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Okumura E, Onodera S, Jimbo H. Subacute In-Stent Occlusion 2 Weeks after CASPER Rx Stenting: A Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2023; 17:173-179. [PMID: 37609575 PMCID: PMC10442173 DOI: 10.5797/jnet.cr.2023-0009] [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: 02/21/2023] [Accepted: 06/03/2023] [Indexed: 08/24/2023]
Abstract
Objective CASPER Rx stent (Terumo, Tokyo, Japan) is one of the dual-layer micromesh stents for carotid artery stenosis. Although it is expected to be safe and efficacious even for vulnerable plaque, we report a case of in-stent occlusion 2 weeks after stenting with CASPER Rx stent. Case Presentation The patient was a 78-year-old man with a symptomatic, severely stenosed lesion of the cervical internal carotid artery (ICA). He had an unstable plaque and underwent carotid artery stenting with the CASPER Rx stent. There were no problems with the procedure or the patient's subsequent course, and he was discharged home 1 week after the procedure. However, on postoperative day 14, the patient had a transit ischemic attack and imaging showed acute occlusion due to thrombus in the stent and in the distal part of the ICA. Mechanical thrombectomy was performed and good recanalization was achieved, but postoperative cerebral infarction was observed and the patient was transferred to other hospital with modified Rankin Scale 2. Conclusion We experienced a case of in-stent occlusion 2 weeks after stenting with the CASPER Rx stent.
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Affiliation(s)
- Eitaro Okumura
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Sho Onodera
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Hiroyuki Jimbo
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
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2
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Wang H, Xu L, Qin Y, Xiao G. Revascularization of acute stent thrombosis caused by diarrhea after carotid artery stenting in an intermediate clopidogrel metabolizer. BMC Neurol 2023; 23:260. [PMID: 37415135 DOI: 10.1186/s12883-023-03293-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023] Open
Abstract
Carotid artery stenting (CAS) is an alternative treatment to carotid endarterectomy for carotid artery stenosis. Acute stent thrombosis (ACST) is an extremely rare complication but can have devastating consequences. Although many cases have been reported, the best treatment is still uncertain. In this study, we report the treatment of ACST caused by diarrhea in an intermediate clopidogrel metabolizer. We also review the literature and discuss appropriate treatment strategies for this rare event.
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Affiliation(s)
- Huaishun Wang
- Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Longdong Xu
- fifth People's Hospital of Changshu, Suzhou, 215004, China
| | - Yan Qin
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou, 215004, China.
| | - Guodong Xiao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou, 215004, China.
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3
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Lu J. Rescue of immediate post-transcarotid artery revascularization carotid stent thrombosis due to clopidogrel resistance using flow-reversal and aspiration thrombectomy. J Vasc Surg Cases Innov Tech 2023; 9:101205. [PMID: 37274441 PMCID: PMC10238582 DOI: 10.1016/j.jvscit.2023.101205] [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: 02/16/2023] [Accepted: 04/14/2023] [Indexed: 06/06/2023] Open
Abstract
An 84-year-old patient developed immediate thrombosis of his carotid stent in recovery after transcarotid artery revascularization. In the present report, the technical details about intraoperative management for neurovascular rescue using the transcarotid artery revascularization flow-reversal system are described. The patient was determined to have clopidogrel resistance. Intraoperative medical management is also discussed. The current alternative intravenous and oral antiplatelet therapies such as glycoprotein IIb/IIIa and P2Y12 inhibitors are explored. The debate regarding preoperative antiplatelet resistance testing remains ambiguous, and increasing studies have demonstrated the safety and efficacy of alternatives to clopidogrel. Despite an unpredictable and devastating complication, the patient's outcome was successful using contemporary strategies.
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Affiliation(s)
- Joyce Lu
- Correspondence: Joyce Lu, MD, South Valley Vascular Associates, Division of BASS Medical Group, 820 S. Akers St., Suite 120, Visalia 93277, CA
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4
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Segawa M, Inoue T, Tsunoda S, Kanamaru T, Okubo S. Carotid endarterectomy for acute carotid thrombosis after carotid artery stenting with CASPER Rx® stent: A case report. Surg Neurol Int 2023; 14:25. [PMID: 36895231 PMCID: PMC9990767 DOI: 10.25259/sni_1021_2022] [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: 11/07/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023] Open
Abstract
Background Acute carotid stent thrombosis (ACST) is a rare but devastating complication for carotid artery stenting (CAS). That requires early diagnosis and immediate treatment. Although administration of drugs or endovascular treatment is the most widely used approach for patients with ACST, there is no consensus on the standard treatment of this disease. Case Description The present study reports on an 80-year-old female patient with the right internal carotid artery stenosis (ICS) that had been followed up by ultrasonography for 8 years. Although the optimal medical treatment was followed, the patient's right ICS worsened, and the patient was subsequently hospitalized for CAS. On the 12th day after CAS, left paralysis and dysarthria were observed. Head magnetic resonance imaging (MRI) showed acute obstruction of the stent and scattered cerebral infarction in the right cerebral hemisphere caused possibly by the discontinuation of temporary antiplatelet drug therapy as a means to prepare for embolectomy of the femoral artery. Stent removal and carotid endarterectomy (CEA) were selected as the appropriate treatment approach. CEA was performed with the precaution of stent removal and distal embolism, and complete recanalization was obtained. Postoperative head MRI showed no new findings of cerebral infarction, and the patients remained symptom-free after 6 months of postoperative follow-up. Conclusion Stent removal with CEA could be an appropriate curative option in some cases with ACST except in patients at high risk of CEA and in the chronic phase after CAS.
