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Silvestri O, Accarino G, Turchino D, Squizzato F, Piazza M, Bastianon M, Di Gregorio S, Pratesi G, Antonello M, Costa D, Serra R, Bracale UM. Mid-Term Results of an Italian Multicentric Experience with the Roadsaver TM Dual-Layer Carotid Stent System. Healthcare (Basel) 2024; 12:120. [PMID: 38201025 PMCID: PMC10778716 DOI: 10.3390/healthcare12010120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Carotid artery stenting (CAS) using first-generation single-layer stents is widely accepted as a good alternative to standard carotid endarterectomy (CEA) but it is associated with worse outcomes in terms of both plaque prolapse and cerebral embolization. AIM To evaluate the perioperative and midterm outcomes of CAS using the new-generation RoadsaverTM dual-layer micromesh-covered carotid stent. METHODS Herein, we present the results of an observational, retrospective, multicentric study on non-consecutive patients who underwent the CAS procedure between January 2017 and December 2022 at three Italian, high-volume vascular surgery centers. The inclusion criteria were the patients' eligibility for the CAS procedure in accordance with the current Italian guidelines, and the implantation of a Roadsaver stent. Both symptomatic and asymptomatic patients were included in the study. The patients requiring reintervention for carotid restenosis following CEA were also included. Perioperative data regarding procedural success was defined as the successful implantation of the device in the desired position, less than 30% residual stenosis, and the absence of intraoperative neurological complications. The primary outcome was any adverse cerebrovascular event such as stroke or transient ischemic attack (TIA) during the procedure and/or after discharge. The secondary outcomes were the need for further intervention, and all-cause death following procedure. RESULTS Three-hundred-fifty-three (353) patients were included in our study; the mean age was 74.3 years. A total of 5.9% of the patients were symptomatic on their operated side, while 7.3% had contralateral carotid occlusion. A cerebral embolic protection device (CPD) was employed in all patients. A total of 13.3% of the patients were operated on for restenosis after CEA Technical success was achieved in 96.9% of the cases with an intraoperative report of six TIAs (1.7%) and six ipsilateral strokes (1.7%). The mean hospital stay was 1.8 days. The thirty-day follow up showed one TIA and one more stroke. At the mean 35-month follow-up time, the primary outcome was present in six patients (1.7%), where four TIAs (1.1%) and two strokes (0.5%) were reported. Restenosis occurred in five patients (1.4%). Death for any cause was reported in 11 patients (3.1%). CONCLUSIONS As most recent, high-quality studies show, the CAS procedure with second-generation devices such as the Roadsaver stent is safe and effective in preventing carotid-related cerebrovascular events in both symptomatic and asymptomatic patients. The intraoperative and postoperative cerebrovascular complication rate in high volume centers is very low, ensuring confidence in its employment for the CAS procedure along with a CPD as a valid alternative to CEA.
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Affiliation(s)
- Olga Silvestri
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, 80131 Naples, Italy; (O.S.); (G.A.); (U.M.B.)
| | - Giulio Accarino
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, 80131 Naples, Italy; (O.S.); (G.A.); (U.M.B.)
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy
| | - Davide Turchino
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, 80131 Naples, Italy; (O.S.); (G.A.); (U.M.B.)
| | - Francesco Squizzato
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, School of Medicine, Padua University Hospital, 35100 Padua, Italy; (F.S.); (M.P.); (M.A.)
| | - Michele Piazza
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, School of Medicine, Padua University Hospital, 35100 Padua, Italy; (F.S.); (M.P.); (M.A.)
| | - Martina Bastianon
- Vascular and Endovascular Surgery, IRCCS Ospedale Policlinico San Martino, University of Genova, 16100 Genova, Italy; (M.B.); (S.D.G.); (G.P.)
| | - Sara Di Gregorio
- Vascular and Endovascular Surgery, IRCCS Ospedale Policlinico San Martino, University of Genova, 16100 Genova, Italy; (M.B.); (S.D.G.); (G.P.)
| | - Giovanni Pratesi
- Vascular and Endovascular Surgery, IRCCS Ospedale Policlinico San Martino, University of Genova, 16100 Genova, Italy; (M.B.); (S.D.G.); (G.P.)
| | - Michele Antonello
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, School of Medicine, Padua University Hospital, 35100 Padua, Italy; (F.S.); (M.P.); (M.A.)
| | - Davide Costa
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Umberto Marcello Bracale
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, 80131 Naples, Italy; (O.S.); (G.A.); (U.M.B.)
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Gerardi D, Fioretti V, Stabile E. Editorial: Carotid artery stenting with DLS: New insights for long-term outcome. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 57:41-42. [PMID: 37543501 DOI: 10.1016/j.carrev.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Donato Gerardi
- Division of Cardiology, Cardiovascular Department, Azienda Ospedaliera Regionale "San Carlo", Potenza, Italy; CardioPath PhD Student, Federico II University, Naples, Italy
| | - Vincenzo Fioretti
- Division of Cardiology, Cardiovascular Department, Azienda Ospedaliera Regionale "San Carlo", Potenza, Italy
| | - Eugenio Stabile
- Division of Cardiology, Cardiovascular Department, Azienda Ospedaliera Regionale "San Carlo", Potenza, Italy.
