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Fu PC, Wang JY, Su Y, Liao YQ, Li SL, Xu GL, Huang YJ, Hu MH, Cao LM. Intravascular ultrasonography assisted carotid artery stenting for treatment of carotid stenosis: Two case reports. World J Clin Cases 2023; 11:7127-7135. [PMID: 37946762 PMCID: PMC10631408 DOI: 10.12998/wjcc.v11.i29.7127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/09/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Digital subtraction angiography (DSA), the gold standard of cerebrovascular disease diagnosis, is limited in its diagnostic ability to evaluate arterial diameter. Intravascular ultrasonography (IVUS) has advantages in assessing stenosis and plaque nature and improves the evaluation and effectiveness of carotid artery stenting (CAS). CASE SUMMARY Case 1: A 65-year-old man presented with a five-year history of bilateral lower limb weakness due to stroke. Physical examination showed decreased strength (5-/5) in both lower limbs. Carotid artery ultrasound, magnetic resonance angiography, and computed tomography angiography (CTA) showed a right proximal internal carotid artery (ICA) stenosis (70%-99%), acute cerebral infarction, and severe right ICA stenosis, respectively. We performed IVUS-assisted CAS to measure the stenosis and detected a low-risk plaque at the site of stenosis prior to stent implantation. Post-stent balloon dilatation was performed and postoperative IVUS demonstrated successful expansion and adherence. CTA six months postoperatively showed no significant increase in in-stent stenosis. Case 2: A 36-year-old man was admitted with a right common carotid artery (CCA) dissection detected by ultrasound. Physical examination showed no positive neurological signs. Carotid ultrasound and CTA showed lumen dilation in the proximal CCA with an intima-like structure and bulging in the proximal segment of the right CCA with strip-like low-density shadow (dissection or carotid web). IVUS-assisted DSA confirmed right CCA dissection. CAS was performed and intraoperative IVUS suggested a large residual false lumen. Post-stent balloon dilatation was performed reducing the false lumen. DSA three months postoperatively indicated good stent expansion with mild stenosis. CONCLUSION IVUS aids decision-making during CAS by accurately assessing carotid artery wall lesions and plaque nature preoperatively, dissection and stenosis morphology intraoperatively, and visualizing and confirming CAS postoperatively.
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Affiliation(s)
- Peng-Cheng Fu
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Jing-Yi Wang
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macau 999078, China
| | - Ying Su
- Graduate School, Guangzhou Medical University, Guangzhou 511495, Guangdong Province, China
| | - Yu-Qi Liao
- School of Medicine, Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Shao-Ling Li
- School of Medicine, Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Ge-Lin Xu
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Yan-Jiao Huang
- Medical Department, Baise People’s Hospital, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Ming-Hua Hu
- Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha 410219, Hunan Province, China
| | - Li-Ming Cao
- Clinical College of the Shenzhen Second People’s Hospital, Anhui Medical University, Shenzhen 518000, Guangdong Province, China
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Yamaguchi Y, Takada T, Uchida K, Miyata K, Kurisu K, Okuyama T, Tomeoka F, Ajiki M, Hokari M, Asaoka K. Carotid Artery Stenting Using Stent-in-Stent Technique with a Closed-Cell Stent and a Dual-Layer Micromesh Stent: A Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2023; 17:101-106. [PMID: 37546544 PMCID: PMC10400896 DOI: 10.5797/jnet.cr.2023-0003] [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: 02/02/2023] [Accepted: 03/31/2023] [Indexed: 08/08/2023]
Abstract
Objective Recent studies evaluating plaque protrusion at carotid artery stenting (CAS) using optical coherence tomography showed not a few cases of plaque protrusion when using double-layer micromesh stents. We report a case of symptomatic internal carotid artery (ICA) stenosis with at-risk unstable plaques in which CAS was successfully performed using a stent-in-stent technique by the combined use of a closed-cell stent and a dual-layer micromesh stent. Case Presentation An 87-year-old Japanese man with dysarthria and right hemiparesis was diagnosed with atheromatous cerebral embolism caused by severe left ICA stenosis on MRI and DSA. MRI with T1-weighted black blood methods showed high intensities in the plaques of the left ICA, suggesting unstable plaque characteristics with intraplaque hemorrhage components. On day 20, CAS was performed. After the pre-stent dilation under proximal and distal protection, a Carotid WALLSTENT was placed to cover the stenotic lesion. Then, a CASPER Rx was placed from the proximal left ICA to the common carotid artery to cover the Carotid WALLSTENT. Although visible plaque debris was recognized in the aspirated blood, the debris became invisible after aspiration of 1300 mL. Postoperative angiography showed enough dilation of the left ICA, with no plaque protrusion or acute stent thrombosis. The patient had an uneventful postoperative course and was discharged without any neurological sequelae. Conclusion The present case suggests that the combined stent-in-stent technique using a closed-cell stent and a micromesh stent can be considered as one of the treatment strategies for preventing plaque protrusion and procedural ischemic complications in patients with high-risk carotid plaques.
