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Fujita O, Hayashi S, Oshima R, Matsuyama T, Tamai H. Use of covered stent grafts to treat an extracranial carotid artery aneurysm due to carotid stent deformation: A case report. Clin Neurol Neurosurg 2024; 241:108272. [PMID: 38636359 DOI: 10.1016/j.clineuro.2024.108272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/21/2024] [Accepted: 03/31/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Ohju Fujita
- Department of Neurosurgery, Kasugai Municipal Hospital, 1-1-1 Takakicho, Kasugai, Aichi 486-8510, Japan.
| | - Shigemasa Hayashi
- Department of Neurosurgery, Kasugai Municipal Hospital, 1-1-1 Takakicho, Kasugai, Aichi 486-8510, Japan
| | - Ryosuke Oshima
- Department of Neurosurgery, Kasugai Municipal Hospital, 1-1-1 Takakicho, Kasugai, Aichi 486-8510, Japan
| | - Tomoki Matsuyama
- Department of Neurosurgery, Kasugai Municipal Hospital, 1-1-1 Takakicho, Kasugai, Aichi 486-8510, Japan
| | - Hiroaki Tamai
- Department of Vascular and Endovascular Surgery, Kasugai Municipal Hospital, 1-1-1 Takakicho, Kasugai, Aichi 486-8510, Japan
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Sakaeyama Y, Kondo K, Terazono S, Fuchinoue Y, Kubota S, Mikai M, Abe M, Sugo N, Nagao T, Nemoto M. Local and systemic factors associated with quantitative stiffness of carotid plaque. Acta Neurochir (Wien) 2024; 166:54. [PMID: 38289409 DOI: 10.1007/s00701-024-05952-z] [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] [Received: 11/05/2023] [Accepted: 01/06/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE Plaque stiffness in carotid artery stenosis is a clinically important factor involved in the development of stroke and surgical complications. The purpose of this study was to clarify which local and systemic factors are associated with the quantitatively measured stiffness of plaque. METHODS The subjects were 104 consecutive patients who underwent carotid endarterectomy at our institution. To measure quantitative stiffness of plaque, we used an industrial hard meter in the operating room within 1 h after removal of plaque. Local factors related to carotid plaque hardness were evaluated, including maximum intima-media thickness (max IMT), degree of stenosis using the European Carotid Surgery Trial (ECST), presence of ulceration or calcification, and echo brightness on preoperative carotid ultrasound. The degree of stenosis was also evaluated using the North American Symptomatic Carotid Endarterectomy Trial method in digital subtraction angiography. Age, sex, and presence or absence of hypertension, diabetes, and dyslipidemia (low-density lipoprotein cholesterol and triglyceride [TG] levels) served as systemic factors and were compared with the quantitative stiffness of carotid plaque. RESULTS In multivariate analysis, ECST stenosis degree, calcification, and IMT max as local factors affected plaque stiffness. As a systemic factor, plaque stiffness was statistically significantly negatively correlated with TG values in multivariate analysis (p < 0.05). CONCLUSION The quantitative stiffness of the plaque was negatively correlated with TG levels as a systemic factor in addition to local factors. This might suggest that reducing high TG levels is associated with plaque stabilization.
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Affiliation(s)
- Yuki Sakaeyama
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, 6-11-1, Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Kosuke Kondo
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, 6-11-1, Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Sayaka Terazono
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, 6-11-1, Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Yutaka Fuchinoue
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, 6-11-1, Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan
| | | | - Masataka Mikai
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, 6-11-1, Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan
| | | | - Nobuo Sugo
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, 6-11-1, Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan.