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Mazurek A, Malinowski K, Sirignano P, Kolvenbach R, Capoccia L, DE Donato G, VAN Herzeele I, Siddiqui AH, Castrucci T, Tekieli L, Stefanini M, Wissgott C, Rosenfield K, Metzger DC, Snyder K, Karpenko A, Kuczmik W, Stabile E, Knapik M, Casana R, Pieniazek P, Podlasek A, Taurino M, Schofer J, Cremonesi A, Sievert H, Schmidt A, Grunwald IQ, Speziale F, Setacci C, Musialek P. Carotid artery revascularization using second generation stents versus surgery: a meta-analysis of clinical outcomes. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:570-582. [PMID: 38385840 DOI: 10.23736/s0021-9509.24.12933-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Meta-analyses and emerging randomized data indicate that second-generation ('mesh') carotid stents (SGS) may improve outcomes versus conventional (single-layer) stents but clinically-relevant differences in individual SGS-type performance have been identified. No comparisons exist for SGS versus carotid endarterectomy (CEA). EVIDENCE ACQUISITION Thirty-day death (D), stroke (S), myocardial infarction (M), and 12-month ipsilateral stroke and restenosis in SGS studies were meta-analyzed (random effect model) against CEA outcomes. Eligible studies were identified through PubMed/EMBASE/COCHRANE. Forest plots were formed for absolute adverse evet risk in individual studies and for relative outcomes with each SGS deign versus contemporary CEA outcomes as reference. Meta-regression was performed to identify potential modifiers of treatment modality effect. EVIDENCE SYNTHESIS Data were extracted from 103,642 patients in 25 studies (14 SGS-treated, 41% symptomatic; nine randomized controlled trial (RCT)-CEA-treated, 37% symptomatic; and two Vascular Quality Initiative (VQI)-CEA-treated, 23% symptomatic). Casper/Roadsaver and CGuard significantly reduced DSM versus RCT-CEA (-2.70% and -2.95%, P<0.001 for both) and versus VQI-CEA (-1.11% and -1.36%, P<0.001 for both). Gore stent 30-day DSM was similar to RCT-CEA (P=0.581) but increased against VQI-CEA (+2.38%, P=0.033). At 12 months, Casper/Roadsaver ipsilateral stroke rate was lower than RCT-CEA (-0.75%, P=0.026) and similar to VQI-CEA (P=0.584). Restenosis with Casper/Roadsaver was +4.18% vs. RCT-CEA and +4.83% vs. VQI-CEA (P=0.005, P<0.001). CGuard 12-month ipsilateral stroke rate was similar to VQI-CEA (P=0.850) and reduced versus RCT-CEA (-0.63%, P=0.030); restenosis was reduced respectively by -0.26% and -0.63% (P=0.033, P<0.001). Twelve-month Gore stent outcomes were overall inferior to surgery. CONCLUSIONS Meta-analytic integration of available clinical data indicates: 1) reduction in stroke but increased restenosis rate with Casper/Roadsaver, and 2) reduction in both stroke and restenosis with CGuard MicroNET-covered stent against contemporary CEA outcomes at 30 days and 12 months used as a reference. This may inform clinical practice in anticipation of large-scale randomized trials powered for low clinical event rates (PROSPERO-CRD42022339789).
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Affiliation(s)
- Adam Mazurek
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland -
- St. John Paul II Hospital Stroke Thrombectomy-Capable Center, Krakow, Poland -
| | - Krzysztof Malinowski
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
- KCRI, Krakow, Poland
| | - Pasqualino Sirignano
- Department of Vascular and Endovascular Surgery, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Ralf Kolvenbach
- Department of Vascular Surgery in Sana Kliniken, Düsseldorf Gerresheim, Germany
| | - Laura Capoccia
- Department of Vascular Surgery "Paride Stefanini", Policlinico Umberto I, La Sapienza University, Rome, Italy
| | | | | | - Adnan H Siddiqui
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, and Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Tomaso Castrucci
- Department of Vascular Surgery, Sant' Eugenio Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Lukasz Tekieli
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland
- St. John Paul II Hospital Stroke Thrombectomy-Capable Center, Krakow, Poland
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Matteo Stefanini
- Department of Radiology and Interventional Radiology, Casilino Hospital, Rome, Italy
| | - Christian Wissgott
- Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, Imland Klinik Rendsburg, Rendsburg, Germany
| | - Kenneth Rosenfield
- Section of Vascular Medicine and Intervention, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Kenneth Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Andrey Karpenko
- Center of Vascular and Hybrid Surgery, E.N. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Waclaw Kuczmik
- Department of General, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, Katowice, Poland
| | - Eugenio Stabile
- Dipartimento Cardiovascolare, Azienda Ospedaliera Regionale "San Carlo", Potenza, Italy
| | - Magdalena Knapik
- Department of Radiology, Podhalanski Multispecialty Regional Hospital, Nowy Targ, Poland
| | - Renato Casana
- Vascular Surgery Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Piotr Pieniazek
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Podlasek
- Tayside Innovation MedTech Ecosystem (TIME), University of Dundee, Dundee, UK
- Precison Imaging Beacon, Radiological Sciences, University of Nottingham, Nottingham, UK
| | - Maurizio Taurino
- Department of Vascular and Endovascular Surgery, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Joachim Schofer
- MVZ-Department Structural Heart Disease, Asklepios Clinic St Georg, Hamburg, Germany
| | - Alberto Cremonesi
- Department of Cardiology, Humanitas Gavazzeni, Bergamo, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Horst Sievert
- Department of Cardiology and Vascular Medicine, Cardiovascular Center, Frankfurt, Germany
| | - Andrej Schmidt
- Department of Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Iris Q Grunwald
- Tayside Innovation MedTech Ecosystem (TIME), University of Dundee, Dundee, UK
- Department of Radiology Ninewells Hospital, University of Dundee, Dundee, UK
| | - Francesco Speziale
- Department of Vascular Surgery "Paride Stefanini", Policlinico Umberto I, La Sapienza University, Rome, Italy
| | - Carlo Setacci
- Department of Vascular Surgery, University of Siena, Siena, Italy
| | - Piotr Musialek
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland
- St. John Paul II Hospital Stroke Thrombectomy-Capable Center, Krakow, Poland
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Squizzato F, Piazza M, Forcella E, Colacchio EC, Fedrigo M, Angelini A, Grego F, Antonello M. Impact of Carotid Stent Design on Embolic Filter Debris Load During Carotid Artery Stenting. Stroke 2023; 54:2534-2541. [PMID: 37593847 DOI: 10.1161/strokeaha.123.043117] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND The carotid stent design may influence the risk of embolization during carotid artery stenting. The aim of the study was to assess this risk by comparing the quantity of embolized material captured by filters during carotid artery stenting, using different stent designs. METHODS We conducted a single-center retrospective study of patients undergoing carotid artery stenting for asymptomatic carotid stenosis >70% (2010-2022) in a tertiary academic hospital (Padua University Hospital, Italy). Carotid stents were classified according to their design as open-cell (OCS), closed-cell (CCS), or micromesh stents (MMS). A distal filter protection was used in all patients, and the amount of captured embolized particles was semiautomatically analyzed using a dedicated software (Image-Pro Plus, Media Cybernetics). Primary end point was embolic filter debris (EFD) load, defined as the ratio of the filter area covered by particulate material to the total filter area. Secondary end points were 30 days major stroke and death. RESULTS Four-hundred-eighty-one carotid artery stentings were included; 171 (35%) using an OCS, 68 (14%) a CCS, and 242 (50%) a MMS. Thirty-days mortality was 0.2% (n=1) and major stroke rate was 0.2% (P=0.987). Filters of patients receiving MMS were more likely to be free from embolized material (OCS, 30%; CCS, 13%; MMS, 41%; P<0.001) and had a lower EFD load (OCS, 9.1±14.5%; CCS, 7.9±14.0%; MMS, 5.0±9.1%; P<0.001) compared with other stent designs. After stratification by plaque characteristics, MMS had a lower EFD load in cases of hypoechogenic plaque (OCS, 13.4±9.9%; CCS, 10.9±8.7%; MMS, 6.5±13.1%; P<0.001), plaque length>15 mm (OC, 10.2±15.3; CC, 8.6±12.4; MM, 8.2±13.6; P<0.001), and preoperative ipsilateral asymptomatic ischemic cerebral lesion (OCS, 12.9±16.8%; CCS, 8.7±19.5%; MMS, 5.4±9.7%; P<0.001). After multivariate linear regression, use of MMS was associated with lower EFD load (P=0.038). CONCLUSIONS The use of MMS seems to be associated with a lower embolization rate and EFD load, especially in hypoechogenic and long plaques and in patients with a preoperative evidence of asymptomatic ischemic cerebral lesion.
