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Osipova OS, Bugurov SV, Saaya SB, Cheban AV, Gostev AA, Rabtsun AA, Ignatenko PV, Karpenko AA. Relationship of pharmacotherapy and the incidence of embolic complications of carotid reconstructive surgery. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To evaluate the relationship between lipid-lowering and antiplatelet therapy and the incidence of cerebral microembolism and related complications in open and endovascular revascularization of the carotid arteries (CA).Material and methods. This single-center study involved patients with internal CA stenosis. The patients were divided into 2 groups depending on the surgery type performed: carotid endarterectomy (CEA) — 163 patients; CA stenting (CAS) — 71 patients. All patients underwent intraoperative transcranial Doppler monitoring to register cerebral embolism during CAS and CE.Results. In CAS, microembolism episodes were observed in 66,2% vs 22,1% of patients in the CEA group (p=0,04), the largest number of which was recorded during catheterization of the internal CA and embolic filter installation (p=0,000). There were no significant differences between the groups in terms of the stroke incidence. In 8 patients in the CAS group and 1 patient in the CEA group, a transient ischemic attack was observed within 30 days after surgery (p=4x10-4 ). Intraoperative embolism was a predictor of a neurological event in the early postoperative period (odds ratio (OR), 33,08; 95% confidence interval (CI): 3,49-56,37 (p6 months before surgery reduces the likelihood of embolism by 4 times (OR 0,25; 95% CI: 0,11-0,58 (p=0,001), while lipid-lowering and antiplatelet therapy combination — by 12,5 times (OR, 0,08; 95% CI: 0,01-0,40 (p=0,001)).Conclusion. Preoperative antiplatelet and statin therapy reduces the likelihood of embolism during the CA revascularization procedure.
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Artas H, Okcesiz I. Three-dimensional ultrasonographic evaluation of carotid artery plaque surface irregularity. Arch Med Sci 2020; 16:58-65. [PMID: 32051706 PMCID: PMC6963133 DOI: 10.5114/aoms.2018.81135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/30/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate 3-dimensional (3D) ultrasonography (US) in determining the surface irregularity of carotid artery plaques. MATERIAL AND METHODS This study included 50 patients (20 females and 30 males) aged between 56 and 82 years with plaques in the carotid artery which were detected during routine neck ultrasound. Simultaneously these cases were evaluated in terms of plaque echogenicities and surface characteristics with 2D and 3D US. RESULTS 3D imaging was successfully performed in 45 of the 50 cases and the technical success rate was 90%. A single plaque was detected in 64.4% of the patients, with the remaining 35.6% having more than one plaque. The lengths of the plaques ranged from 2 to 12 mm (mean: 3.98 ±1.70 mm); the widths ranged from 1.8 to 3.2 mm (mean: 2.11 ±0.37 mm). No significant difference was found between 2D and 3D plaque echo-structures (observer 1, p = 0.317; observer 2, p = 0.276), but there were significant differences between 2D and 3D plaque surface irregularities (observer 1, p = 0.002; observer 2, p = 0.004). The inter-observer agreement on 2D and 3D plaque echo-structure and surface irregularity was very good (k coefficients were 0.89 and 0.83, respectively, for echo-structure, and 0.91 and 0.95, respectively, for surface irregularity). CONCLUSIONS The present study shows that 3D US examination is a valuable non-invasive method for investigation of surface irregularity of carotid artery plaques.
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Affiliation(s)
- Hakan Artas
- Department of Radiology, Faculty of Medicine, Firat University, Elazığ, Turkey
| | - Izzet Okcesiz
- Department of Radiology, Faculty of Medicine, Firat University, Elazığ, Turkey
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Matsukawa H, Fujii M, Uemura A, Suzuki K, Yamamoto D, Takahashi O, Niimi Y. Pathology of embolic debris in carotid artery stenting. Acta Neurol Scand 2015; 131:197-202. [PMID: 25312877 DOI: 10.1111/ane.12303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The relationship between magnetic resonance (MR) plaque imaging and the pathology of distal embolic debris is unknown. We aimed to evaluate the relationship between the pathology of embolic debris in the embolic filter during carotid artery stenting (CAS), MR plaque imaging, and new ischemic lesions on diffusion-weighted imaging (DWI). METHOD We prospectively reviewed the 36 patients who underwent CAS using a filter-type embolic protection device. Pathology of debris was categorized into thrombosis, inflammatory cells, elastic fiber, and calcification. We compared the clinical parameters, MR plaque imaging, and pathological characteristics of the embolic debris retained in the filter during CAS on univariate analysis. RESULTS Eleven patients had and 25 patients did not have new lesion on DWI. All of DWI-high lesions were identified in affected side middle cerebral artery territory. Embolic debris was microscopically confirmed in 28 patients (78%); thrombosis in 11 (31%), inflammatory cells in 13 (36%), elastic fiber in 12 (33%), and calcification in 9 (25%). Proportion of asymptomatic carotid stenosis, intra-operative bradycardia/hypotension, and inflammatory cells of debris were significantly higher in patients with new DWI-high lesions. There was no significant relationship between the pathological characteristics and MR plaque imaging of distal embolic debris. CONCLUSIONS Our study showed that new DWI-high lesions might be influenced by types of debris in the filter. The need for future studies specifically examine the association of pathology of debris and findings of MR plaque imaging with new DWI-high lesions during CAS is emphasized.