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Affiliation(s)
- Masafumi Segawa
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tomohiro Inoue
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Sho Tsunoda
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Takuya Kanamaru
- Department of Cerebrovascular Medicine, NTT Medical Center Tokyo, Tokyo, Japan
| | - Seiji Okubo
- Department of Cerebrovascular Medicine, NTT Medical Center Tokyo, Tokyo, Japan
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5
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Zhang JB, Fan XQ, Chen J, Liu P, Ye ZD. Acute carotid stent thrombosis: A case report and literature review. World J Clin Cases 2022; 10:9310-9317. [PMID: 36159434 PMCID: PMC9477654 DOI: 10.12998/wjcc.v10.i26.9310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/10/2021] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute carotid stent thrombosis (ACST) is a rare but devastating complication in the carotid artery stenting (CAS) procedure. The aim of this article is to report a case and review cases of ACST reported in the literature, and investigate risk factors and management strategies for ACST.
CASE SUMMARY We reviewed the treatment process of a patient with ACST after CAS. Then multiple databases were systematically searched to identify studies reporting ACST from 2005 to 2020. The demographic data, risk factors, treatment strategies, and prognosis were extracted and analyzed.
CONCLUSION The reason for ACST is multifactorial. Proper patient selection, normative anti-platelet treatment, and perfect technical detail may decrease the incidence of ACST. Several treatment strategies such as thrombolysis, mechanical thrombectomy, and open surgery may be options for the treatment of ACST. Limited data have shown that carotid endarterectomy is effective with favorable results.
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Affiliation(s)
- Jian-Bin Zhang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xue-Qiang Fan
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jie Chen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Peng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zhi-Dong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing 100029, China
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6
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Wei W, Wang Y, Wang P, Li Z. Revascularization of acute stent thrombosis after carotid artery stenting in a CYP2C19*2 heterozygote patient. J Int Med Res 2021; 49:3000605211001191. [PMID: 33745326 PMCID: PMC7989125 DOI: 10.1177/03000605211001191] [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] [Indexed: 11/20/2022] Open
Abstract
Carotid artery stenting (CAS) is an alternative strategy to carotid endarterectomy for the prevention of ischemic stroke. Acute carotid stent thrombosis (ACST) is an extremely rare but devastating complication of CAS. Although cases of successful recanalization have been reported, there is still a lack of experience regarding the choice of ACST treatment methods and the timing of such treatments, especially when patients are confirmed CYP2C19*2 heterozygotes. Here, we report a case of successful revascularization after ACST in a patient with CYP2C19*2 heterozygosity. We also review the literature and discuss appropriate treatment strategies for this devastating and rare event.