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Affiliation(s)
- Francesco Squizzato
- Section of Vascular and Endovascular Surgery (F.S., M.P., E.F., E.C.C., F.G., M.A.), Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Italy
| | - Michele Piazza
- Section of Vascular and Endovascular Surgery (F.S., M.P., E.F., E.C.C., F.G., M.A.), Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Italy
| | - Edoardo Forcella
- Section of Vascular and Endovascular Surgery (F.S., M.P., E.F., E.C.C., F.G., M.A.), Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Italy
| | - Elda Chiara Colacchio
- Section of Vascular and Endovascular Surgery (F.S., M.P., E.F., E.C.C., F.G., M.A.), Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Italy
| | - Marny Fedrigo
- Section of Cardio Thoracic and Vascular Pathology (A.A., M.F.), Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Italy
| | - Annalisa Angelini
- Section of Cardio Thoracic and Vascular Pathology (A.A., M.F.), Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Italy
| | - Franco Grego
- Section of Vascular and Endovascular Surgery (F.S., M.P., E.F., E.C.C., F.G., M.A.), Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Italy
| | - Michele Antonello
- Section of Vascular and Endovascular Surgery (F.S., M.P., E.F., E.C.C., F.G., M.A.), Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Italy
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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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Xu R, Zhao Q, Wang T, Yang Y, Luo J, Zhang X, Feng Y, Ma Y, Dmytriw AA, Yang G, Chen S, Yang B, Jiao L. Optical Coherence Tomography in Cerebrovascular Disease: Open up New Horizons. Transl Stroke Res 2023; 14:137-145. [PMID: 35445969 DOI: 10.1007/s12975-022-01023-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
Optical coherence tomography (OCT), based on the backscattering or reflection of near-infrared light, enables an ultra-high resolution of up to 10 μm. The successful application of OCT in coronary artery diseases has sparked increasing interest in its implementation in cerebrovascular diseases. OCT has shown promising potential in the atherosclerotic plaque structure characterization, plaque rupture risk stratification, pre-stenting and post-stenting evaluation, and long-term follow-up in extracranial and intracranial atherosclerotic stenosis (ICAS). In hemorrhagic cerebrovascular diseases, OCT plays an important role in the structure evaluation, rupture risk stratification, and healing and occlusion evaluation following initial treatment in intracranial aneurysms (IAs). In this study, we summarized the applications of OCT in the diagnosis, treatment, and follow-up of cerebrovascular diseases, especially in ICAS and IAs. The current limitations and future directions of OCT in the endovascular treatment of cerebrovascular diseases were also discussed.
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Affiliation(s)
- Ran Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
- China International Neuroscience Institute (China-INI), 45 Changchun Street, Beijing, 100053, China
| | - Qing Zhao
- M.D. Program, Peking Union Medical College, No. 9 Dongdansantiao Street, Beijing, 100730, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
- China International Neuroscience Institute (China-INI), 45 Changchun Street, Beijing, 100053, China
| | - Yutong Yang
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, G210 Guy Scadding Building, London, SW3 6LY, UK
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
- China International Neuroscience Institute (China-INI), 45 Changchun Street, Beijing, 100053, China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
- China International Neuroscience Institute (China-INI), 45 Changchun Street, Beijing, 100053, China
| | - Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
- China International Neuroscience Institute (China-INI), 45 Changchun Street, Beijing, 100053, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
- China International Neuroscience Institute (China-INI), 45 Changchun Street, Beijing, 100053, China
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Boston, MA, 02114, USA
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02215, USA
| | - Ge Yang
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Science, Beijing, 100190, China
| | - Shengpan Chen
- Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, 510080, Guangdong Province, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China.
- China International Neuroscience Institute (China-INI), 45 Changchun Street, Beijing, 100053, China.
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China.
- China International Neuroscience Institute (China-INI), 45 Changchun Street, Beijing, 100053, China.
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China.
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Miccichè E, Condello F, Cao D, Azzano A, Ioppolo AM, Mangiameli A, Cremonesi A. Procedural embolic protection strategies for carotid artery stenting: current status and future prospects. Expert Rev Med Devices 2023; 20:373-391. [PMID: 37000987 DOI: 10.1080/17434440.2023.2198124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Carotid artery angioplasty and stenting (CAS) is an established procedure to treat carotid artery stenosis for either primary or secondary prevention of stroke. Randomized clinical trials have shown an increased risk of periprocedural cerebrovascular events with CAS compared with carotid endarterectomy (CEA). Several strategies have been proposed to mitigate this risk, including alternative vascular access site, proximal/distal embolic protection devices, and dual-layer stents, among others. AREAS COVERED This review provides a general overview of current embolic protection strategies for CAS. The phases of the procedure which can affect the early risk of stroke and how to reduce it with novel techniques and devices have been discussed. EXPERT OPINION Innovations in device technologies have dramatically improved the safety and efficacy of CAS. To minimize the gap with surgery, a thorough, patient-oriented approach should be pursued. Endovascular technologies and techniques should be selected on an individual basis to address unique lesion characteristics and vascular anatomies. Meticulous pre-procedural planning, both clinical and anatomical, is needed to assess the embolic risk of each procedure. Only by having an in-depth understanding of the wide range of available endovascular devices and techniques, the operator will choose the most appropriate strategy to optimize CAS results.
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Fioretti V, Gerardi D, Luzi G, Stabile E. Proximal versus distal protection: dissecting clinical trials. Minerva Cardiol Angiol 2022; 70:727-737. [PMID: 36700668 DOI: 10.23736/s2724-5683.22.06233-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Carotid artery stenting (CAS) is a valid alternative to conventional carotid endarterectomy for treatment of carotid artery stenosis. Distal embolization of atherosclerotic debris causing cerebrovascular accidents during CAS has been the most significant concern limiting widespread application of CAS technology. A variety of embolic protection devices (EPDs) with different mechanism of action, have been designed to minimize the risk of major embolization causing stroke and their use is recommended by current guidelines. Two general types of EPDs are available: proximal protection devices (PPDs) and distal protection devices (DPDs). However, there is no convincing clinical evidence of the clinical superiority of one device over another. This review will examine the different types of available devices and also innovative devices and techniques, including strengths and weaknesses of each, and present the available evidence and rationale for their routine use during CAS.