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Affiliation(s)
- H. Matsukawa
- Department of Neurosurgery; St. Luke's International Hospital; Tokyo Japan
| | - M. Fujii
- Department of Neurosurgery; St. Luke's International Hospital; Tokyo Japan
| | - A. Uemura
- Department of Neuroendovascular Therapy; St. Luke's International Hospital; Tokyo Japan
| | - K. Suzuki
- Department of Pathology; St. Luke's International Hospital; Tokyo Japan
| | - D. Yamamoto
- Department of Neurosurgery; St. Luke's International Hospital; Tokyo Japan
| | - O. Takahashi
- Division of General Internal Medicine; Department of Medicine; St. Luke's International Hospital; Tokyo Japan
| | - Y. Niimi
- Department of Neuroendovascular Therapy; St. Luke's International Hospital; Tokyo Japan
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Shimamura N, Kikkawa T, Hatanaka M, Naraoka M, Munakata A, Ohkuma H. Dilation of the Internal Carotid Artery at the Entrance to the Carotid Canal following Carotid Artery Stenting Predicts Postprocedural Hyperperfusion. INTERVENTIONAL NEUROLOGY 2014; 2:1-7. [PMID: 25187780 DOI: 10.1159/000354289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Ischemic stroke and hyperperfusion (HP) are the most frequent and important complications in carotid artery stenosis surgery. Carotid artery stenting (CAS) has replaced carotid endarterectomy in high medical risk patients. Prior to CAS, initial angiographic findings disclose a small caliber internal carotid artery (IC) due to stenosis, but after the stenosis is relieved, the diameter of the IC becomes enlarged. We investigated whether a change in the IC diameter was related to ischemic complication and HP using cerebral blood flow single photon emission computed tomography (SPECT). METHODS From February 2008 to December 2009 we consecutively performed 39 CAS on 35 patients. We retrospectively analyzed the relationship between changes at the level before the entry to the petrous bone canal of the IC and stenosis of the etiological artery, improvement in stenosis, HP and postintervention diffusion-weighted image high-intensity lesions. Statistical analyses comprised Wilcoxon/Kruskal-Wallis analysis, analysis of variance and a multivariate logistic analysis. RESULTS A total of 9 cases showed HP in SPECT. Severity of IC stenosis and change in the IC at the level before the entry to the petrous bone canal were related with statistical significance to HP. Other factors did not correlate with HP. CONCLUSION Procedure-related dilation of the IC at the level before the entry to the petrous bone canal occurred due to release of the etiological stenosis. This finding can also support the prediction of HP.
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Affiliation(s)
- Norihito Shimamura
- Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Towada, Japan
| | - Tomoshige Kikkawa
- Department of Neurosurgery, Kuroishi Hospital, Kuroishi, Towada, Japan
| | | | - Masato Naraoka
- Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Towada, Japan
| | - Akira Munakata
- Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Towada, Japan
| | - Hiroki Ohkuma
- Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Towada, Japan
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Kim BJ, Kwon JY, Jung JM, Lee DH, Kang DW, Kim JS, Kwon SU. Association between silent embolic cerebral infarction and continuous increase of P2Y12 reaction units after neurovascular stenting. J Neurosurg 2014; 121:891-8. [PMID: 25036195 DOI: 10.3171/2014.6.jns132448] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Endovascular procedures are one of the important treatment options for steno-occlusive arteries in ischemic stroke patients. However, embolic complications after such procedures are always a concern. The authors investigated the association between serial change of residual platelet reactivity and silent embolic cerebral infarction (SECI) after endovascular treatment. METHODS Ischemic stroke patients undergoing stenting of intra- or extracranial arteries were recruited prospectively. Residual platelet reactivity, represented by aspirin reaction units (ARUs) and P2Y12 reaction units (PRUs), was measured serially (6 hours before, immediately after, and 24 hours after the procedure). A loading dosage of aspirin (500 mg) and/or clopidogrel (300 mg) was given 24 hours before the procedure to patients naïve to antiplatelet agents, whereas the usual dosage (aspirin 100 mg and clopidogrel 75 mg) was continued for patients who had previously been taking these agents for more than a week. Diffusion-weighted MRI was performed before and 24 hours after the procedure to detect new SECIs. Clinical characteristics, baseline