| | - Takaaki Nagao
- Department of Neurosurgery (Sakura), School of Medicine, Faculty of Medicine, Toho University, Sakura-City, Chiba, Japan
| | - Masaaki Nemoto
- Department of Neurosurgery (Sakura), School of Medicine, Faculty of Medicine, Toho University, Sakura-City, Chiba, Japan
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Percutaneous transluminal angioplasty and stenting of post-irradiation stenosis of the vertebral artery. J Neuroradiol 2022; 50:431-437. [PMID: 36610936 DOI: 10.1016/j.neurad.2022.11.008] [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: 10/03/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The outcomes of percutaneous transluminal angioplasty and stenting (PTAS) in patients with medically refractory post-irradiation stenosis of the vertebral artery (PISVA) have not been clarified. AIM This retrospective study evaluated the safety and outcomes of PTAS in patients with severe PISVA compared with their radiation-naïve counterparts (non-RT group). METHODS Patients with medically refractory severe symptomatic vertebral artery stenosis and undergoing PTAS between 2000 and 2021 were classified as the PISVA group or the non-RT group. The periprocedural neurological complications, periprocedural brain magnetic resonance imaging, the extent of symptom relief, and long-term stent patency were compared. RESULTS As compared with the non-RT group (22 cases, 24 lesions), the PISVA group (10 cases, 10 lesions) was younger (62.0 ± 8.6 vs 72.4 ± 9.7 years, P = 0.006) and less frequently had hypertension (40.0% vs 86.4%, P = 0.013) and diabetes mellitus (10.0% vs 54.6%, P = 0.024). Periprocedural embolic infarction was not significantly different between the non-RT group and the PISVA group (37.5% vs 35.7%, P = 1.000). At a mean follow-up of 72.1 ± 58.7 (3-244) months, there was no significant between-group differences in the symptom recurrence rate (0.00% vs 4.55%, P = 1.000) and in-stent restenosis rate (10.0% vs 12.5%, P = 1.000). CONCLUSION PTAS of severe medically refractory PISVA is effective in the management of vertebrobasilar ischemic symptoms in head and neck cancer patients. Technical safety and outcome of the procedure were like those features in radiation-naïve patients.
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Fukushima D, Kondo K, Harada N, Terazono S, Uchino K, Shibuya K, Sugo N. Quantitative comparison between carotid plaque hardness and histopathological findings: an observational study. Diagn Pathol 2022; 17:58. [PMID: 35818059 PMCID: PMC9275256 DOI: 10.1186/s13000-022-01239-y] [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: 12/24/2021] [Accepted: 06/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background Plaque hardness in carotid artery stenosis correlates with cerebral infarction. This study aimed to quantitatively compare plaque hardness with histopathological findings and identify the pathological factors involved in plaque hardness. Methods This study included 84 patients (89 lesions) undergoing carotid endarterectomy (CEA) at our institution. Plaque hardness was quantitatively measured immediately after excision using a hardness meter. Collagen and calcification were evaluated as the pathological factors. Collagen was stained with Elastica van Gieson stain, converted to a gray-scale image, and displayed in a 256-step histogram. The median gray-scale median (GSM) was used as the collagen content. The degree of calcification was defined by the hematoxylin–eosin stain as follows: "0:" no calcification, "1:" scattered microcalcification, or "2:" calcification greater than 1 mm or more than 2% of the total calcification. Carotid echocardiographic findings, specifically echoluminance or the brightness of the narrowest lesion of the plaque, classified as hypo-, iso-, or hyper-echoic by comparison with the intima-media complex surrounding the plaque, and clinical data were reviewed. Results Plaque hardness was significantly negatively correlated with GSM [Spearman's correlation coefficient: -0.7137 (p < 0.0001)]: the harder the plaque, the higher the collagen content. There were significant differences between plaque hardness and degree of calcification between "0" and "2" (p = 0.0206). For plaque hardness and echoluminance (hypo-iso-hyper), significant differences were found between hypo-iso (p = 0.0220), hypo-hyper (p = 0.0006), and iso-hyper (p = 0.0015): the harder the plaque, the higher the luminance. In single regression analysis, GSM, sex, and diabetes mellitus were significant variables, and in multiple regression analysis, only GSM was extracted as a significant variable. Conclusions Plaque hardness was associated with a higher amount of collagen, which is the main component of the fibrous cap. Greater plaque hardness was associated with increased plaque stability. The degree of calcification may also be associated with plaque hardness.
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Affiliation(s)
- Daisuke Fukushima
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, 143-8541, Japan.
