Carotid Angioplasty and Stenting is Safe in Women

Background Results of randomized controlled trials have shown that carotid endarterectomy poses greater perioperative risks to women than to men. There are limited studies regarding sex differences in carotid angioplasty and stenting. Objectives To compare male and female patients undergoing carotid stenting with regard to their intraprocedural complications and 30-day outcome. Methods We reviewed patients who underwent carotid stenting between 1997 and 2007 at our tertiary centre. Distal protection devices were used in all patients after 1999. Demographics, risk factors, intraprocedural complications, and 30-day outcomes were compared between female and male patients. Results Among 243 patients who underwent 255 procedures, 67 were women (27.6%). The mean (SD) age of the female patients was 72.2 ± 8.4 years and that of the male patients was 72.0 ± 9.6 years ( P = .83). The majority of patients had symptomatic carotid artery disease; 11 women (16.4%) and 30 men (16.0%) were asymptomatic. The following intraprocedural complications were noticed in female vs male patients: asymptomatic carotid and/or iliac dissections 7.5% vs 0% ( P = .001), minor stroke 0% vs 1.1% ( P = 1.00), major stroke 0% vs 0.5% ( P = 1.00), and cardiac dysrhythmias 3% vs 2.7% ( P = 1.00). At 30 days, the outcomes in women vs men were as follows: mortality 3.0% vs 3.2% ( P = 1.00), major stroke 3.0% vs 2.1 % ( P = .66), and minor stroke 3.0% vs 3.2% ( P = 1.00). Conclusion Although minor asymptomatic intraprocedural dissections were more common in women, we did not find any impact of sex on the 30-day outcome. We concluded that carotid stenting can be performed as safely in women as in men.

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Surgical Advances for Extracranial Carotid Stenosis

Neurosurgery ◽

10.1227/neu.0000000000000150 ◽

2014 ◽

Vol 74 (suppl_1) ◽

pp. S83-S91 ◽

Cited By ~ 1

Author(s):

Robert E. Harbaugh ◽

Akshal Patel

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Endarterectomy ◽

Internal Carotid ◽

Carotid Artery Disease ◽

Carotid Angioplasty ◽

Artery Disease ◽

Angioplasty And Stenting ◽

Carotid Angioplasty And Stenting

Abstract Carotid endarterectomy is a commonly performed operation to prevent stroke in patients who have asymptomatic or symptomatic internal carotid artery atherosclerotic stenosis. Carotid angioplasty and stenting has also been advocated for treatment of these patients. In this article, we address a number of questions for which a review of available data will advance our understanding of the role of carotid endarterectomy in stroke prevention. These include the following: Are carotid endarterectomy and carotid angioplasty and stenting equivalent procedures for the treatment of carotid artery disease? Which patients should be deemed at high risk for carotid endarterectomy? Should carotid endarterectomy be an urgent procedure in symptomatic patients with severe internal carotid artery stenosis? Finally, what is the role of carotid endarterectomy in asymptomatic patients? We also review the senior author's personal experience with >2000 consecutive carotid endarterectomies, with special attention to his present approach to this operation. We believe that carotid endarterectomy, in experienced hands, is a minimally invasive operation that remains the procedure of choice for most patients with carotid artery disease who will benefit from invasive treatment.

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Outcomes after Carotid Angioplasty and Stenting in Symptomatic Octogenarians

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100011859 ◽

2011 ◽

Vol 38 (3) ◽

pp. 446-451 ◽

Cited By ~ 5

Author(s):

M. A. Almekhlafi ◽

P. L. Couillard ◽

A. Pandya ◽

N. Shobha ◽

W. F. Morrish ◽

...

Keyword(s):

