Routine Stent Flushing with Heparinized Saline during Distal Filter-Protected Carotid Artery Stenting: A Technical Modification to Reduce Delayed Embolization

Background and purpose Placement of a large-bore guiding sheath or catheter into the common carotid artery (CCA) is crucial in transbrachial carotid artery stenting (CAS). Herein, we describe technical tips for the navigation of a 6-French guiding sheath into the CCA using a tri-axial catheter system in transbrachial CAS. Materials and methods A total of 27 patients underwent transbrachial CAS. For the right side, a 6-French straight guiding sheath was navigated directly into the CCA using a tri-axial catheter system, with a 4-French Simmons catheter placed through a 6-French straight guiding catheter. For the left side, a 6-French Simmons guiding sheath was navigated into the CCA using a tri-axial catheter system, with a 4-French Simmons catheter placed through a 6-French Simmons guiding catheter. After the placement of a 6-French guiding sheath into the CCA, CAS was performed under distal filter or balloon protection. Results Fifteen patients had a right carotid stenosis and 12 patients had a left carotid stenosis. The 6-French guiding sheath was safely placed with ease and provided adequate stabilization for CAS. All procedures were successfully performed without any complications. Conclusion The use of a tri-axial catheter system for the navigation of a 6-French guiding sheath into the CCA appears safe and efficient, allowing transbrachial CAS, with 6-French guiding sheath stabilization, to be performed without any complication.

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Abstract 66: Predictors of Vascular Events or Death within One Year of Carotid Artery Stenting: Investigation on Devices and Anti-platelet Therapy for Carotid Artery Stenting (IDEALCAST)

Stroke ◽

10.1161/str.44.suppl_1.a66 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Hiroshi Yamagami ◽

Nobuyuki Sakai ◽

Yoshihiro Matsubara ◽

Yasushi Okada ◽

Hiroyoshi Yokoi ◽

...

Keyword(s):

Carotid Artery ◽

Primary Endpoint ◽

Carotid Artery Stenting ◽

Older Age ◽

Antiplatelet Drugs ◽

Vascular Events ◽

Factors Affecting ◽

Multivariate Proportional Hazard ◽

One Year ◽

Distal Filter

Background and Purpose: Carotid artery stenting (CAS) using distal filter protection device has been approved in April 2008 in Japan. However, factors affecting the development of vascular events and deaths after CAS have not been clarified in our country. The present study was conducted to identify the predictive factors for the development of vascular events or death after CAS. Methods: CAS was indicated for patients with at least one risk factor for carotid endarterectomy and with > 50 % stenosis in symptomatic or > 80% stenosis in asymptomatic carotid arteries. Between June 2008 and June 2010, we enrolled 949 patients who were planning to undergo elective CAS in 43 Japanese centers. Patients were followed at 30days and 12 months after stenting. The primary endpoint was the composite of death, any stroke, transient ischemic attack, myocardial infarction, and serious systemic bleeding. Results: Of the 934 patients (818 men, 72 ± 7 years old) followed for 1 year after stenting, primary endpoint was observed in 109 (11.7%) patients, including 18 (1.9%) deaths, 52 (5.6%) ischemic strokes, 7 (0.8%) hemorrhagic strokes, 16 (1.7%) transient ischemic attacks, 4 (0.4%) myocardial infarctions, and 11 (1.2%) serious systemic bleeding. In a multivariate proportional hazard model, older age (hazard ratio [HR], 1.24 per 5 years; 95% confidence interval [CI], 1.07 to 1.44; P=0.005), history of ischemic stroke (HR, 1.68; 95% CI, 1.10 to 2.62; P=0.015), combination of pre-procedural antiplatelet drugs (P=0.03), usage of diabetes drugs (HR, 1.93; 95% CI, 1.29 to 2.88, P=0.002), femoral artery puncture (HR,0.36; 95% CI 0.18 to 0.80; =0.015), use of guiding catheter system (HR, 1.69; 95% CI 1.08 to 2.71, P=0.021) and use of Angioguard XP in the procedure (HR, 1.92; 95% CI, 1.16 to 3.40, P=0.011) were associated with the development of vascular events or death. Conclusions: In addition to older age and medical history, selection of pre-procedural antiplatelet drugs and procedural devices can predict vascular events or death after CAS.

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