed and fractured carotid stent. Neuroradiology 2009; 52:629-32. [DOI: 10.1007/s00234-009-0556-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 06/22/2009] [Indexed: 10/20/2022]
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45
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Robertson SW, Cheng CP, Razavi MK. Biomechanical Response of Stented Carotid Arteries to Swallowing and Neck Motion. J Endovasc Ther 2008; 15:663-71. [DOI: 10.1583/08-2528.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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