The Elderly ◽

Carotid Stenting ◽

Complication Rates ◽

Carotid Angioplasty ◽

Short Term ◽

The Mean ◽

Complications Rate ◽

Angioplasty And Stenting ◽

Carotid Angioplasty And Stenting ◽

Length Of Hospitalization

Objective:Octogenarians were excluded from participation in many carotid endarterectomy trials due to the high complication rates observed in past studies. However, stroke resulting from carotid stenosis is expected to increase with the aging population. Moreover, advances in Carotid Angioplasty and Stenting (CAS) techniques have resulted in perceived improved safety of this procedure. We sought to review our experience with carotid stenting in symptomatic octogenarians with an emphasis on short-term outcomes and complications.Methods:This is a retrospective longitudinal cohort study of all symptomatic patients who underwent CAS in our center between 1997 and 2007. Thirty-day stroke and death rates, and length of hospitalization were compared between the symptomatic octogenarians and non-octogenarians.Results:A total of 214 procedures were performed on 211 symptomatic patients (56 females). Fifty-nine patients (14 females) were octogenarians. The median (interquartile range) age on procedure date for the octogenarian cohort was 83 (4) years. Periprocedural death occurred in two (3.4%) octogenarians and five (3.3%) non-octogenarians (p = 0.97). At 30 days from the procedure, stroke occurred in four (6.8%) octogenarians and seven (4.6%) non-octogenarians (p= 0.52). The mean hospital stay (4.8 days) was not different between the two cohorts. Age was not a predictor of the 30-day risk of composite stroke or death.Conclusion:The complications rate observed in octogenarians was not significantly higher than non-octogenarians. Our findings suggest that octogenarians should be included in randomized trials examining CAS to better define the risk-benefit profile of this procedure in the elderly.

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Hemodynamic Compromise During Carotid Angioplasty and Stenting

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53441 ◽

2011 ◽

Author(s):

A. G. Lynch ◽

M. T. Walsh

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Disease ◽

Arterial Disease ◽

Neurological Deficits ◽

Carotid Angioplasty ◽

Hemodynamic Compromise ◽

Artery Disease ◽

Angioplasty And Stenting ◽

Carotid Angioplasty And Stenting

Modern surgical treatment of arterial disease is moving towards minimally invasive procedures, as the benefits are numerous. However, one area that is resisting this trend is the treatment of carotid artery disease. For the past number of decades carotid endarterectomy surgery has been referred to as the “gold standard” in the treatment of carotid artery disease. However, in recent year’s carotid angioplasty and stenting (CAS) has emerged to challenge carotid endarterectomy surgery (CES) as a viable alternative for the prevention of strokes. However uptake of this procedure has been hindered due to the peri-operative complications associated with the treatment. During this procedure blood flow in one of the internal carotid arteries supplying blood to the brain is interrupted for a period of time. However, it has been shown that not all patients can accommodate this interruption. Qureshi et al. suggests that ischemic neurological deficits occur in 3 to 13% of patients as a result of hemodynamic compromise.

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Abstract TP131: Use of Fixed-Dose Heparin Protocol for Carotid Angioplasty and Stenting in Patients with Symptomatic Carotid Stenosis

Stroke ◽

10.1161/str.48.suppl_1.tp131 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

M. Fareed K. Suri,MD ◽

Muhammad Shah Miran,MD ◽

Ahmed Riaz,MD ◽

Mohammad Rauf Afzal, MD ◽

Iryna Lobanova, MD ◽

...

Keyword(s):

Ischemic Stroke ◽

Fixed Dose ◽

Minor Stroke ◽

Care Hospital ◽

Carotid Angioplasty ◽

Ischemic Event ◽

Dose Heparin ◽

Symptomatic Carotid Stenosis ◽

Angioplasty And Stenting ◽

Carotid Angioplasty And Stenting

Introduction: Appropriate dosing of anticoagulation during carotid angioplasty and stenting remains unstudied. Although 70 units /kg is a commonly used dose, in patients with acute stroke, this dose may increase the risk of hemorrhagic transformation. We report safety of a novel low fixed-dose protocol in patients treated with CAS after recent ischemic event. Methods: All patients who underwent carotid angioplasty and stenting after or during a recent admission with acute ischemic stroke, at a tertiary care hospital, from Jun 2012 to August 2015 were retrospectively identified from a prospectively maintained database. A dose of 25 u/kg was used if patient had a recent infarct on imaging, or in case imaging cannot rule out an acute infarct, a recent clinical stroke. In other patients a dose of 50 u/kg was used. Activated clotting time (ACT) was checked in all patients at the time of stent deployment. Results: CAS was performed in 59 patients (mean age 71.3+/-13.3, 68% men) as per fixed-dose heparin protocol. Procedure was performed within 48 hours, 48 hours to 7 days, and after 7 days of the event in 18, 15 and 26 patients, respectively. Clinical characteristics of patients in three groups are shown in table. Only 2 patients suffered transient ischemic event and 1 patient suffered minor stroke during hospitalization. No patients suffered any hemorrhagic complication or death. Conclusion: A fixed low dose heparin protocol during carotid angioplasty and stenting ay be safe and effective, especially in patients with recent ischemic stroke.

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