| | - Kosuke Kondo
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, 143-8541, Japan
| | - Naoyuki Harada
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, 143-8541, Japan
| | - Sayaka Terazono
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, 143-8541, Japan
| | - Kei Uchino
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, 143-8541, Japan
| | - Kazutoshi Shibuya
- Department of Pathology, Toho University Omori Medical Center, Tokyo, Japan
| | - Nobuo Sugo
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, 143-8541, Japan
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Al-Bayati AR, Nogueira RG, Haussen DC. Carotid Artery Stenting: Applications and Technical Considerations. Neurology 2021; 97:S137-S144. [PMID: 34785612 DOI: 10.1212/wnl.0000000000012802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 03/03/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE REVIEW To examine current understanding of diverse etiologies of extracranial carotid disease, including clinical and imaging manifestations as well as treatment approaches. RECENT FINDINGS Increasing availability of advanced cerebrovascular imaging modalities continues to elucidate atherosclerotic and nonatherosclerotic carotid steno-occlusive disease as a common culprit of cerebral ischemia. Individualized treatment strategies targeting each etiologic subset would optimize preventive measures and minimize recurrence of cerebral ischemia. SUMMARY Ischemic stroke is a prominent cause of mortality and long-term disability worldwide. The magnified effect of carotid disease warrants constant and close inspection.
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Affiliation(s)
- Alhamza R Al-Bayati
- From the Department of Neurology and Radiology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA.
| | - Raul G Nogueira
- From the Department of Neurology and Radiology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA
| | - Diogo C Haussen
- From the Department of Neurology and Radiology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA
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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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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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de Bakker M, Timmerman N, van Koeverden ID, de Kleijn DPV, de Borst GJ, Pasterkamp G, Boersma E, den Ruijter HM. The age- and sex-specific composition of atherosclerotic plaques in vascular surgery patients. Atherosclerosis 2020; 310:1-10. [PMID: 32861960 DOI: 10.1016/j.atherosclerosis.2020.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 06/15/2020] [Accepted: 07/15/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS The sex- and age-related differences in the composition of iliofemoral atherosclerotic plaques are largely unknown. Therefore, the aim of the current study is to gain insight into plaque composition across strata of age and sex in a large cohort of vascular surgery patients. METHODS Peripheral atherosclerotic plaques of patients who underwent iliofemoral endarterectomy (n = 790) were harvested between 2002 and 2014. The plaques were semi-quantitatively analyzed for the presence of lipid cores, calcifications, plaque hemorrhages (PH), collagen, macrophage and smooth muscle cell (SMC) content, and quantitatively for microvessel density. Patients were stratified by age tertiles and sex. RESULTS Ageing was independently associated with rupture-prone iliofemoral plaque characteristics, such as higher prevalence of plaque calcifications (OR 1.52 (95%CI:1.03-2.24) p = 0.035) and PH (OR 1.46 (95%CI:1.01-2.09) p = 0.042), and lower prevalence of collagen (OR 0.52 (95%CI:0.31-0.86) p = 0.012) and SMCs (OR 0.59 (95%CI:0.39-0.90) p = 0.015). Sex-stratified data showed that men had a higher prevalence of lipid cores (OR 1.62 (95%CI:1.06-2.45) p = 0.025) and PH (OR 1.62 (95%CI:1.16-2.54) p = 0.004) compared to women. These sex-differences attenuated with increasing age, with women showing an age-related increase in calcifications (p = 0.002), PH (p = 0.015) and decrease in macrophages (p = 0.005). In contrast, men only showed a decrease in collagen (p = 0.043). CONCLUSIONS Atherosclerotic iliofemoral plaques derived from men display more rupture-prone characteristics compared to women. Yet, this difference is attenuated with an increase in age, with older women having more rupture-prone characteristics compared to younger women.