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Affiliation(s)
- Vincenzo Fioretti
- Division of Cardiology, Cardiovascular Department, San Carlo Regional Hospital, Potenza, Italy
| | - Donato Gerardi
- Division of Cardiology, Cardiovascular Department, San Carlo Regional Hospital, Potenza, Italy
| | - Giampaolo Luzi
- Division of Cardiac Surgery, Cardiovascular Department, San Carlo Regional Hospital, Potenza, Italy
| | - Eugenio Stabile
- Division of Cardiology, Cardiovascular Department, San Carlo Regional Hospital, Potenza, Italy -
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9
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Kiyosawa R, Saito T, Yamada S, Harada K. Efficacy of Post-Dilatation during Carotid Artery Stenting for Unstable Plaque Using a Double-Layer Stent Evaluated by OFDI. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 16:395-401. [PMID: 37502638 PMCID: PMC10370631 DOI: 10.5797/jnet.oa.2022-0003] [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: 01/15/2022] [Accepted: 02/22/2022] [Indexed: 07/29/2023]
Abstract
Objective This study aimed to use optical frequency domain imaging (OFDI) to evaluate the efficacy of post-dilatation (PD) after stent placement for unstable plaques during carotid artery stenting (CAS) using a double-layer stent. Methods Twelve unstable carotid plaque lesions diagnosed by MRI were evaluated using OFDI during CAS. The pre-procedural minimum lumen diameter was 1.6 ± 0.7 mm. Each lesion was pre-dilated with balloon catheters (diameter, 5.3 ± 0.5 mm), and a double-layer stent was deployed. PD was performed with balloon catheters of the same size as those used for pre-dilatation. Cross-sectional OFDI images within the stented segment were evaluated at 1-mm intervals for a 20-mm segment, including the most stenotic lesion. Slice rates for the presence of in-stent plaque protrusion (PP) and plaque between the double-layer lumen were calculated. Results No procedural complications occurred with the use of an embolic protection device. Compared to after stent placement, slice rates for any PP (44 ± 19% to 62 ± 22%, P <0.05) and plaque between the double-layer lumen (79 ± 16% to 91 ± 34%, P <0.05) were significantly increased after PD; slice rates for >500 μm PP (7.5 ± 14% to 0%, P <0.05) were significantly decreased. Visible debris were captured in 50% of lesions. Conclusion PD after double-layer carotid stent placement decreases in-stent large PP. Double-layer construction contributed to the prevention of large PP, as the PP may have been crushed into debris by PD.
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Affiliation(s)
- Ryuichiro Kiyosawa
- Department of Neurosurgery, Fukuoka Wajiro Hospital, Fukuoka, Fukuoka, Japan
| | - Takaya Saito
- Department of Neurosurgery, Fukuoka Wajiro Hospital, Fukuoka, Fukuoka, Japan
| | - Shingo Yamada
- Department of Neurosurgery, Fukuoka Wajiro Hospital, Fukuoka, Fukuoka, Japan
| | - Kei Harada
- Department of Neurosurgery, Fukuoka Wajiro Hospital, Fukuoka, Fukuoka, Japan
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10
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Kedev S, Müller-Hülsbeck S, Langhoff R. “Real-World Study of a Dual-Layer Micromesh Stent in Elective Treatment of Symptomatic and Asymptomatic Carotid Artery Stenosis (ROADSAVER)”. Cardiovasc Intervent Radiol 2022; 45:277-282. [PMID: 35043241 PMCID: PMC8921099 DOI: 10.1007/s00270-021-03051-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/18/2021] [Indexed: 12/24/2022]
Abstract
Purpose Endovascular carotid artery stenosis treatment is associated with a higher peri- and early post-procedural stroke risk relative to surgery. Dual-layer micromesh carotid stents were specifically designed for improved plaque coverage to reduce the cerebral embolization risk and related ischemic events. ROADSAVER study aims to further confirm the safety and efficacy of the Roadsaver™ dual-layer micromesh stent for the treatment of elective patients with carotid artery stenosis. Materials and Methods ROADSAVER is a prospective, multi-center, observational study. Between January 2018 and February 2021, a total of 1967 patients featuring asymptomatic or symptomatic, non-occlusive and non-thrombotic carotid stenosis eligible for an elective stenting procedure were enrolled across 13 European countries (52 centers). Follow-up visits are scheduled at 30 days and at 12 months. The primary outcome measure is the major adverse event rate, i.e., cumulative incidence of any death or stroke up to 30 days post-procedure. All deaths, strokes and carotid revascularizations are adjudicated by an independent Clinical Events Committee. Sub-analyses are prespecified and focused on baseline patient characteristics (e.g., age, neurologic status), procedural features (e.g., access route, embolic protection use), advanced imaging, and treatment efficacy up to 12 months. Conclusion The present study evaluates the Roadsaver™ dual-layer micromesh carotid stent in the real-world clinical practice aiming to provide valuable insights into the contemporary European treatment trends and outcomes of elective carotid artery stenting. The large study population and predefined sub-analyses should help identify the best practices and patient subsets to benefit most from the treatment. Trial Registration Clinicaltrial.gov identifier: NCT03504228.
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Affiliation(s)
- Sasko Kedev
- Cardiology Department, Medical Faculty, University St Cyril and Methodius, University Clinic of Cardiology, Vodnjanska 17, 1000, Skopje, North Macedonia.
| | - Stefan Müller-Hülsbeck
- Department of Diagnostic and Interventional Radiology/Neuroradiology, Academic Hospitals Flensburg, Flensburg, Germany
| | - Ralf Langhoff
- Department for Angiology, Center for Internal Medicine I, Brandenburg Medical School Theodor Fontane, Campus Clinic Brandenburg, Brandenburg an der Havel, Germany
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11
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Bracale UM, Peluso A, Di Mauro E, Del Guercio L, Di Taranto MD, Giannotta N, Ielapi N, Provenzano M, Andreucci M, Serra R. Carotid Endarterectomy versus Carotid Artery Stenting With Double-Layer Micromesh Carotid Stent: Contemporary Results of a Single-Center Retrospective Study. Ann Vasc Surg 2021; 82:41-46. [PMID: 34902476 DOI: 10.1016/j.avsg.2021.10.073] [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] [Received: 09/23/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Severe carotid stenosis (CS) is a major risk factor for stroke. Carotid Endarterectomy (CEA) is the gold standard revascularization technique of CS while carotid artery stenting (CAS) is considered an alternative treatment option, especially in high-risk patients or those with relative contraindications to CEA. The aim of this study was to evaluate the results of CEA and CAS with Roadsaver® stent device. METHODS We made a retrospective analysis of 119 patients undergoing treatment of CS. All CS were evaluated with imaging exams. The patients were divided into CEA group and CAS group. As primary endpoints of the study overall and cardiovascular cause - related mortality, freedom from stroke, and restenosis were considered. All patients were followed up and revaluated with duplex scan over a minimum of 6 months and a maximum of 36 months (follow-up mean time 22.3 ± 3.4 months). RESULTS In the whole cohort 86 of 119 patients underwent CEA and 33 of 119 CAS. Risk factors were superposable in both groups. During follow-up, we observed 4 deaths, 2 cardiovascular events and 12 restenosis. CEA was associated with lower death probability than CAS (P = 0.036). Probability of Restenosis and cardiovascular events did not vary between CAS and CEA groups. CONCLUSIONS Albeit CEA remains the gold standard for the treatment of severe CS, CAS with new double layer micromesh stent can be considered a useful and safe alternative in some clinical conditions.