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Affiliation(s)
- Yoshitaka Yamaguchi
- Department of Cerebrovascular Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Tatsuro Takada
- Department of Cerebrovascular Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Kazuki Uchida
- Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Kei Miyata
- Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Kota Kurisu
- Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Tomohiro Okuyama
- Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Fumiki Tomeoka
- Department of Cerebrovascular Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Minoru Ajiki
- Department of Cerebrovascular Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Masaaki Hokari
- Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Katsuyuki Asaoka
- Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
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Wada T, Takayama K, Myouchin K, Oshima K, Tanaka T, Kichikawa K. Intraprocedural Plaque Protrusion during Carotid Artery Stenting with a CASPER Stent: A Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 17:32-36. [PMID: 37501884 PMCID: PMC10370511 DOI: 10.5797/jnet.cr.2022-0054] [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: 08/13/2022] [Accepted: 10/10/2022] [Indexed: 07/29/2023]
Abstract
Objective Plaque protrusion (PP) during carotid artery stenting (CAS) is considered to be associated with periprocedural ischemic stroke. A new double-layer micromesh stent, the CASPER stent (CS), was approved for use in Japan in 2020. The expectation is that this micromesh stent system will reduce the risk of PP, but we report a case of PP during CAS despite the use of a CS. Case Presentation An 87-year-old man presented with left hemiparesis. MRI showed right brain infarction and angiography showed right internal carotid artery stenosis with thrombus. Follow-up angiography after medical treatment showed that thrombus disappeared. We therefore performed CAS for right internal carotid artery stenosis with unstable plaque. CAS was performed under local anesthesia with Mo.Ma Ultra and FilterWire EZ protection using a CS placed to sufficiently cover the stenotic region. Conservative post-dilatation was then performed. Intravascular ultrasonography (IVUS) after post-dilatation showed the presence of PP. A second CS was then added using the stent-in-stent technique. No postoperative neurological abnormalities were found and the patient was discharged without postoperative complications. No stroke or restenosis has been observed as of 16 months after CAS. Conclusion PP can occur even when CAS is performed using the CS for carotid artery stenosis with unstable plaque. The importance of checking for PP using IVUS is suggested.