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Affiliation(s)
- Marie de Bakker
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, the Netherlands
| | - Nathalie Timmerman
- Department of Vascular Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Ian D van Koeverden
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Dominique P V de Kleijn
- Department of Experimental Vascular Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Gerard Pasterkamp
- Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Eric Boersma
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, the Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
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de Vries EE, Meershoek AJA, Vonken EJ, den Ruijter HM, van den Berg JC, de Borst GJ. A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting. J Vasc Surg 2019; 69:1952-1961.e1. [PMID: 31159989 DOI: 10.1016/j.jvs.2018.11.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/10/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Procedural characteristics, including stent design, may influence the outcome of carotid artery stenting (CAS). A thorough comparison of the effect of stent design on outcome of CAS is thus warranted to allow for optimal evidence-based clinical decision making. This study sought to evaluate the effect of stent design on clinical and radiologic outcomes of CAS. METHODS A systematic search was conducted in MEDLINE, Embase, and Cochrane databases in May 2018. Included were articles reporting on the occurrence of clinical short- and intermediate-term major adverse events (MAEs; any stroke or death) or radiologic adverse events (new ischemic lesions on postprocedural magnetic resonance diffusion-weighted imaging [MR-DWI], restenosis, or stent fracture) in different stent designs used to treat carotid artery stenosis. Random effects models were used to calculate combined overall effect sizes. Metaregression was performed to identify the effect of specific stents on MAE rates. RESULTS From 2654 unique identified articles, two randomized, controlled trials and 66 cohort studies were eligible for analysis (including 46,728 procedures). Short-term clinical MAE rates were similar for patients treated with open cell vs closed cell or hybrid stents. Use of an Acculink stent was associated with a higher risk of short-term MAE compared with a Wallstent (risk ratio [RR], 1.51; P = .03), as was true for use of Precise stent vs Xact stent (RR, 1.55; P < .001). Intermediate-term clinical MAE rates were similar for open vs closed cell stents. Use of open cell stents predisposed to a 25% higher chance (RR, 1.25; P = .03) of developing postprocedural new ischemic lesions on MR-DWI. No differences were observed in the incidence of restenosis, stent fracture, or intraprocedural hemodynamic depression with respect to different stent design. CONCLUSIONS Stent design is not associated with short- or intermediate-term clinical MAE rates in patients undergoing CAS. Furthermore, the division in open and closed cell stent design might conceal true differences in single stent efficacy. Nevertheless, open cell stenting resulted in a significantly higher number of subclinical postprocedural new ischemic lesions detected on MR-DWI compared with closed cell stenting. An individualized patient data meta-analysis, including future studies with prospective homogenous study design, is required to adequately correct for known risk factors and to provide definite conclusions with respect to carotid stent design for specific subgroups.
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Affiliation(s)
- Evelien E de Vries
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Armelle J A Meershoek
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evert J Vonken
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hester M den Ruijter
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jos C van den Berg
- Centro Vascolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland; Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, University of Bern, Bern, Switzerland
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
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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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Self-Expanding Metallic Stent Fracture in the Treatment of Malignant Biliary Obstruction. Gastroenterol Res Pract 2018; 2018:6527879. [PMID: 29849597 PMCID: PMC5914116 DOI: 10.1155/2018/6527879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/13/2017] [Accepted: 12/18/2017] [Indexed: 01/14/2023] Open
Abstract
Background Palliative therapies for malignant biliary obstruction (MBO) include choledochojejunostomy and self-expanding metallic stent (SEMS) insertion. Fractures following SEMS insertion in MBO treatment are scarce. Objective To assess the clinical features of biliary stent fractures and evaluate associated factors. Methods One hundred fifty-six consecutive patients who underwent biliary SEMS placement for MBO treatment at Beijing Chaoyang Hospital affiliated to Capital Medical University, in 2010–2015, were evaluated retrospectively. Demographics, clinical features, stent parameters and patency times, and survival times were collected. Across the ampulla of Vater, balloon dilatation, number of stents, stent patency time, and survival time were compared between the stent and nonstent fracture groups. Results There were 168 biliary metallic stents inserted in 156 patients, including 144 and 12 patients with one and 2-3 stents, respectively. Pre- and/or postballoon dilation was performed in 107 patients. Stents across and above the duodenal papilla were used in 105 and 51 patients, respectively. Six cases (3.8%) with stent occlusion had stent fractures. Single- and multiple-stent fracture rates were 4/144 (2.8%) and 2/12 (16.7%), respectively. Fracture times after stent deployment were 126.8 ± 79.0 (median, 115.5) days. Stent patency times in the stent and nonstent fracture groups were 151.8 ± 67.8 (median, 160.5) days and 159.3 ± 73.6 (median, 165.5) days, respectively. Overall survival times in the stent and nonstent fracture groups were 399.7 ± 147.6 (median, 364.0) days and 283.7 ± 126.1 (median, 289.0) days, respectively. Conclusion Stent fractures following MBO treatment constitute a relatively rare long-term complication. Though there were no factors found to be significantly associated with SEMSs fracture, a trend could be observed towards more fractures in multistent, transpapillary, and balloon dilation groups.
