Comorbidities and Health-Related Quality of Life Following Revascularization for Asymptomatic Critical Internal Carotid Artery Stenosis Treated with Carotid Endarterectomy or Angioplasty with Stenting

Comparison of the Outcome and Efficacy of Single-Layer versus Dual-Layer Mesh Stent among Carotid Stenosis Patients Attending a Tertiary Care Setting—A Prospective Observational Study

Introduction The effect of stent design whether single-layer or double-layer on long-term durability of carotid artery stenting (CAS) is unknown. The aim of this article was to compare the clinical outcome and efficacy of single-layer versus dual-layer mesh stent for CAS among carotid stenosis patients.

Methods A prospective observational study was conducted among 41 consecutive patients, who underwent CAS procedures between November 2019 and November 2021. Procedural data and outcomes for patients treated with the single-layer stent (n = 19patients) and double-layer stent (n = 22) were compared. Procedural efficacy and complications were considered as primary outcome variable. SPSS version 22 was used for statistical analysis.

Results Mean age of study population in dual-layer stents group was 63.86 ± 11.08 years and it was 61.47 ± 8.26 years in single-layer stent group. There was no statistically significant difference between two groups with age, stenosis, side of stenosis, prestenting angioplasty, and poststenting angioplasty (p-value >0.05). Out of 22 participants with dual-layer stent, only one (4.5%) participant experienced five episodes of transient ischemic attack in last 1 month. Both clinical and associated complaints were more in dual-layer group compared with single layer. One (5.26%) participant in single-layer group had reclusion/restenosis at 30 days. Majority in single-(57.8%) and double-layer (63.64%) stents group showed modified Rankin Scale score of 0.

Conclusion Restenosis after CAS occurred less frequently in patients treated with double-layer mesh when compared with single-layer stent. However, both stents were equally effective at preventing peri procedural complications.

Stenting for elderly patients with internal carotid artery stenosis: analysis of clinical efficacy

OBJECTIVE

This retrospective study aimed to investigate the clinical efficacy and safety of carotid artery stenting (CAS) in elderly patients with internal carotid artery stenosis (ICS).

METHODS

Ninety elderly ICS patients admitted between January 2019 - July 2021 were selected and divided into a control group and a research group according to different treatment method. The 42 cases in the control group were received carotid endarterectomy and the 48 cases in the research group were treated with CAS. The effects of the two intervention methods on the National Institutes of Health Stroke Scale (NIHSS) score, complication rate, oxidative stress, inflammatory cytokines and cognitive function were observed and evaluated.

RESULTS

Compared to baseline (before treatment), the research group showed significantly reduced scores of NIHSS and activities of daily living, appreciably decreased levels of malonaldehyde, interleukin-6 and high-sensitivity C-reactive-protein, but increased superoxide dismutase, Rapid Verbal Retrieve score and Digit Span Test score after treatment. Also, the same trends were found when comparing the above results with those of the control group after treatment. The two groups showed a comparable complication rate.

CONCLUSIONS

The above data indicate a definite clinical efficacy and a favorable safety profile of CAS for ICS in the elderly. CAS can effectively reduce the oxidative stress and inflammatory cytokines of patients and enhance their cognitive function.

No Evidence for Long Term Blood Pressure Differences Between Eversion and Conventional Carotid Endarterectomy in Two Independent Study Cohorts

OBJECTIVE

Blood pressure (BP) management is a vital aspect of stroke prevention and post-stroke care. Different surgical carotid endarterectomy (CEA) techniques may impact on BP control post-operatively. Specifically, the carotid sinus nerve, which innervates the carotid baroreceptors and carotid body, is commonly left intact during conventional CEA but is routinely transected as part of eversion CEA. The aim of this study was to assess long term BP control after eversion and conventional CEA.

METHODS

Patients from the International Carotid Stenting Study (ICSS cohort) and a personal series of patients from the Stroke Clinical Trials Unit at University College London (UCL cohort) were separately analysed and divided into eversion and conventional CEA groups. Mixed effect linear models were fitted and adjusted for baseline demographic data and antihypertensive treatment to test for changes in BP from baseline over a three year follow up period after the respective procedures.