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Affiliation(s)
- Takeshi Wada
- Department of Interventional Neuroradiology/Radiology, Kouseikai Takai Hospital, Tenri, Nara, Japan
| | - Katsutoshi Takayama
- Department of Interventional Neuroradiology/Radiology, Kouseikai Takai Hospital, Tenri, Nara, Japan
| | - Kaoru Myouchin
- Department of Interventional Neuroradiology/Radiology, Kouseikai Takai Hospital, Tenri, Nara, Japan
| | - Keisuke Oshima
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
| | - Toshihiro Tanaka
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
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Morosetti D, Lenci I, Argirò R, Milana M, Gasparrini F, Crociati S, Tisone G, Floris R, Baiocchi L. Use of Intravascular Ultrasound to Improve Diagnosis and Treatment of Transjugular Intrahepatic Portosystemic Shunt Dysfunction in Patients in the Long-term Follow-up. Euroasian J Hepatogastroenterol 2022; 12:50-56. [PMID: 35990871 PMCID: PMC9357521 DOI: 10.5005/jp-journals-10018-1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To evaluate the efficacy of intravascular ultrasound (IVUS) in transjugular intrahepatic portosystemic shunt (TIPS) revision associated with phlebography and invasive pressure measurement in patients with clinical or radiological signs of TIPS malfunction. Background Four patients underwent TIPS revision between February and August 2021. Right internal jugular vein access was achieved under ultrasonographic guidance, a catheter was advanced to achieve the Inferior Vena Cava (IVC) and afterward the Portal vein through the TIPS. Once the Portal vein was achieved, a phlebography was performed, followed by invasive pressure measurement and IVUS exam over the guidewire. Based on the combination of phlebography, invasive pressure measurement, and IVUS evaluations, TIPS dysfunction was treated either with angioplasty or stent apposition. Case description In all patients, we obtained the reduction of porto-systemic gradient. In three patients, angioplasty with a 10 mm diameter balloon catheter was performed. Anticoagulation therapy was added to one patient. In one patient, the Viatorr's proximal extremity in the suprahepatic vein wall was dislocated, so it was lengthened with a “Viabahn” covered stent. None of the patients developed hepatic encephalopathy after both TIPS placement and TIPS revision. No complications related to the procedure were observed during the follow-up. Clinical improvement in the immediate follow-up period was observed in all patients. In two patients, the abdominal ascites resolved. In another one, the abdominal pain disappeared, and a reduction of the longitudinal spleen diameter was recorded at 3 months follow-up. Conclusion The use of IVUS allowed us to correctly visualize the organic cause of TIPS malfunction and to obtain direct visualization of the results of endovascular treatment. How to cite this article Morosetti D, Lenci I, Argirò R, et al. Use of Intravascular Ultrasound to Improve Diagnosis and Treatment of Transjugular Intrahepatic Portosystemic Shunt Dysfunction in Patients in the Long-term Follow-up. Euroasian J Hepato-Gastroenterol 2022;12(1):50–56.
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Affiliation(s)
- Daniele Morosetti
- Department of Interventional Radiology Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Ilaria Lenci
- Department of Experimental Medicine and Surgery, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Renato Argirò
- Department of Interventional Radiology Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Martina Milana
- Department of Experimental Medicine and Surgery, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Fulvio Gasparrini
- Department of Interventional Radiology Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Sara Crociati
- Department of Interventional Radiology Unit, University of Rome Tor Vergata, Rome, Latium, Italy
- Sara Crociati, Department of Interventional Radiology Unit, University of Rome Tor Vergata, Rome, Latium, Italy, Phone: +39 3331579930, e-mail:
| | - Giuseppe Tisone
- Department of Experimental Medicine and Surgery, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Roberto Floris
- Department of Interventional Radiology Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Leonardo Baiocchi
- Department of Experimental Medicine and Surgery, Policlinico Universitario Tor Vergata, Rome, Italy