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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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Kondo K, Nemoto M, Harada N, Fukushima D, Masuda H, Sugo N. Comparison between Quantitative Stiffness Measurements and Ultrasonographic Findings of Fresh Carotid Plaques. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:138-144. [PMID: 27692874 DOI: 10.1016/j.ultrasmedbio.2016.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 06/13/2016] [Accepted: 08/12/2016] [Indexed: 06/06/2023]
Abstract
Using a stiffness meter, we quantitatively measured the stiffness of fresh plaques that had been excised by carotid endarterectomy. The objective of this study was to clarify the correlation between plaque stiffness and pre-operative carotid ultrasonographic findings, and predict the stiffness of plaques before surgery by comparison with the stiffness of common items. The study population comprised 44 patients (44 lesions) who had undergone carotid endarterectomy at our institution between December 2009 and October 2014. The stiffness of excised fresh plaques was measured using a stiffness meter and compared with the pre-operative echographic findings for the plaques and the stiffness of selected foods and common items. The mean stiffness value for all plaques was 4.52 ± 3.30 MPa (mean ± standard deviation). The plaques exhibiting calcification were significantly harder (p = 0.001). On classification of lesions on the basis of echographic findings, plaque hardness was in the order low-echoic (15 lesions) < iso-echoic (20 lesions) < high-echoic (9 lesions) (p = 0.02). The stiffness of the low-echoic group was equivalent to that of tofu or sliced cheese, whereas the plaques in the iso- and high-echoic groups exhibited stiffness similar to that of ham and a plastic eraser, respectively. A significant correlation was observed between the quantitative stiffness values of carotid plaques and their brightness on carotid ultrasonography. Using these data, operators might be able to predict plaque stiffness from pre-operative echographic findings. In addition, it might be useful for operators to compare such quantitative stiffness measurements with stiffness data for foods and common items to gain an understanding of the state of the target plaque before treatment.
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Affiliation(s)
- Kosuke Kondo
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan.
| | - Masaaki Nemoto
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan
| | - Naoyuki Harada
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan
| | - Daisuke Fukushima
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan
| | - Hiroyuki Masuda
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan
| | - Nobuo Sugo
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan
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Fatigue of Metallic Stents: From Clinical Evidence to Computational Analysis. Ann Biomed Eng 2015; 44:287-301. [PMID: 26438450 DOI: 10.1007/s10439-015-1447-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
Abstract
The great success of stents in treating cardiovascular disease is actually undermined by their long-term fatigue failure. The high variability of stent failure incidence suggests that it is due to several correlated aspects, such as loading conditions, material properties, component design, surgical procedure, and patient functional anatomy. Numerical and experimental non-clinical assessments are included in the recommendations and requirements of several regulatory bodies and they are thus exploited in the analysis of stent fatigue performance. Optimization-based simulation methodologies have been developed as well, to improve the fatigue endurance of novel designs. This paper presents a review on the fatigue issue in metallic stents, starting from a description of clinical evidence about stent fracture up to the analysis of computational approaches available from the literature. The reported discussion on both the experimental and numerical framework aims at providing a general insight into stent lifetime prediction as well as at understanding the factors which affect stent fatigue performance for the design of novel components.
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Aaronson NL, Johnson MH, Sasaki CT. Carotid stent extrusion following carotid blowout. Auris Nasus Larynx 2015; 42:176-8. [PMID: 25579083 DOI: 10.1016/j.anl.2014.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/14/2014] [Accepted: 10/21/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We describe an unusual foreign body, a carotid stent extruded into the upper airway, and discuss the predisposing factors. METHODS This is a single patient case report with review of the literature. RESULTS Our patient is a 59 year old female treated for T3N2aM0 (stage IVa) left tonsil squamous cell carcinoma who experienced a carotid blowout treated by carotid stent placement with subsequent carotid coiling and vessel takedown. Approximately ten months later, she coughed and expelled approximately 3cm of tubular stent-appearing material into her airway causing acute stridor and dysphagia. CT angiography (CTA) showed the distal and proximal stent in proper position without evidence of extravasation. The stent was extracted transorally showing the distal end of the carotid to be patent and covered by fibrin within its lumen. Review of the literature shows that such stent extrusions, although rare, do occur. CONCLUSION Carotid stents are a valuable tool in cases of carotid blowout. However, long-term data on patient prognosis is lacking. The foreign body response triggered by stent placement can cause dislodgement. The potential for stent extrusion is greatest in patients who have preexisting ulceration or who have undergone radiation, both common in head and neck cancer patients.