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Affiliation(s)
| | - Antonio Peluso
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, Italy
| | - Ernesto Di Mauro
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, Italy
| | - Luca Del Guercio
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, Italy
| | - Maria Donata Di Taranto
- Department of Molecular Medicine and Medical Biotechnology, University Federico II of Naples, Italy
| | - Nicola Giannotta
- Department of Medical and Surgical Sciences, University of Catanzaro, Italy
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Italy
| | - Michele Provenzano
- Department of Medical and Surgical Sciences, University of Catanzaro, Italy
| | | | - Raffaele Serra
- Department of Medical and Surgical Sciences, University of Catanzaro, Italy.; Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology" at the Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy..
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12
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Stabile E, Gerardi D. Carotid Artery Stenting With Dual-Layer Stent: Expanding Evidence With a Randomized Trial. JACC Cardiovasc Interv 2021; 14:2388-2390. [PMID: 34736738 DOI: 10.1016/j.jcin.2021.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Eugenio Stabile
- Cardiovascular Department, Azienda Ospedaliera Regionale "San Carlo," Potenza, Italy.
| | - Donato Gerardi
- Division of Cardiology, Azienda Ospedaliera Regionale "San Carlo"-"San Giovanni di Dio" Hospital, Melfi, Italy
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13
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Nakagawa I, Kotsugi M, Park H, Furuta T, Sato F, Myochin K, Nishimura F, Yamada S, Motoyama Y, Nakase H. Near-infrared spectroscopy carotid plaque characteristics and cerebral embolism in carotid artery stenting. EUROINTERVENTION 2021; 17:599-606. [PMID: 33283761 PMCID: PMC9725057 DOI: 10.4244/eij-d-20-01050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Perioperative thromboembolism is the main consideration in carotid artery stenting (CAS). Precise evaluation of carotid plaque components is clinically important to reduce ischaemic complications since CAS mechanically pushes plaque outwards, which releases plaque debris into the bloodstream. AIMS This study aimed to determine whether high lipid core plaque (LCP) assessed by catheter-based near-infrared spectroscopy (NIRS) is associated with ipsilateral cerebral embolism by diffusion-weighted magnetic resonance imaging during CAS using a first-generation stent. METHODS Carotid stenosis magnetic resonance (MR) T1-weighted plaque signal intensity ratio (T1W-SIR) followed by NIRS assessment at the time of CAS (using the carotid artery Wallstent) was performed in 117 consecutive patients. RESULTS The maximum lipid core burden index (max-LCBI) at minimal luminal areas (MLA; max-LCBIMLA) and the max-LCBI for any 4 mm segment in a target lesion defined as max-LCBIarea were significantly higher for the post-procedural new ipsilateral diffusion-weighted magnetic resonance imaging (DWI)-positive than negative patients (p<0.001 for all). There was a significant linear correlation between max-LCBIarea and the number of new emboli (r=0.544, p<0.0001). We also found that the second quantile (Q2) of T1W-SIRMLA had a significantly higher max-LCBIMLA and a higher incidence of DWI positivity than Q1 and Q3 (p<0.001 for all). Furthermore, max-LCBIMLA appeared to distinguish between patients with and without postoperative new ipsilateral DWI positivity (AUC 0.91, 95% CI: 0.86-0.96; p<0.0001). CONCLUSIONS High LCP assessed by NIRS is associated with cerebral embolism by diffusion-weighted imaging in CAS using a first-generation stent.
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Affiliation(s)
- Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hun Park
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Takanori Furuta
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Fumiya Sato
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Kaoru Myochin
- Department of Radiology, Nara Medical University, Nara, Japan
| | | | - Syuichi Yamada
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Nara, Japan
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Kahlberg A, Bilman V, Ardita V, Mascia D, Bertoglio L, Rinaldi E, Melissano G, Chiesa R. Contemporary Results of Carotid Artery Stenting Using Low-Profile Dual-Metal Layer Nitinol Micromesh Stents in Relation to Single-Layer Carotid Stents. J Endovasc Ther 2021; 28:726-736. [PMID: 34137659 DOI: 10.1177/15266028211025046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate patients characteristics, procedural details, perioperative outcomes, and midterm results of carotid artery stenting (CAS) performed with the Roadsaver/Casper stent (Terumo Corp, Tokyo, Japan) as compared to concurrent patients treated with other commercially available carotid stents. MATERIALS AND METHODS This is a single-center, retrospective, nonrandomized study including 200 consecutive patients who underwent a total of 205 elective CAS procedures due to severe internal carotid artery stenosis between April 2015 and December 2018. Procedural data and outcomes for patients treated with the Roadsaver/Casper stent implantation (100 procedures, in 97 patients) vs first-generation carotid stents implantations (90 procedures, in 88 patients) were compared. Fifteen patients were treated with CGuard carotid stent (InspireMD, Tel Aviv, Israel), and outcomes were reported separately. Primary endpoints were the occurrence of major adverse cerebrovascular events (MACE), including death, ipsilateral stroke, and transitory ischemic attack (TIA). Secondary endpoints were the rate of intrastent stenosis, the need for reintervention, and the occurrence of adverse cardiovascular events, including myocardial infarction, arrhythmias, and need for inotropic support. RESULTS No difference in demographics and preoperative risk factors were observed between patients treated with and without the Roadsaver/Casper stent. The mean procedure time was shorter in the Roadsaver/Casper group (40.7±16.9 vs 49.4±27.3 minutes; p=0.008), while radial percutaneous access was more frequent (24% vs 5%; p<0.001). The rate of stroke/TIA/death at 30 days was 3% in the Roadsaver group vs 1% in the first-generation stent group (p=0.623). The primary patencyrate was 100% and 93.4% at 1- and 3-year of follow-up in the Roadsaver/Casper groupand 99% and 94.3% in the other stent group, respectively (p=0.95). CONCLUSIONS In this real-world cohort of patients undergoing CAS, the Roadsaver/Casper stent was used to treat more symptomatic and vulnerable carotid plaques as compared to other carotid stents. Nevertheless, patients treated with this low-profile dual-layer micromesh stent showed low events rates at both 30 days and follow-up, similar to that observed for other stents.
