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Petr O, Brinjikji W, Murad MH, Glodny B, Lanzino G. Selective-versus-Standard Poststent Dilation for Carotid Artery Disease: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2017; 38:999-1005. [PMID: 28302610 DOI: 10.3174/ajnr.a5103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/12/2016] [Indexed: 11/07/2022]
Abstract
BACKROUND The safety and efficacy of standard poststent angioplasty in patients undergoing carotid artery stent placement have not been well-established. PURPOSE We conducted a systematic review of the literature to evaluate the safety and efficacy of carotid artery stent placement and analyzed outcomes of standard-versus-selective poststent angioplasty. DATA SOURCES A systematic search of MEDLINE, EMBASE, Scopus, and the Web of Science was performed for studies published between January 2000 and January 2015. STUDY SELECTION We included studies with >30 patients describing standard or selective poststent angioplasty during carotid artery stent placement. DATA ANALYSIS A random-effects meta-analysis was used to pool the following outcomes: periprocedural stroke/TIA, procedure-related neurologic/cardiovascular morbidity/mortality, bradycardia/hypotension, long-term stroke at last follow-up, long-term primary patency, and technical success. DATA SYNTHESIS We included 87 studies with 19,684 patients with 20,378 carotid artery stenoses. There was no difference in clinical (P = .49) or angiographic outcomes (P = .93) in carotid artery stent placement treatment with selective or standard poststent balloon angioplasty. Both selective and standard poststent angioplasty groups had a very high technical success of >98% and a low procedure-related mortality of 0.9%. There were no significant differences between both groups in the incidence of restenosis (P = .93) or procedure-related complications (P = .37). LIMITATIONS No comparison to a patient group without poststent dilation could be performed. CONCLUSIONS Our meta-analysis demonstrated no significant difference in angiographic and clinical outcomes among series that performed standard poststent angioplasty and those that performed poststent angioplasty in only select patients.
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Affiliation(s)
- O Petr
- From the Departments of Neurologic Surgery (O.P., G.L.) .,Neurosurgery (O.P.), Medical University Innsbruck, Innsbruck, Austria
| | | | - M H Murad
- Division of Preventive Medicine (M.H.M.), Mayo Clinic, Rochester, Minnesota
| | | | - G Lanzino
- From the Departments of Neurologic Surgery (O.P., G.L.).,Radiology (W.B., G.L.)
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Borhani Haghighi A, Yousefi S, Bahramali E, Kokabi S, Heydari ST, Shariat A, Nikseresht A, Ashjazadeh N, Izadi S, Petramfar P, Poursadegh M, Rahimi Jaberi A, Emami S, Agheli H, Nemati R, Yaghoubi E, Abdi MH, Panahandeh M, Heydari M, Safari A, Basir M, Cruz-Flores S, Edgell R. Demographic and Technical Risk Factors of 30-Day Stroke, Myocardial Infarction, and/or Death in Standard- and High-Risk Patients Who Underwent Carotid Angioplasty and Stenting. INTERVENTIONAL NEUROLOGY 2015; 3:165-73. [PMID: 26279663 DOI: 10.1159/000430923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Carotid angioplasty and stenting (CAS) is an accepted treatment to prevent stroke in patients with carotid artery stenosis. The purpose of this study is to identify risk factors for major complications after CAS. MATERIALS AND METHODS This is a prospective study that was conducted at Shiraz University of Medical Sciences in southern Iran from March 2011 to June 2014. Consecutive patients undergoing CAS were enrolled. Both standard- and high-risk patients for endarterectomy were enrolled. Demographic data, atherosclerotic risk factors, site of stenosis, degree of stenosis, and data regarding technical factors were recorded. Thirty-day stroke, myocardial infarction, and/or death were considered as the composite primary outcomes of the study. RESULTS A total of 251 patients were recruited (mean age: 71.1 ± 9.6 years; male: 65.3%). Of these, 178 (70.9%) were symptomatic, 73 (29.1%) were diabetic, 129 (51.4%) were hyperlipidemic, 165 (65.7%) were hypertensive, and 62 (24.7%) patients were smokers. CAS was performed for left internal carotid artery (ICA) in 113 (45.4%) patients. Fourteen (5.6%) patients had sequential bilateral stenting. Mean stenosis of operated ICA was 80.2 ± 13.8%. An embolic protection device was used in 203 (96.2%) patients. Pre- and postdilation were performed in 39 (18.5%) and 182 (86.3%) patients, respectively. Composite outcomes were observed in 3.6% of patients (3.2% stroke, 0% myocardial infarction, and 1.2% death). Left-sided lesions and the presence of diabetes mellitus were significantly associated with poor short-term outcome (p = 0.025 and p = 0.020, respectively). CONCLUSION There was a higher risk of short-term major complications in diabetic patients and for left carotid artery intervention.