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Affiliation(s)
- Nicole L Aaronson
- Section of Otolaryngology, Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
| | - Michele H Johnson
- Section of Interventional Neuroradiology, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Clarence T Sasaki
- Section of Otolaryngology, Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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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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Giuliani E, Genedani S, Moratto R, Veronesi J, Carone C, Bonvecchio C, Mosca F, Coppi G, Barbieri A. Neural damage biomarkers during open carotid surgery versus endovascular approach. Ann Vasc Surg 2014; 28:1671-9. [PMID: 24911800 DOI: 10.1016/j.avsg.2014.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/28/2014] [Accepted: 05/30/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) is the gold standard for treating severe carotid artery stenosis, whereas carotid artery stenting (CAS) represents an endovascular alternative. The objective of this study was to assess the potential neural damage following open or endovascular carotid surgery measured by peripheral blood concentration of 3 biomarkers: S100β, matrix metalloproteinase-9 (MMP-9), and d-dimer. METHODS Data for this prospective investigation were obtained from the Carotid Markers study (January 2010-2011), which sought to measure the levels of specific biomarkers of neuronal damage and thrombosis on candidates to CEA or CAS presenting at the Department of Vascular Surgery of the Nuovo Ospedale S. Agostino Estense of Modena (Italy) at baseline and at 24 hr after surgery. Relevant medical comorbidities were noted. RESULTS A total of 113 consecutive patients were enrolled in the study, 41 in the endarterectomy group and 72 in the endovascular group. The baseline levels of the studied biomarkers did not show any statistically significant difference between the groups with the exception of MMP-9, which showed higher concentrations in the endovascular group (median 731 vs. 401, P = 0.0007), while 24 hr after surgery the endarterectomy group featured significantly higher peripheral blood concentrations of MMP-9, S100β, and d-dimer. Conversely, no significant difference was detected in the endovascular group except the d-dimer level. CONCLUSIONS Neural damage biomarkers demonstrated a substantial difference between open and endovascular carotid surgery, which, if performed in selected patients, may become a less invasive alternative to CEA.
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Affiliation(s)
- Enrico Giuliani
- School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy
| | - Susanna Genedani
- Deparment of Pharmacology, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Moratto
- Department of Vascular Surgery, Nuovo Ospedale S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Jessica Veronesi
- Department of Vascular Surgery, Nuovo Ospedale S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Carone
- Deparment of Pharmacology, University of Modena and Reggio Emilia, Modena, Italy
| | - Cinzia Bonvecchio
- School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Mosca
- School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy
| | - Gioachino Coppi
- Department of Vascular Surgery, Nuovo Ospedale S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Barbieri
- School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy.
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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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Surgical Treatment for Carotid Stenoses with Highly Calcified Plaques. J Stroke Cerebrovasc Dis 2014; 23:148-54. [PMID: 23273787 DOI: 10.1016/j.jstrokecerebrovasdis.2012.11.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 11/24/2012] [Accepted: 11/28/2012] [Indexed: 11/21/2022] Open
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23
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Hawkins BM, Jaff MR. Non-Invasive Carotid Imaging: A Comparative Assessment and Practical Approach. Interv Cardiol Clin 2014; 3:13-20. [PMID: 28582149 DOI: 10.1016/j.iccl.2013.08.002] [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: 10/26/2022]
Abstract
Stroke originating from carotid artery disease remains a significant source of morbidity and mortality, and both medical and invasive therapies targeting the carotid artery can improve patient outcomes. Multiple noninvasive imaging methods, including duplex ultrasonography, computerized tomographic angiography, and magnetic resonance angiography, are available to assess the extracranial carotid artery and guide clinical decision making. This article discusses the advantages and limitations of these imaging modalities and provides a practical framework by which clinicians may use imaging to evaluate patients with carotid artery disease.
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Affiliation(s)
- Beau M Hawkins
- Cardiovascular Section, Department of Internal Medicine, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd, Williams Pavilion 3010, Oklahoma City, OK 73104, USA
| | - Michael R Jaff
- Vascular Medicine Section, Cardiology Division, Massachusetts General Hospital, 55 Fruit Street, Warren Building 905, Boston, MA 02115, USA.
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Moratto R, Veronesi J, Silingardi R, Njila MKS, Trevisi Borsari G, Coppi G, Coppi G. Urgent Carotid Artery Stenting With Technical Modifications for Patients With Transient Ischemic Attacks and Minor Stroke. J Endovasc Ther 2012; 19:627-35. [DOI: 10.1583/jevt-12-3852mr.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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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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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