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Mishra B, Pandit AK, Miyachi S, Ohshima T, Kawaguchi R, Vishnu VY, Misra S, Srivastava MVP, Srivastava AK, Kale SS, Phalak M. Clinical Utility of Intravascular Ultrasound (IVUS) in Carotid Artery Interventions: A Systematic Review and Meta-analysis. J Endovasc Ther 2021; 29:678-691. [PMID: 34955053 DOI: 10.1177/15266028211064824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Carotid plaque morphology plays an important role in determining outcome of carotid artery stenting (CAS). Intravascular ultrasound (IVUS) and its extension VH (Virtual Histology)-IVUS evaluate plaque characteristics in real time and guide decision making during stenting. To date, there is no consensus about indications of IVUS and its validated methods. This systematic review and meta-analysis aims to evaluate the clinical utility of IVUS in carotid artery interventions (CAS) and develop a future consensus for research and practice parameters. METHODS A systematic review and meta-analysis was performed of the English literature articles published till February 2021. Studies reporting on IVUS parameters and findings and also its performance compared with other imaging modalities were included in review. Pooled prevalence with 95% confidence intervals (CI) was calculated. The statistical analysis was conducted in R version 3.6.2. RESULTS A total of 2015 patients from 29 studies were included. Proportional meta-analysis was performed on 1566 patients from 11 studies. In 9 studies, stroke/transient ischemic attack (TIA) had a pooled prevalence of 4% (95% CI 3%-5%) while asymptomatic stroke had a pooled prevalence of 46% (95% CI 31%-62%) in 4 studies following IVUS. Two studies reported that IVUS detected more plaque protrusion compared with angiography (n=33/396 vs 11/396). IVUS led to stent type or size change in 8 of 48 cases which were missed on angiography in 3 other studies. Concordance between VH-IVUS and true histology was good at 80% to 85% reported in 2 studies. CONCLUSIONS This systematic review and meta-analysis showed, though IVUS fared better to computed tomography (CT)/magnetic resonance (MR) angiography for better stent selection during CAS, with low to moderate risk of bias in the studies included. However, large scale, preferably randomized controlled studies are needed to predict its role in determining clinical outcome.
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Affiliation(s)
- B Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - A K Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - S Miyachi
- Department of Neurological Surgery, Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Japan
| | - T Ohshima
- Department of Neurological Surgery, Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Japan
| | - R Kawaguchi
- Department of Neurological Surgery, Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Japan
| | - V Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - S Misra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V P Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - A K Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - S S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - M Phalak
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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A rare case of a giant circumflex coronary artery aneurysm 10 years after bentall surgery. Radiol Case Rep 2021; 16:1749-1753. [PMID: 34007396 PMCID: PMC8111465 DOI: 10.1016/j.radcr.2021.03.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 11/21/2022] Open
Abstract
In this paper, we describe a rare case of coronary artery aneurysms occasionally found on a pre interventional Coronary Computed Tomography Angiography performed on a 67-year-old man with a history of aneurysm of the ascending aorta previously treated with Bentall surgery, who arrived at our hospital to have a percutaneous valve-in-valve implantation procedure. Even though the patient was considered not eligible for the procedure, due to his many comorbidities, and conservatively managed, at 1-year followup his angiographic condition remained stable.
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Taguchi H, Takayama K, Kishida H, Wada T, Myouchin K, Tanaka T, Kichikawa K. A Case of Intraprocedural Plaque Protrusion during Carotid Artery Stenting Using the Stent-in-Stent Technique for Carotid Artery Stenosis with Unstable Plaque. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:46-51. [PMID: 37502026 PMCID: PMC10370619 DOI: 10.5797/jnet.cr.2020-0207] [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: 12/04/2020] [Accepted: 03/14/2021] [Indexed: 07/29/2023]
Abstract
Objective Carotid artery stenting (CAS) using the stent-in-stent technique was reported to prevent intraprocedural plaque protrusion (PP) in patients with carotid artery stenosis with unstable plaque. We report a case of intraoperative PP after CAS despite the use of stent-in-stent technique. Case Presentation A 63-year-old man presented with rapid progression of right carotid artery stenosis with unstable plaque during follow-up and was admitted to undergo CAS. Under local anesthesia with Mo.Ma Ultra and FilterWire EZ protection, CAS was performed using the stent-in-stent technique. The first 8 mm × 29 mm Carotid Wallstent (CWS) was placed. The second CWS (6 mm × 22 mm) was placed in a stent-in-stent manner to match the stenotic lesion, and conservative postdilation was performed. Then the third CWS (6 mm × 22 mm) was added due to the presence of PP on intravascular ultrasonography (IVUS). No postoperative neurological abnormalities were found, and no new high-signal areas were observed on diffusion-weighted MRI the day after surgery. The patient was discharged without postoperative complications. No stroke and restenosis were observed at 3 months after CAS. Conclusion PP can occur even with stent-in-stent technique, suggesting the importance of diagnosis by IVUS.