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Affiliation(s)
- Andrea Kahlberg
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Victor Bilman
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Ardita
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Mascia
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Bertoglio
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Rinaldi
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Germano Melissano
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
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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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16
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Machnik RA, Pieniążek P, Misztal M, Plens K, Kazibudzki M, Tomaszewski T, Brzychczy A, Musiał R, Trystuła M, Tekieli ŁM. Carotid artery stenting with Roadsaver stent. Early and four-year results from a single-center registry. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:444-451. [PMID: 33598018 PMCID: PMC7863817 DOI: 10.5114/aic.2020.101770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/19/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Prevention of peri- and postprocedural complications is still a challenge in carotid artery stenting (CAS). AIM To assess immediate and long-term safety and effectiveness of CAS using the Roadsaver double-nitinol-layer-micromesh stent. MATERIAL AND METHODS Since 2014, 298 CAS procedures in 287 non-consecutive patients (203 men, mean age 70.5 ±8.6 years, 100% symptomatic/high risk lesions) have been performed using the Roadsaver stent and proximal (40%) or distal (60%) neuroprotection system. Clinical and neurological examinations as well as duplex ultrasound were completed before CAS, before discharge, at 1, 6 and 12 months, then annually. RESULTS All CAS procedures were successful. Carotid stenosis was reduced from 84.9 ±9.9% to 11.0 ±9.4% (p < 000.1). In hospital, 1 ipsilateral periprocedural major (0.3%) and 3 minor (1.34%) ischemic strokes occurred, 2 (0.7%) patients died due to a cerebral hemorrhage on day 9 and 21. Three (1.0%) additional ipsilateral minor strokes within 30 consecutive days occurred. Thus, 30-day complications were observed in 9 (3.0%) patients. Two minor strokes were associated with in-stent thrombosis (0.7%). The 4-year follow-up showed 82% overall survival (95% CI: 69-91%) with no significant difference between asymptomatic (77%) and symptomatic patients (97%; p = 0.076). The stroke-free survival was 89% (95% CI: 77-95%), 84% asymptomatic vs. 98% symptomatic (p = 0.187). Seven (2.3%) patients developed > 50% in-stent restenosis. CONCLUSIONS Carotid artery stenting using the Roadsaver stent for symptomatic patients and high risk lesions showed to be safe and effective, with a low complication rate and acceptable in-stent restenosis risk in 4-year follow-up.
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Affiliation(s)
- Roman A. Machnik
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | - Piotr Pieniążek
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, John Paul II Hospital, Krakow, Poland
| | - Marcin Misztal
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | | | - Marek Kazibudzki
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | | | - Andrzej Brzychczy
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | - Robert Musiał
- Department of Anesthesiology and Intensive Medical Therapy, John Paul II Hospital, Krakow, Poland
| | - Mariusz Trystuła
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | - Łukasz M. Tekieli
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, John Paul II Hospital, Krakow, Poland
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Pasarikovski CR, Ku JC, Priola SM, da Costa L, Yang VXD. Endovascular optical coherence tomography imaging in cerebrovascular disease. J Clin Neurosci 2020; 80:30-37. [PMID: 33099363 DOI: 10.1016/j.jocn.2020.07.064] [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: 05/19/2020] [Revised: 07/18/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Endovascular optical coherence tomography (OCT) is the highest resolution imaging modality currently available with spatial resolution of 10 µm. Although originally developed for interventional cardiology, the ability to visualize the luminal environment and anatomy, along with the stent-vessel interaction could be of great utility for various cerebrovascular diseases, and the adoption of endovascular OCT imaging in the evolving field of interventional neuroradiology seems instinctive. The purpose of this study is to conduct a systematic review of the literature regarding applications of endovascular OCT in the diagnosis and treatment of cerebrovascular diseases. In addition, the authors report their institutional experience with the use of OCT in carotid atherosclerotic disease, cerebral aneurysms, and acute ischemic stroke. A systematic review of the literature was undertaken. Peer-reviewed articles were collected through MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) searches through March 2020. A total of 34 studies with 598 patients were included in the qualitative synthesis. These include 23 studies of carotid atherosclerotic disease, 7 studies of cerebral aneurysms, and 4 studies of non-aneurysmal posterior circulation pathology. OCT imaging was feasible in 94% of patients with 0.6% complication rate. Endovascular OCT appears to be safe and feasible, allowing clinicians to visualize stent-vessel interactions, aneurysmal healing, and vulnerable atherosclerotic plaque features. OCT carries great promise, however additional investigations are needed before any imposing statement can be made about the role of OCT in cerebrovascular imaging.
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Affiliation(s)
| | - Jerry C Ku
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Stefano M Priola
- Division of Neurosurgery, Department of Surgery, Health Sciences North, Sudbury, Ontario, Canada; Norther Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Leodante da Costa
- Division of Neurosurgery, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Victor X D Yang
- Division of Neurosurgery, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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18
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Yamada K, Yoshimura S, Yoshida K, Uchida K, Shirakawa M, Kawasaki M, Miura M, Ishii A, Kataoka H, Miyamoto S. Carotid Artery Stenting Using a Double-layer Micromesh Stent. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:407-412. [PMID: 37502654 PMCID: PMC10370536 DOI: 10.5797/jnet.ra.2020-0066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/10/2020] [Indexed: 07/29/2023]
Abstract
Carotid artery stenting (CAS) has recently emerged as a potential alternative to carotid endarterectomy (CEA) in Japan. However, one of its disadvantages is the higher incidence of ischemic complications than CEA, such as distal embolism during or after the procedure. Plaque protrusion (PP) through the stent strut after deployment of the stent has been suggested as one of the major causes of distal embolism, especially in patients with unstable plaques. The need for increased plaque coverage to reduce the risk of PP through the stent struts has led to the development of a double-layer micromesh stent (micromesh stent) system. This stent system has already been used clinically in European countries with good short- to medium-term follow-up results. Also clinical trials evaluating micromesh stents have been completed in Japan. Hence, usefulness of the micromesh stent for CAS is expected. According to the results of several clinical studies, CAS with the double-layer micromesh stent has the potential to minimize distal embolism during or after the procedure even in patients with unstable plaques. However, it may not be suitable for emergency CAS at this point. Also, since results of only short- to medium-term follow-up have been reported, longer-term follow-up will be required in the near future.