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Affiliation(s)
- Wei Wei
- Department of Emergency, Chengdu Second People's Hospital, Chengdu, China
| | - Yan Wang
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu, China
| | - Pian Wang
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu, China
| | - Zheng Li
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu, China
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7
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Coelho AP, Lobo M, Nogueira C, Gouveia R, Campos J, Augusto R, Coelho N, Semião AC, Canedo A. Overview of evidence on risk factors and early management of acute carotid stent thrombosis during the last two decades. J Vasc Surg 2019; 69:952-964. [DOI: 10.1016/j.jvs.2018.09.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/20/2018] [Indexed: 10/27/2022]
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8
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Beppu M, Mineharu Y, Imamura H, Adachi H, Sakai C, Tani S, Arimura K, Tokunaga S, Sakai N. Postoperative in-stent protrusion is an important predictor of perioperative ischemic complications after carotid artery stenting. J Neuroradiol 2018. [DOI: 10.1016/j.neurad.2018.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Moulakakis KG, Mylonas SN, Lazaris A, Tsivgoulis G, Kakisis J, Sfyroeras GS, Antonopoulos CN, Brountzos EN, Vasdekis SN. Acute Carotid Stent Thrombosis. Vasc Endovascular Surg 2016; 50:511-521. [DOI: 10.1177/1538574416665986] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute carotid stent thrombosis (ACST) is a rare complication that can lead to dramatic and catastrophic consequences. A rapid diagnosis and prompt recanalization of the internal carotid artery are needed to minimize the ischemic insult and the reperfusion injury. We reviewed the current literature on this devastating complication of CAS with the intention of investigating the potential causative factors and to define the appropriate management. According to our study discontinuation of antiplatelet therapy, resistance to antiplatelet agents and inherent or acquired thrombotic disorders are the main causes of thrombosis. Technical intraprocedural parameters such as dissection, atheroma prolapse, kinking of the distal part of internal carotid artery and embolic protection device occlusion can also result in early carotid stent thrombosis. Rapid reperfusion ensures an improved neurological outcome and a better prognosis in the short and long term. Thrombolysis, mechanical thrombectomy or thromboaspiration in combination with drug or thrombolytic therapy, surgical therapy and re-angioplasty are treatment options that have been used with encouraging results. In conclusion, optimal perioperative antiplatelet treatment as well as technical considerations regarding the carotid artery stenting plays a determinant role.
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Affiliation(s)
- Konstantinos G. Moulakakis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Spyridon N. Mylonas
- Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - Andreas Lazaris
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Georgios Tsivgoulis
- Department of Neurology, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - John Kakisis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Giorgos S. Sfyroeras
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Constantine N. Antonopoulos
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Elias N. Brountzos
- Department of Radiology, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Spyridon N. Vasdekis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
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10
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Kim YW, Kang DH, Hwang JH, Park J, Hwang YH, Kim YS. Rescue strategy for acute carotid stent thrombosis during carotid stenting with distal filter protection using forced arterial suction thrombectomy with a reperfusion catheter of the Penumbra System: a technical note. Acta Neurochir (Wien) 2013; 155:1583-8. [PMID: 23689967 DOI: 10.1007/s00701-013-1744-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/26/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Among the procedural complications related to carotid artery stenting (CAS), internal carotid artery (ICA) flow arrest is one of the most drastic complications, as it can cause major ischemic stroke. Acute carotid stent thrombosis (ACST) is a rare etiology of ICA flow arrest during carotid artery stenting with distal filter protection, but the most devastating. Moreover, no definitive management strategy has been established so far for treating ACST. METHODS We introduce a rescue management strategy for differential diagnosis of ICA flow arrest and for recanalization of ACST with a simple endovascular mechanical thrombectomy technique. RESULTS In three cases of ICA flow arrest caused by ACST, selective angiography with a 1.7 F microcatheter provided confirmative diagnosis. Recanalization was then achieved with a Penumbra System (PS) reperfusion catheter using the forced arterial suction thrombectomy (FAST) technique. Successful recanalization with a Thrombolysis In Cerebral Infarction score of 3 was achieved for all three patients. Recanalization was confirmed with follow-up angiography at least 24 h after the procedure. No complications associated with this technique occurred. CONCLUSIONS Based on our preliminary experiences, selective microangiography can be helpful for rapid diagnosis of ACST, and the present mechanical thrombectomy technique, using a modification of the PS, can play a role in adjuvant management or as a last resort for the treatment of ACST during CAS.
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Affiliation(s)
- Yong-Won Kim
- Department of Neurology, Cerebrovascular Center, Kyungpook National University Hospital, Daegu, Republic of Korea
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11
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Kanemaru K, Nishiyama Y, Yoshioka H, Satoh K, Hashimoto K, Hanihara M, Horikoshi T, Ozaki Y, Kinouchi H. In-stent thrombosis after carotid artery stenting despite sufficient antiplatelet therapy in a bladder cancer patient. J Stroke Cerebrovasc Dis 2013; 22:1196-200. [PMID: 23834849 DOI: 10.1016/j.jstrokecerebrovasdis.2012.12.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 12/07/2012] [Accepted: 12/21/2012] [Indexed: 11/28/2022] Open
Abstract
In-stent thrombosis (IST) after carotid artery stenting (CAS) is a rare but potentially devastating complication. We present a case of early IST after CAS despite sufficient antiplatelet therapy in a patient with bladder cancer. A 77-year-old man under preventive triple antiplatelet therapy underwent CAS without any intra- or periprocedural complications. However, the patient developed a large asymptomatic IST 6 days after CAS. Anticoagulant therapy with argatroban was reintroduced to treat IST concomitant with antiplatelet agents. Subsequently, the IST shrank and disappeared without any thrombotic symptoms. Malignancy is regarded as an acquired thrombophilic condition associated with a significant risk of thrombosis. In the field of coronary stents, cancer is associated with a significant increasing risk of IST. The cause of IST in our case was possibly related in hypercoagulable state because of the patient's cancer. Attention for IST should be paid in CAS cases with these risk factors, and repeated examination is recommended.