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Affiliation(s)
- Hidehiko Taguchi
- Department of Interventional Neuroradiology and Radiology, Koseikai Takai Hospital, Tenri, Nara, Japan
- Department of Radiology, Higashiosaka City Medical Center, Higashiosaka, Osaka, Japan
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
| | - Katsutoshi Takayama
- Department of Interventional Neuroradiology and Radiology, Koseikai Takai Hospital, Tenri, Nara, Japan
| | - Hayato Kishida
- Department of Interventional Neuroradiology and Radiology, Koseikai Takai Hospital, Tenri, Nara, Japan
| | - Takeshi Wada
- Department of Interventional Neuroradiology and Radiology, Koseikai Takai Hospital, Tenri, Nara, Japan
| | - Kaoru Myouchin
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
| | - Toshihiro Tanaka
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
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Rothstein E, Aronow H, Hawkins BM, Young MN. Intravascular Imaging for Peripheral Vascular Disease and Endovascular Intervention. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-9526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Montorsi P, Caputi L, Galli S, Ravagnani PM, Teruzzi G, Annoni A, Calligaris G, Fabbiocchi F, Trabattoni D, de Martini S, Grancini L, Pontone G, Andreini D, Troiano S, Restelli D, Bartorelli AL. Carotid Wallstent Versus Roadsaver Stent and Distal Versus Proximal Protection on Cerebral Microembolization During Carotid Artery Stenting. JACC Cardiovasc Interv 2020; 13:403-414. [DOI: 10.1016/j.jcin.2019.09.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/14/2019] [Accepted: 09/04/2019] [Indexed: 11/29/2022]
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Kawabata Y, Nakajima N, Miyake H, Fukuda S, Tsukahara T. Postoperative ischemic events in patients undergoing carotid artery stenting using algorithmic selection for embolic protection. Neuroradiol J 2019; 32:294-302. [PMID: 30971186 DOI: 10.1177/1971400919839644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Carotid artery stenting (CAS) is a valuable alternative to carotid endarterectomy, especially in high-risk patients. However, the reported incidences of perioperative stroke and death remain higher than for carotid endarterectomy, even when using embolic protection devices (EPDs) during CAS. Our purpose was to evaluate 30-day major adverse events after CAS when selecting the most appropriate EPD. METHODS We reviewed the clinical outcomes of 61 patients with 64 lesions who underwent CAS with EPDs. Patients who underwent CAS associated with thrombectomy and who had a preoperative modified Rankin scale score >3 were excluded from the analysis. The EPD was selected based on symptoms, carotid wall magnetic resonance imaging and lesion length, and we analyzed combined 30-day complication rates (transient ischemic attack, minor stroke, major stroke or death). RESULTS Forty-nine patients were men and 12 were women. The median age was 72 years (range: 59-89 years) and 44 lesions were asymptomatic. A filter-type EPD was selected in 23 procedures, distal-balloon protection in 14 procedures and proximal-occlusive protection in 27 procedures. Two patients (3.1%) experienced a transient ischemic attack and one patient (1.6%) had a minor stroke within 30 days of the procedure. No patients experienced procedure-related morbidities (modified Rankin score >2) or death. CONCLUSIONS The perioperative stoke rate was low when we selected a proximal-occlusive-type EPD in high-risk patients with vulnerable carotid artery disease. Our algorithm for EPD selection was an effective tool in the perioperative management of carotid artery stenosis.
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Affiliation(s)
- Yasuhiro Kawabata
- 1 Department of Neurosurgery, Kyoto Katsura Hospital, Japan.,2 Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Japan
| | - Norio Nakajima
- 1 Department of Neurosurgery, Kyoto Katsura Hospital, Japan
| | | | - Shunichi Fukuda
- 2 Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Japan
| | - Tetsuya Tsukahara
- 2 Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Japan
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