Carotid Stent: Device-Specific Complications With the Wallstent

Purpose: To study the dynamics of carotid stent healing over a 2-year period using duplex ultrasound imaging. Methods: One hundred twelve patients with 121 successfully stented carotid arteries were examined with color-coded duplex ultrasound the day after the stent procedure and at 1, 3, 6, 12, and 24 months in follow-up. The maximal thickness and echogenicity of the layer between the stent and the perfused lumen (SPL) were evaluated. Echogenicity was classified as echogenic if the SPL layer was clearly detected in B mode and echolucent if the SPL layer was barely visible in B mode, its border defined by assistance of color-coded flow. Results: At day 1, an echolucent SPL layer with a median thickness of 0.7 mm was interpreted as a thrombotic layer, which decreased at 1 month to practically zero (i.e., not detectable). In follow-up, increases in thickness (mainly up to 6 months) and echogenicity (up to 12 months) of the SPL layer were interpreted as neointimal ingrowth. At 3, 6, and 12 months, the median maximal thickness of the SPL layer was 0.5 mm, 0.9 mm, and 1.0 mm, respectively, whereas the percentage of patients with an echogenic SPL layer was 27% (32/119), 56% (66/117), and 95% (105/110), respectively, at the same time intervals. No further change was observed at the 24-month examination. Conclusions: Three phases of carotid stent incorporation are defined: (1) an early unstable period soon after stent placement with an echolucent (thrombotic) SPL layer, (2) a moderately unstable phase with ingrowing neointima (1–12 months), and (3) a stable phase from the second year on. These data may indicate the need for different intensities of therapy and surveillance intervals.

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Repeat Revascularization over 10 Years Following Carotid Endarterectomy or Carotid Stent Placement: An Analysis of CREST

World Neurosurgery ◽

10.1016/j.wneu.2021.07.118 ◽

2021 ◽

Author(s):

Adnan I. Qureshi ◽

Wei Huang ◽

Iryna Lobanova ◽

M. Fawad Ishfaq ◽

Brandi R. French ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Stent Placement ◽

Carotid Stent ◽

Repeat Revascularization

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Impact of Carotid Stent Cell Design on Vessel Scaffolding: A Case Study Comparing Experimental Investigation and Numerical Simulations

Journal of Endovascular Therapy ◽

10.1583/10-3338.1 ◽

2011 ◽

Vol 18 (3) ◽

pp. 397-406 ◽

Cited By ~ 28

Author(s):

Michele Conti ◽

Denis Van Loo ◽

Ferdinando Auricchio ◽

Matthieu De Beule ◽

Gianluca De Santis ◽

...

Keyword(s):

Experimental Investigation ◽

Numerical Simulations ◽

Cell Design ◽

Carotid Stent

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Carotid Plaque Characterization Using Digital Image Processing and its Potential in Future Studies of Carotid Endarterectomy and Angioplasty

Journal of Endovascular Therapy ◽

10.1177/152660289800500309 ◽

1998 ◽

Vol 5 (3) ◽

pp. 240-246 ◽

Cited By ~ 9

Author(s):

Giorgio M. Biasi ◽

Paolo M. Mingazzini ◽

Lucia Baronio ◽

Maria Rosa Piglionica ◽

Stefano A. Ferrari ◽

...

Keyword(s):

Cerebral Infarction ◽

Carotid Endarterectomy ◽

Carotid Plaque ◽

Screening Tool ◽

Brain Infarction ◽

Carotid Stent ◽

Plaque Characterization ◽

Duplex Scan ◽

Future Studies ◽

The Mean

Purpose: To corroborate the validity of a computerized methodology for evaluating carotid lesions at risk for stroke based on plaque echogenicity. Methods: The records of 96 carotid endarterectomy patients (59 men; median age 69.5 years, range 52 to 83) with stenoses > 50% were studied retrospectively. Forty-one patients (43%) had been symptomatic preoperatively. All patients had undergone computed tomography (CT) to detect infarction in the carotid territory and a duplex scan to measure carotid stenosis. Plaque echogenicity was analyzed by computer, expressing the echodensity in terms of the gray scale median (GSM). The incidence of CT-documented cerebral infarction was analyzed in relation to symptomatology, percent stenosis, and echodensity. Results: Symptoms correlated well with CT evidence of brain infarction: 32% of symptomatic patients had a positive CT scan versus 16% for asymptomatic plaques (p = 0.076). The mean GSM value was 56 ± 14 for plaques associated with negative CT scans and 38 ± 13 for plaques from patients with positive scans (p < 0.0001). However, there was no difference in the GSM value between plaques with > or < 70% stenosis. Furthermore, the incidence of CT infarction was 40% in the cerebral territory of carotid plaques with a GSM value < 50 and only 9% in those with a GSM > 50 (p < 0.001). Conclusions: Computerized analysis of plaque echogenicity appears to provide clinically useful data that correlates with the incidence of cerebral infarction and symptoms. This method of analyzing plaque echolucency could be used as a screening tool for carotid stent studies to identify high-risk lesions better suited to conventional surgical treatment.

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Abstract P426: Platelet Glycoprotein IIb/IIIa Inhibitors as an Adjunct to Stent Placement of Carotid Stenosis in Symptomatic Patients

Stroke ◽

10.1161/str.52.suppl_1.p426 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Sachin M Bhagavan ◽

Ammad Ishfaq ◽

Muhammad F Ishfaq ◽

Mukaish Kumar ◽

Shruthi Pulimamidi ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Carotid Stenosis ◽

Transient Ischemic Attack ◽

Stent Placement ◽

Severe Disability ◽

Platelet Glycoprotein ◽

Carotid Stent ◽

Significant Difference ◽

Ischemic Attack

Background: Intra-arterial or intravenous platelet glycoprotein (GP) IIb/IIIa inhibitors have been used as adjunct to stent placement of carotid stenosis in patients with ischemic stroke or transient ischemic attack. Objective: To determine the proportion of patients with ischemic stroke or transient ischemic attack who received platelet GP IIb/IIIa inhibitors as adjunct to carotid stent placement and associated outcomes. Methods: We analyzed data from Cerner Health Facts® which collected data from participating facilities from January 1, 2000 to July 1, 2018. We identified patients with ischemic stroke or transient ischemic attack who underwent carotid stent placement for carotid stenosis and received Abciximab, Eptifibatide, or Tirofiban. Outcome was defined by discharge destination and classified into none to minimal disability, moderate to severe disability, or death. Results: A total of 8.4 % of 4567 patients with ischemic stroke or transient ischemic attack who underwent carotid stent placement for carotid stenosis received platelet GP IIb/IIIa inhibitors. Patients who received platelet GP IIb/IIIa inhibitors were more likely to experience cerebral ischemia (14.8% versus 7.5%) and undergo intubation/mechanical ventilation (4.4% versus 2%). There was a significant difference between patients who did or did not receive platelet GP IIb/IIIa inhibitors in terms of in hospital mortality rates (2.7% versus 1.2%, p=0.0152), none to mild disability (67.3% vs 75.7%, p=0.0003), and moderate to severe disability (30.1% vs 23.1%,p=0.0024). Conclusions: Adjunct use of platelet GP IIb/IIIa inhibitors in patients undergoing carotid stent placement for symptomatic carotid stenosis was associated with increased rates of in hospital mortality and moderate to severe disability.

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