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Affiliation(s)
- Kazuya Kanemaru
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
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12
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Markatis F, Petrosyan A, Abdulamit T, Bergeron P. Acute carotid stent thrombosis: a case of surgical revascularization and review of treatment options. Vascular 2012; 20:217-20. [DOI: 10.1258/vasc.2011.cr0303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Carotid artery stenting is considered to be an alternative to carotid endarterectomy for selected patients by many vascular specialists around the world. Acute stent thrombosis following the procedure, although very infrequent, can risk the survival of the patient. In this report, we present a case of acute stent thrombosis 24 hours following the procedure. After a slow deterioration of the clinical state of the patient, he was urgently subjected to thrombectomy with extraction of the stent, with eventual resolution of his symptoms. A review of the current literature is presented together with all the possible treatment options of this serious complication. In conclusion, several neurorescue procedures are available for the vascular surgeon who has to act urgently and, in some cases, aggressively, when stent thrombosis is diagnosed.
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Affiliation(s)
- Fotis Markatis
- Department of Thoracic and Great Vessels Surgery, Saint-Joseph Hospital, Marseille, France
| | - Andranyk Petrosyan
- Department of Thoracic and Great Vessels Surgery, Saint-Joseph Hospital, Marseille, France
| | - Timur Abdulamit
- Department of Thoracic and Great Vessels Surgery, Saint-Joseph Hospital, Marseille, France
| | - Patrice Bergeron
- Department of Thoracic and Great Vessels Surgery, Saint-Joseph Hospital, Marseille, France
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13
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Kono K, Tanaka Y, Yoshimura R, Fujimoto T, Okada H, Shintani A, Terada T. Emergent carotid artery stenting using a flow reversal system for acute atherosclerotic occlusion of the internal carotid artery. Acta Neurochir (Wien) 2011; 153:2175-80. [PMID: 21892634 DOI: 10.1007/s00701-011-1142-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 08/23/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Kenichi Kono
- Department of Neurological Surgery, Wakayama Rosai Hospital, Japan.
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14
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Nicosia A, Nikas D, Castriota F, Biamino G, Cao P, Cremonesi A, Mathias K, Moussa I, Hopkins LN, Setacci C, Sievert H, Reimers B. Classification for carotid artery stenting complications: manifestation, management, and prevention. J Endovasc Ther 2010; 17:275-94. [PMID: 20557164 DOI: 10.1583/09-2943.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Carotid artery stenting is a rapidly evolving method for treating carotid artery disease. Various intraprocedural and postprocedural complications have been reported in the literature. However, the absence of a unified classification scheme for these complications makes it difficult, if not impossible, to study their precise incidence, predictors, and management. The aim of this article is to propose the first joint classification of periprocedural complications, to analyze their incidence and etiology, and suggest possible ways to manage and prevent them. This classification is intended to be used as a common platform for prompt recognition, evaluation, treatment, and universal study of the complications during carotid stenting procedures. For this purpose, the opinions of the major experts on carotid interventions worldwide were merged with all the available information reported in the English-language literature to present as accurately as possible the management and prevention of carotid stenting complications according to this proposed classification.
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Affiliation(s)
- Antonino Nicosia
- Cardiac Catheterization Laboratory, M.P. Arezzo Hospital, Ragusa, Italy
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15
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Iancu A, Grosz C, Lazar A. Acute carotid stent thrombosis: review of the literature and long-term follow-up. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2010; 11:110-3. [PMID: 20347802 DOI: 10.1016/j.carrev.2009.02.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 02/13/2009] [Indexed: 11/18/2022]
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16
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Naito T, Miyachi S, Izumi T, Matsubara N, Haraguchi KI, Nakamura S, Sumitomo M, Wakabayashi T. Rescue stenting for subacute thrombosis after carotid stenting-Report of 2 cases. ACTA ACUST UNITED AC 2010. [DOI: 10.3995/jstroke.32.427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Takemoto K, Iwaasa M, Uda K, Inoue T, Fukushima T. A Case of Occlusion due to Acute In-stent Thrombosis after Carotid Artery Stenting. ACTA ACUST UNITED AC 2009. [DOI: 10.7887/jcns.18.305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | - Ken Uda
- Department of Neurosurgery, National Hospital Organization, Kyushu Medical Center
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University School of medicine
| | - Takeo Fukushima
- Department of Neurosurgery, Fukuoka University School of medicine
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