RESULTS

There were no differences in changes in baseline BP readings and follow up readings between eversion and conventional CEA in the ICSS or UCL cohorts. In the ICSS cohort a mild but significant systolic (-8.6 mmHg; 95% confidence interval [CI] -10.6 - -6.6) and diastolic (-4.9 mmHg; 95% CI -6.0 - -3.8) BP lowering effect was evident at discharge in the conventional group but not in the eversion CEA group. BP monitoring during follow up did not reveal any consistent BP changes with either conventional or eversion CEA vs. baseline levels.

CONCLUSION

Neither conventional nor eversion CEA seem to result in clinically significant long term BP changes. Potential concerns related to either short or long term alterations in BP levels with transection of the carotid sinus nerve during eversion CEA could not be substantiated.

Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice

Objectives

We sought to assess the technical and clinical feasibility of continuous aspiration catheter-directed mechanical thrombectomy (CDT) in patients with high- or intermediate-high-risk pulmonary embolism (PE).

Methods and Results

Fourteen patients (eight women and six men; age range: 29–71 years) with high- or intermediate-high-risk PE and contraindications to or ineffective systemic thrombolysis were prospectively enrolled between October 2018 and February 2020. The Indigo Mechanical Thrombectomy System (Penumbra, Inc., Alameda, California) was used as CDT device. Low-dose local thrombolysis (alteplase, 3–12 mg) was additionally applied in three patients. Technical and procedural success was achieved in 14 patients (100%). Complete or nearly complete clearance of pulmonary arteries was achieved in nine patients (64.3%), whereas partial clearance was achieved in five (35.7%). A significant improvement in the pre- and postprocedural patients' clinical status was observed in the following fields (median; interquartile range): heart rate (110; 100–120/min vs. 85; 80–90/min; p < 0.0001), systolic blood pressure (106; 90–127 mmHg vs. 123; 110–133 mmHg; p = 0.049), arterial oxygen saturation (88.5; 84.2–93% vs. 95.0; 93.8–95%, p = 0.0051), pulmonary artery systolic pressure (55; 44–66 mmHg vs. 42; 34–53 mmHg; p = 0.0015), Miller index score (21.5; 20–23 vs. 9.5; 8–13; p < 0.0001) and right ventricular/left ventricular ratio (1.3; 1.3–1.5 vs. 1.0; 0.9–1.0; p < 0.0001). No major periprocedural bleeding was detected.

Conclusions

CDT is a feasible and promising technique for management of high- or intermediate-high-risk PE to decrease thrombus burden, reduce right heart strain, and improve hemodynamic and clinical status. Some patients may benefit from simultaneous local low-dose thrombolytic therapy. Nevertheless, its criteria and role in CTD-managed patients require further elucidation.

Carotid Artery Angioplasty and Stenting for Carotid Stenosis: A Single-Center Experience from Saudi Arabia

Purpose

Atherosclerotic stenosis of the extracranial carotid artery accounts for approximately 20% of all strokes. Both carotid artery endarterectomy and carotid artery angioplasty with stenting (CAAS) are recommended for symptomatic patients with 50% or more stenosis or asymptomatic patients with 70% or more stenosis. CAAS is under-reported in Saudi Arabia, as evidenced by a thorough literature search. In this article, we aim to share our experience of CAAS to call for the necessity of conducting more research on stroke and emphasize the local need of utilizing more endovascular treatments like CAAS.

Materials and Methods

A retrospective single-center observational study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The inclusion criteria consisted of all adult patients (18 years and above) with carotid stenosis who were treated with CAAS.

Results

A total of 16 patients were included in the study. The mean age of the participants was 66.9±13.5 years (range 30–87 years). All patients were symptomatic (had a previous stroke or transient ischemic attack). The procedure was successful in 14 patients (87.5%), while it failed in 2 patients (12.5%) due to technical reasons. All patients had no stroke or myocardial infarction within 30 days of the procedure.

Conclusion

Despite the advancement in medicine with free healthcare services in Saudi Arabia, the interventional procedures for secondary prevention of strokes are underutilized. Collaboration between different hospitals will be extremely helpful since few centers in each city are providing such treatments by an expert neurointerventionist and/or strokologist. The good selection of candidates, optimal management of comorbid conditions, and multidisciplinary care may improve outcomes and reduce mortality.