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Affiliation(s)
- Afshin Borhani Haghighi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Samaneh Yousefi
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Ehsan Bahramali
- Cardiology Department, Faculty of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Safoora Kokabi
- Transgenic Technology Research Center, Shiraz University of Medical Sciences, Fasa, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Shiraz University of Medical Sciences, Fasa, Iran
| | - Abdolhamid Shariat
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Alireza Nikseresht
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Nahid Ashjazadeh
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Sadegh Izadi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Peyman Petramfar
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Maryam Poursadegh
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Abbas Rahimi Jaberi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Sajjad Emami
- Department of Neurology, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Hamid Agheli
- Shahidzadeh Hospital, Behbahan, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Reza Nemati
- Department of Neurology, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ehsan Yaghoubi
- Department of Neurology, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mohammad Hosein Abdi
- Motaharri Hospital, Marvdasht, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Majid Panahandeh
- Ordibehesht Hospital, Shiraz, Fasa University of Medical Sciences, Fasa, Iran
| | - Moslem Heydari
- Department of Neurology, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Anahid Safari
- Department of Pharmacology, Kazeroon Azad University, Kazeroon, Iran
| | - Marziyeh Basir
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | | | - Randal Edgell
- Department of Neurology, Saint Louis University, Saint Louis, Mo., USA ; Department of Psychiatry, Saint Louis University, Saint Louis, Mo., USA
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Hu XY, Zhang M, Wang DM, Feng XY, Shen XL, Wei ML, Pan H, Tang XM, Fang J, Huang JX, Huang Q, Yan WH, Su JJ, Liu JR. Prevalence of Carotid Artery Stenosis in Southern China: A Retrospective, Cross-Sectional Study. Int J Stroke 2013; 8:E31-2. [PMID: 23879756 DOI: 10.1111/ijs.12078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Xiao-Yue Hu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
- The two authors contribute equally
| | - Min Zhang
- Department of Internal Medicine, Armed Police Hospital of Hangzhou, Hangzhou, PR China
- The two authors contribute equally
| | - Da-Ming Wang
- Departments of Physical Medicine and Rehabilitation, Zhejiang Chinese Medical University Affiliated Jinhua TCM Hospital, Jinhua, PR China
| | - Xiao-Yan Feng
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xiao-Lei Shen
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Meng-Li Wei
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Hui Pan
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xue-Mei Tang
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jie Fang
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jin-Xiu Huang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Qiong Huang
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Wei-Hong Yan
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jing-Jing Su
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jian-Ren Liu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
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Leonardi M, Dall'olio M, Raffi L, Cenni P, Simonetti L, Marasco R, Giagnorio F. Carotid Stenting without Angioplasty and without Protection: The Advantages of a Less Invasive Procedure. Interv Neuroradiol 2008; 14:153-63. [PMID: 20557756 DOI: 10.1177/159101990801400206] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 05/30/2008] [Indexed: 11/15/2022] Open
Abstract
SUMMARY Endovascular stenting is a consolidated alternative to thrombendarterectomy in the treatment of extracranial carotid artery atheromasic stenosis. The most common complication of stenting is a distal embolism causing clinically silent orsymptomatic cerebral ischaemia. To prevent this complication distal embolism protection devices are often used but their effectiveness remains unsettled. In addition, there is some evidence that distal embolism may actually be triggered by the protection systems due to clot formationat their distal surface or in the intimal lesions these systems cause. Another rarer complicationis hyperperfusion syndrome arising during both stenting and thrombendarterectomy but more common in endovascular procedures. To avoid these complications the Neuroradiology Service at Bellaria Hospital (Bologna Local Health Trust) has devised a mini-invasive carotid stenting technique that does not require either distal embolism protection or angioplasty. The technique uses only the radial force exerted by the self-expanding stent to widen the atherosclerotic stenosis slowly and gradually. The goal of treatment has also changed from a prompt restoration of the atheromasic vessel's original calibre to slow transformation of the hemodynamic significance of the stenosis. The technique's success lies mainly in selecting the stenosis to treat using CT angiography to analyse plaque morphology and structure.We used the technique to treat 83 stenotic lesions in 75 patients. The study aims to describe and discussour experience.
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Affiliation(s)
- M Leonardi
- Neuroradiology Department, Bellaria Hospital; Bologna, Italy -
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