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Affiliation(s)
- Kiyofumi Yamada
- Department of Neurosurgery, Kyoto University, Kyoto, Kyoto, Japan
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | | | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | | | - Masatomo Miura
- Department of Neurology, Kumamoto Red Cross Hospital, Kumamoto, Kumamoto, Japan
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University, Kyoto, Kyoto, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, Kyoto University, Kyoto, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University, Kyoto, Kyoto, Japan
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de Donato G, Pasqui E, Alba G, Giannace G, Panzano C, Cappelli A, Setacci C, Palasciano G. Clinical considerations and recommendations for OCT-guided carotid artery stenting. Expert Rev Cardiovasc Ther 2020; 18:219-229. [PMID: 32294392 DOI: 10.1080/14779072.2020.1756777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction: Optical Coherence Tomography (OCT) is an intravascular imaging providing high-resolution images of morphological features of arterial wall. Nowadays, OCT is an accepted intravascular modality to study coronary arteries, stent implantation, and vessel injury. In the last decade, an increasing interest have been focused on the application of OCT in carotid arteries.Areas covered: Literature evidence in the application of OCT in carotid arteries still remains debated. So far, OCT has been used as a research tool, aiming to evaluate atherosclerotic plaques' features and stents' behavior after implantation. This paper is intended to summarize clinical evidences and practices in the use of OCT in carotid arteries district and during CAS procedures. Literature review was completed via Pubmed search using Keywords.Expert opinion: CAS is a safe and effective procedure when performed by trained physicians with a tailored approach. In this scenario, ambiguous pictures at ultrasound, angiography, and IVUS might be clarified using OCT.By providing unprecedented microstructural information on atherosclerotic plaques, OCT may identify the features of vulnerable carotid plaque and, by identifying possible defects after stent implantation as malapposition and plaque prolapse, it may help the tailoring approach to CAS.
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Affiliation(s)
| | - Edoardo Pasqui
- Department of Vascular Surgery, University of Siena, Siena, Italy
| | - Giuseppe Alba
- Department of Vascular Surgery, University of Siena, Siena, Italy
| | | | - Claudia Panzano
- Department of Vascular Surgery, University of Siena, Siena, Italy
| | | | - Carlo Setacci
- Department of Vascular Surgery, University of Siena, Siena, Italy
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20
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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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21
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Musiałek P, Roubin GS. Commentary: Double-Layer Carotid Stents: From the Clinical Need, through a Stent-in-Stent Strategy, to Effective Plaque Isolation… the Journey Toward Safe Carotid Revascularization Using the Endovascular Route. J Endovasc Ther 2019; 26:572-577. [DOI: 10.1177/1526602819861546] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Piotr Musiałek
- Jagiellonian University Department of Cardiac & Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Gary S. Roubin
- Cardiovascular Associates of the Southeast, Birmingham, AL, USA
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22
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Pasarikovski CR, Ramjist J, da Costa L, Black SE, Cardinell J, Yang VXD. Optical Coherence Tomography as an Adjunct During Carotid Artery Stenting for Carotid Atherosclerotic Disease. Clin Neuroradiol 2019; 30:503-509. [DOI: 10.1007/s00062-019-00799-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/13/2019] [Indexed: 11/29/2022]
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23
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Myouchin K, Takayama K, Wada T, Miyasaka T, Tanaka T, Kotsugi M, Kurokawa S, Nakagawa H, Kichikawa K. Carotid Artery Stenting Using a Closed-Cell Stent-in-Stent Technique for Unstable Plaque. J Endovasc Ther 2019; 26:565-571. [PMID: 31074315 DOI: 10.1177/1526602819847698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To examine whether carotid artery stenting (CAS) of stenoses with unstable plaque using a closed-cell stent-in-stent technique prevents plaque protrusion. Materials and Methods: Between December 2014 and August 2018, 35 consecutive patients (mean age 75.8 years; 29 men) with carotid artery stenosis (20 symptomatic) and unstable plaque diagnosed by magnetic resonance imaging were prospectively analyzed. Mean diameter stenosis was 83.5%. All CAS procedures were performed with stent-in-stent placement of Carotid Wallstents using an embolic protection device and conservative postdilation. The technical success rate, incidence of plaque protrusion, ischemic stroke rate within 30 days, and new ipsilateral ischemic lesions on diffusion-weighted imaging (DWI) within 48 hours after CAS were prospectively assessed. Follow-up outcomes included the incidences of ipsilateral stroke and restenosis. Results: The technical success rate was 100%. No plaque protrusion or stroke occurred in any patient. New ischemic lesions were observed on DWI in 10 (29%) patients. During the mean 11.6-month follow-up, no ipsilateral strokes occurred. Two (6%) patients developed asymptomatic restenosis recorded as 53% lumen narrowing and occlusion, respectively. Conclusion: CAS using a closed-cell stent-in-stent technique for unstable plaque may be useful for preventing plaque protrusion and ischemic complications.
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Affiliation(s)
- Kaoru Myouchin
- 1 Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital, Yao, Japan
| | - Katsutoshi Takayama
- 1 Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital, Yao, Japan
| | - Takeshi Wada
- 2 Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
| | - Toshiteru Miyasaka
- 2 Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
| | - Toshihiro Tanaka
- 2 Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
| | - Masashi Kotsugi
- 3 Department of Neurosurgery, Ishinkai Yao General Hospital, Yao, Japan
| | | | - Hiroyuki Nakagawa
- 2 Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
| | - Kimihiko Kichikawa
- 2 Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
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Pasarikovski CR, Cardinell J, Yang VXD. Perspective review on applications of optics in cerebral endovascular neurosurgery. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-7. [PMID: 30915784 PMCID: PMC6975230 DOI: 10.1117/1.jbo.24.3.030601] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/19/2019] [Indexed: 05/20/2023]
Abstract
Cerebral endovascular neurosurgery has transformed the way we manage cerebrovascular disease. Several landmark trials have demonstrated the effectiveness of endovascular techniques leading to continued technological development and applications for various diseases. The utilization of optical technologies and devices is already underway in the field of endovascular neurosurgery. We discuss the contemporary paradigms, challenges, and current optical applications for the most common cerebrovascular diseases: carotid atherosclerotic disease, cerebral aneurysms, intracranial atherosclerosis, and dural arteriovenous fistulas. We also describe needs-based opportunities for future optical applications, with the goal of providing researchers a sense of where we feel optical technologies could impact the way we manage cerebral disease.