ARU and PRU values, and the change in ARU and PRU values after stenting were compared between patients with and without SECIs. RESULTS Among 69 consecutive patients who underwent neurovascular stent insertion, 41 patients (59.4%) had poststenting SECIs. The lesion was located only at the vascular territory of the stented vessel in 21 patients (51.2%), outside the stented vessel territory in 8 patients (19.5%), and both inside and outside in 12 patients (29.3%). The occurrence of SECIs was not associated with the baseline ARU or PRU value, but was associated with PRU increase after stenting (36 ± 73 vs -12 ± 59, p = 0.007), deployment of a longer stent (31.1 ± 16.5 mm vs 21.8 ± 9.9 mm, p = 0.01), and stent insertion in extracranial arteries (78.1% vs 45.2%, p = 0.008). Stent length (OR 1.066, p = 0.01) and PRU change (OR 1.009, p = 0.04) were independently associated with the occurrence of SECI. CONCLUSIONS Residual platelet reactivity after dual antiplatelet treatment measured before stenting did not predict poststenting SECI. However, the longer stent and the serial increase of PRU values after stenting were related to SECI. Continuous increase of platelet activation after endovascular procedure may be important in poststent cerebral infarction.
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Comparison between proximal versus distal protection devices in 287 cases of carotid revascularization using angioplasty and stenting: periprocedure complications, morbidity, and mortality. Cardiovasc Intervent Radiol 2013; 37:639-45. [PMID: 23912495 DOI: 10.1007/s00270-013-0714-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 07/07/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Embolic protection devices may decrease periprocedural thromboembolic complications during carotid angioplasty and stenting (CAS). When using proximal-protection devices (PPDs), protection starts before crossing the lesion. However, in the medical literature, its use is scarcely reported compared with that of distal-protection filters (DPDs). The objective of this study was to compare periprocedure complications, morbidity, and mortality among 287 consecutive cases of CAS performed with PPDs or DPDs. PATIENTS AND METHODS This was a retrospective analysis of 287 patients treated with CAS at our hospital between January 2006 and March 2012. Periprocedure complications, morbidity, and mortality at 30 days, including ischemic stroke or transient ischemic attack, reperfusion syndrome, myocardial infarction (MI), and death, were globally registered, and the results in PPD and DPD groups were compared. RESULTS Two hundred eight patients were treated with DPD and 79 with PPD; 80.8 % were symptomatic. CAS procedures performed with PPD presented a statistically significant greater grade of stenosis than those with DPD (82.5 vs. 74.5 %, p < 0.001). Death rates were 1.9 and 1.3 %; stroke rates were 4.3 and 3.8 %; MI rates were 1.4 and 1.3 %; and total morbidity and mortality rates were 6.2 and 5 % (DPD and PPD groups, respectively); all differences were nonstatistically significant. No statistical difference was found between symptomatic and asymptomatic patients. CONCLUSION Carotid angioplasty and stenting is a safe procedure to treat carotid disease in our patients. PPDs are not always associated with a greater risk of periprocedure complications, morbidity, and mortality than DPDs despite the greater grade of carotid stenosis in the PPD group. This observation may be of interest in the design of future studies with CAS.
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Howard DP, van Lammeren GW, Redgrave JN, Moll FL, de Vries JPP, de Kleijn DP, de Borst GJ, Pasterkamp G, Rothwell PM. Histological Features of Carotid Plaque in Patients With Ocular Ischemia Versus Cerebral Events. Stroke 2013; 44:734-9. [DOI: 10.1161/strokeaha.112.678672] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Patients with carotid artery stenosis and ocular ischemic events have a much lower risk of future ipsilateral ischemic stroke on medical treatment and lower procedural risks for endarterectomy and stenting than patients with cerebral ischemic events, and are closer in risk to patients with asymptomatic stenosis. The reasons for this difference in prognosis are not fully understood, but may reflect differences in carotid plaque pathology.
Methods—
In consecutive patients undergoing carotid endarterectomy for recently symptomatic stenosis (Oxford Plaque Study, Athero-Express Study), we compared carotid plaque histology (using validated semiquantitative scales) in those who had cerebral events within the last 6 months (n=1317) versus those with ocular events only (n=323).
