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Milazzo N, Da Ros V, Diomedi M, Menozzi R, Pezzini A, Ruggiero M, Simonetti L, Zini A, Romano DG, Napoletano R, Vallone S, Bigliardi G, Plebani M, Cappellari M, Cristaudo C, Mangiafico S, Toni D, Consoli A. Current trends in antiplatelet strategies for emergent carotid stenting in acute tandem occlusions: a web-based, nationwide survey in the Italian neurovascular community. Neurol Sci 2024:10.1007/s10072-024-07722-2. [PMID: 39158771 DOI: 10.1007/s10072-024-07722-2] [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: 05/07/2024] [Accepted: 07/29/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Although a benefit from mechanical thrombectomy has been proven, the best treatment strategy for tandem occlusions (TOs) remains unclear. We conducted a survey that aimed to investigate the trends of pharmacological strategy in the setting of emergent carotid stenting for TOs in the Italian neuro-endovascular community. METHODS We administered a 13-multiple choice-questions survey to the Chiefs of the centers participating to the Italian Registry of Endovascular Thrombectomy in Acute Stroke (IRETAS), focused on the technical aspects and on the management of the antiplatelet therapy for emergent carotid tenting in TOs. An internal coherence control was performed by the coordinating investigator. RESULTS We obtained responses from 56/66 centers (84.8%). The main results of the survey showed that most of the center treat TOs using a retrograde approach, deploying a closed-cell stent. A single antiplatelet therapy is preferred at the moment of the deployment of the stent. CONCLUSIONS This survey showed that the current practice regarding the acute management of TOs, in particular the antiplatelet therapy, remains heterogeneous in the Italian neurovascular community. Specific evidences are urgently needed in order to achieve a consensus on the acute management of TOs.
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Affiliation(s)
- Nicola Milazzo
- Diagnostic and Interventional Neuroradiology, Foch Hopital, Suresnes, France.
- UFR Simon Veil Santé, University of Versailles Saint-Quentin-en-Yvelines (UVSQ), Montigny-Le-Bretonneux, France.
- Maurizio Bufalini Hospital, Cesena, Italy.
| | - Valerio Da Ros
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marina Diomedi
- Stroke Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Menozzi
- Diagnostic Department, Neuroradiology Unit, Parma University Hospital, Parma, Italy
| | - Alessandro Pezzini
- Stroke Care Program Department of Emergency, Parma University Hospital, Parma, Italy
| | | | - Luigi Simonetti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neuroradiology Unit, Maggiore Hospital, Bologna, Italy
| | - Andrea Zini
- Department of Neurology and Stroke Center, IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | - Daniele Giuseppe Romano
- Department of Interventional Radiology and Neuroradiology, University Hospital of Salerno, Salerno, Italy
| | - Rosa Napoletano
- Stroke Unit, Department of Medical Sciences, University Hospital of Salerno, Salerno, Italy
| | - Stefano Vallone
- Baggiovara Hospital, Azienda Ospedaliero-Universitaria di Modena, NeuroradiologyModena, Italy
| | - Guido Bigliardi
- Neurology Clinic - Stroke Unit, Baggiovara Hospital, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Mauro Plebani
- Department of Neuroradiology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Manuel Cappellari
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Salvatore Mangiafico
- Interventional Neuroradiology Consultant at IRCCS Neuromed, Pozzilli (IS), and Adjunct Professor of Interventional Neuroradiology at Tor Vergata University, Sapienza University and S. Andrea Hospital, Rome, Italy
| | - Danilo Toni
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Foch Hopital, Suresnes, France
- UFR Simon Veil Santé, University of Versailles Saint-Quentin-en-Yvelines (UVSQ), Montigny-Le-Bretonneux, France
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Ginanni Corradini L, Maresca L, Lucatelli P, Balocco S, D'Onofrio A, Stefanini M. The role of post-dilatation in carotid MicroNet-covered stent implantation, evaluated using 3D cone-beam CT angiography. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:608-614. [PMID: 38015552 DOI: 10.23736/s0021-9509.23.12756-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND This study aims to assess the role and safety of post-dilatation in protected carotid artery stenting (PCAS) using the new MicroNet-covered 2nd-generation stent assessed by cone beam CT scans. METHODS From March 2020 to March 2022, patients were enrolled in the study according to CT angiography results based on the following criteria: Evidence of 70% to 99% carotid stenosis in asymptomatic patients and 50% to 99% in symptomatic patients, per the NASCET index. Using a FilterWire EZ™ (Boston Scientific, Natick, MA, USA) embolic protection system (EPS), MicroNet-covered stent PCAS was performed by two interventional radiologists with at least 8 years of experience in endovascular intervention. Each patient underwent post-dilatation following stent placement. Finally, a third radiologist (not participating in the interventional procedures) evaluated the cone beam CT scans and calculated residual stenosis. Major and minor complications were recorded in the 30 days following the procedure. RESULTS A total of 192 patients (121 male, mean age 73±10 years) were included in the study, and all patients received post-dilatation following stent implantation. Technical successes were achieved in all procedures. Adverse events noted in this study were limited to periprocedural transient ischemic attacks that occurred in three out of 192 patients (1.6%) and showed a swift complete recovery. The post-dilatation balloon diameters used in the study were: 5.0 mm (30.3%), 5.5 mm (39.3%) and 6 mm (30.3%). Optimized postdilatation resulted in a significant increase in the final luminal area. Similar improvements were observed in all subtypes of plaque. CONCLUSIONS Post-dilatation in protected CAS is safe and induces a significant improvement in the cross-sectional area regardless of the stenotic plaque.
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Affiliation(s)
| | - Luciano Maresca
- Department of Radiology and Interventional Radiology, Casilino Hospital, Rome, Italy
| | | | - Simone Balocco
- Department of Mathematics and Informatics, University of Barcelona, Barcelona, Spain
- Computer Vision Center, Bellaterra, Spain
| | - Adolfo D'Onofrio
- Department of Radiology and Interventional Radiology, Casilino Hospital, Rome, Italy
| | - Matteo Stefanini
- Department of Radiology and Interventional Radiology, Casilino Hospital, Rome, Italy
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