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Affiliation(s)
- Christopher R. Pasarikovski
- University of Toronto, Division of Neurosurgery, Department of Surgery, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, NeuroVascular Clinic, Toronto, Ontario, Canada
| | - Jillian Cardinell
- Ryerson University, Bioengineering and Biophotonics Laboratory, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Division of Neurosurgery, Toronto, Ontario, Canada
| | - Victor X. D. Yang
- University of Toronto, Division of Neurosurgery, Department of Surgery, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, NeuroVascular Clinic, Toronto, Ontario, Canada
- Ryerson University, Bioengineering and Biophotonics Laboratory, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Division of Neurosurgery, Toronto, Ontario, Canada
- Address all correspondence to Victor X. D. Yang, E-mail:
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Stabile E, de Donato G, Musialek P, De Loose K, Nerla R, Sirignano P, Chianese S, Mazurek A, Tesorio T, Bosiers M, Setacci C, Speziale F, Micari A, Esposito G. Use of Dual-Layered Stents in Endovascular Treatment of Extracranial Stenosis of the Internal Carotid Artery. JACC Cardiovasc Interv 2018; 11:2405-2411. [DOI: 10.1016/j.jcin.2018.06.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 06/06/2018] [Accepted: 06/26/2018] [Indexed: 12/24/2022]
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Jones MR, Howard G, Roubin GS, Blackshear JL, Cohen DJ, Cutlip DE, Leimgruber PP, Rhodes D, Prineas RJ, Glasser SP, Lal BK, Voeks JH, Brott TG. Periprocedural Stroke and Myocardial Infarction as Risks for Long-Term Mortality in CREST. Circ Cardiovasc Qual Outcomes 2018; 11:e004663. [PMID: 30571337 PMCID: PMC6309309 DOI: 10.1161/circoutcomes.117.004663] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) previously reported increased mortality in patients who sustained a periprocedural stroke or cardiac event (myocardial infarction [MI] or biomarker only) in follow-up to 4 years. We now extend these observations to 10 years. METHODS AND RESULTS CREST is a randomized controlled trial designed to compare the outcomes of carotid stenting versus carotid endarterectomy. Proportional hazards models were used to assess the association between mortality and periprocedural stroke, MI, or biomarker-only events. For 10-year follow-up, patients with periprocedural stroke were at 1.74× the risk of death compared with those without stroke (adjusted hazard ratio [HR]=1.74; 95% CI, 1.21-2.50; P<0.003). This increased risk was driven by increased early (between 0 and 90 days) mortality (adjusted HR=14.41; 95% CI, 5.33-38.94; P<0.0001), with no significant increase in late (between 91 days and 10 years) mortality (adjusted HR=1.40; 95% CI, 0.93-2.10; P=0.11). Patients with a protocol MI were at 3.61× increased risk of death compared with those without MI (adjusted HR=3.61; 95% CI, 2.28-5.73; P<0.0001), with an increased hazard both early (adjusted HR=8.20; 95% CI, 1.86-36.2; P=0.006) and late (adjusted HR=3.40; 95% CI, 2.09-5.53; P<0.0001). Patients with a biomarker-only event were at 2.04× increased risk overall (adjusted HR=2.04; 95% CI, 1.09-3.84; P=0.03) than those without MI, with an increased early hazard (adjusted HR=8.44; 95% CI, 1.09-65.5; P=0.04) and a suggestive but nonsignificant association toward higher 91-day to 10-year risk (1.88; 95% CI, 0.97-3.64; P=0.062) contributing to the increased risk. CONCLUSIONS In the CREST trial, patients with periprocedural events demonstrate a substantial increase in future mortality to 10 years. For stroke, this risk is largely confined to an early time frame while periprocedural MI or biomarker-only events confer a continuous increased mortality for 10 years. Strategies to reduce periprocedural events and to optimize the evaluation and management of patients with cardiac events should be considered in efforts to reduce not only early but also long-term mortality. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT00004732.
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Affiliation(s)
- Michael R. Jones
- Department of Cardiology, Baptist Health Lexington, Lexington, KY
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Gary S. Roubin
- Cardiovascular Associates of the Southeast, Birmingham, AL
| | - Joseph L. Blackshear
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL
| | - David J. Cohen
- St. Luke’s Mid America Heart Institute, University of Missouri, Kansas City, MO
| | | | | | - David Rhodes
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Ronald J. Prineas
- Department of Public Health Services, Wake Forest School of Medicine, Winston Salem, NC
| | - Stephen P. Glasser
- Department of Medicine, Division of Cardiology, University of Kentucky School of Medicine, Lexington, KY
| | - Brajesh K. Lal
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore MD
| | - Jenifer H. Voeks
- College of Medicine, Department of Neurology, Medical University of South Carolina, Charleston, SC
| | - Thomas G. Brott
- Department of Neurology, Mayo Clinic, Jacksonville, FL for the CREST Investigators
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Nerla R, Micari A, Castriota F, Miccichè E, Ruffino MA, de Donato G, Setacci C, Cremonesi A. Carotid artery stenting with a new-generation double-mesh stent in three high-volume Italian centres: 12-month follow-up results. EUROINTERVENTION 2018; 14:1147-1149. [DOI: 10.4244/eij-d-18-00513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Broussalis E, Griessenauer C, Mutzenbach S, Pikija S, Jansen H, Stevanovic V, Killer-Oberpfalzer M. Reduction of cerebral DWI lesion burden after carotid artery stenting using the CASPER stent system. J Neurointerv Surg 2018; 11:62-67. [PMID: 29930158 DOI: 10.1136/neurintsurg-2018-013869] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Despite various measures to protect against distal embolization during carotid artery stenting (CAS), periprocedural ischemic lesions are still encountered. OBJECTIVE To evaluate the periprocedural cerebral diffusion weighted imaging (DWI) lesion burden after CASPER stent placement. METHODS Patients who underwent CAS using the CASPER stent system were reviewed. Degrees of carotid stenosis and plaque configuration were determined. All patients were pretreated with dual antiplatelet agents and cerebral pre- and postprocedural MRI was obtained. All CAS procedures were performed by a single operator. RESULTS A total of 110 patients with severe carotid artery stenosis (median degree of stenosis 80%, median length of stenosis 10 mm) were treated with CAS. Hypoechogenic or heterogeneous, mostly hypoechogenic, plaques were documented in 48.6% (52/107) of patients. Carotid ulceration was present in 15.9% (17/107). Postprocedurally, 7.3% (8/110) of patients were found to have ischemic DWI lesions. They were asymptomatic in all patients. Follow-up at 90 days was available in 88.2% (97/110) of patients with excellent functional outcome (modified Rankin Scale score 0-1) in 95.9% (93/97). CONCLUSION Carotid artery stenting using the new CASPER stent in combination with a distal embolic protection device is safe and results in a lower rate of periprocedural DWI lesion burden compared with reported results for historic controls.
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Affiliation(s)
- Erasmia Broussalis
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.,Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Christoph Griessenauer
- Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.,Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Sebastian Mutzenbach
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Slaven Pikija
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Hendrik Jansen
- Department of Neuroradiology, Paracelsus Medical University, Nuremberg, Germany
| | - Valdo Stevanovic
- Department of Radiology/Section Neuroradiology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Monika Killer-Oberpfalzer
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.,Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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Musialek P, Stabile E. Residual plaque prolapse with novel dual-layer carotid stents: is it mesh-covered or not? EUROINTERVENTION 2017; 13:1266-1268. [DOI: 10.4244/eijv13i11a199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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