Results—
Compared with plaques from patients with ocular events only, those from patients with cerebral events had significantly more large lipid core (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.05–1.82;
P
=0.02), inflammation (OR, 1.32; 95% CI, 1.02–1.72;
P
=0.04) and overall plaque instability (OR, 1.37; 95% CI, 1.05–1.80;
P
=0.02), and less fibrous content (OR, 0.71; 95% CI, 0.54–0.92;
P
=0.01), and calcification (OR, 0.70; 95% CI, 0.54–0.91;
P
=0.008). The overall number of histological features known to be associated with vulnerable plaque was greater in patients with cerebral events than in those with ocular events (
P
=0.002).
Conclusions—
Carotid plaques from patients undergoing endarterectomy for previous ocular ischemic events have fewer vulnerable plaque features than those from patients with recent cerebral ischemic events, possibly explaining some of the differences in risk of stroke between these groups.
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Affiliation(s)
- Dominic P.J. Howard
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (D.P.J.H., J.N.R., P.M.R.); Experimental Cardiology Laboratory (G.W.v.L., D.P.V.d.K., G.P.), and Department of Vascular Surgery (G.W.v.L., F.L.M., G.J.d.B.), University Medical Center Utrecht, the Netherlands; Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands (J.-P.P.M.d.V.); and Surgery NUS and Cardiovascular Research Institute NUHS
| | - Guus W. van Lammeren
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (D.P.J.H., J.N.R., P.M.R.); Experimental Cardiology Laboratory (G.W.v.L., D.P.V.d.K., G.P.), and Department of Vascular Surgery (G.W.v.L., F.L.M., G.J.d.B.), University Medical Center Utrecht, the Netherlands; Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands (J.-P.P.M.d.V.); and Surgery NUS and Cardiovascular Research Institute NUHS
| | - Jessica N. Redgrave
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (D.P.J.H., J.N.R., P.M.R.); Experimental Cardiology Laboratory (G.W.v.L., D.P.V.d.K., G.P.), and Department of Vascular Surgery (G.W.v.L., F.L.M., G.J.d.B.), University Medical Center Utrecht, the Netherlands; Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands (J.-P.P.M.d.V.); and Surgery NUS and Cardiovascular Research Institute NUHS
| | - Frans L. Moll
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (D.P.J.H., J.N.R., P.M.R.); Experimental Cardiology Laboratory (G.W.v.L., D.P.V.d.K., G.P.), and Department of Vascular Surgery (G.W.v.L., F.L.M., G.J.d.B.), University Medical Center Utrecht, the Netherlands; Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands (J.-P.P.M.d.V.); and Surgery NUS and Cardiovascular Research Institute NUHS
| | - Jean-Paul P.M. de Vries
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (D.P.J.H., J.N.R., P.M.R.); Experimental Cardiology Laboratory (G.W.v.L., D.P.V.d.K., G.P.), and Department of Vascular Surgery (G.W.v.L., F.L.M., G.J.d.B.), University Medical Center Utrecht, the Netherlands; Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands (J.-P.P.M.d.V.); and Surgery NUS and Cardiovascular Research Institute NUHS
| | - Dominique P.V. de Kleijn
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (D.P.J.H., J.N.R., P.M.R.); Experimental Cardiology Laboratory (G.W.v.L., D.P.V.d.K., G.P.), and Department of Vascular Surgery (G.W.v.L., F.L.M., G.J.d.B.), University Medical Center Utrecht, the Netherlands; Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands (J.-P.P.M.d.V.); and Surgery NUS and Cardiovascular Research Institute NUHS
| | - Gert Jan de Borst
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (D.P.J.H., J.N.R., P.M.R.); Experimental Cardiology Laboratory (G.W.v.L., D.P.V.d.K., G.P.), and Department of Vascular Surgery (G.W.v.L., F.L.M., G.J.d.B.), University Medical Center Utrecht, the Netherlands; Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands (J.-P.P.M.d.V.); and Surgery NUS and Cardiovascular Research Institute NUHS
| | - Gerard Pasterkamp
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (D.P.J.H., J.N.R., P.M.R.); Experimental Cardiology Laboratory (G.W.v.L., D.P.V.d.K., G.P.), and Department of Vascular Surgery (G.W.v.L., F.L.M., G.J.d.B.), University Medical Center Utrecht, the Netherlands; Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands (J.-P.P.M.d.V.); and Surgery NUS and Cardiovascular Research Institute NUHS
| | - Peter M. Rothwell
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (D.P.J.H., J.N.R., P.M.R.); Experimental Cardiology Laboratory (G.W.v.L., D.P.V.d.K., G.P.), and Department of Vascular Surgery (G.W.v.L., F.L.M., G.J.d.B.), University Medical Center Utrecht, the Netherlands; Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands (J.-P.P.M.d.V.); and Surgery NUS and Cardiovascular Research Institute NUHS
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