Balloon-protected carotid artery stenting. Relationship of periprocedural neurological complications with the size of particulate debris

2002 ◽  
Vol 11 (3) ◽  
pp. 64
Author(s):  
T. Tübler ◽  
M. Schlüter ◽  
O. Dirsch
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Neurological Complications ◽  
Particulate Debris ◽  
Relationship Of

Predictors of periprocedural complications of carotid artery stenting - a multivariate analysis of a single-centre experience

VASA ◽  
2016 ◽  
Vol 45 (5) ◽  
pp. 387-393 ◽  
Author(s):  
Mehmet Bulent Vatan ◽  
Bilgehan Atılgan Acar ◽  
Murat Aksoy ◽  
Yusuf Can ◽  
Ceyhun Varım ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Multivariate Regression Analysis ◽  
Neurological Complications ◽  
Lesion Length ◽  
Plaque Morphology ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Independent Risk Factors

Abstract. Background: Carotid artery stenting (CAS) is currently used as an alternative treatment to carotid endarterectomy (CEA). The objective of this study was to analyse our 5-year experience performing CAS. Secondarily, we sought to determine independent risk factors which predict periprocedural complications. Patients and Methods: A total of 146 patients who underwent 153 CAS procedures were analysed. The majority of patients (123, 84.2%) had symptomatic carotid stenosis. Demographic and interventional data, angiographic lesion characteristics, and periprocedural complications were recorded. Using univariate and multivariate logistic regression analyses, risk factors associated with adverse clinical outcomes were determined. Results: Periprocedural neurological complications, including four (2.7 %) major strokes, three (2 %) transient ischaemic attacks, one (0.7%) amaurosis fugax, and two (1.3 %) cases of hyperperfusion syndrome occurred in ten (6.8%) patients. The incidence of periprocedural complications significantly increased in female patients (r = 0.214, p = 0.009) and patients with longer lesions (r = 0.183, p = 0.027), contralateral stenosis ≥50 % (r = 0.222, p = 0.007), the presence of complicated plaques (r = 0.478, p < 0.001) and inadequate glycaemic control (r = 0.259, p = 0.002). Multivariate regression analysis also determined four variables to be potential independent risk factors for 30-day adverse events: higher age (Odds ratio [OR] = 1.283; 95 % CI, 1.051 to 1.566, p = 0.014); longer lesions (OR = 1.459, 95 % CI, 1.124 to 1.893, p = 0.004); higher tortuosity index (OR = 1.015, 95 % CI, 1.001 to 1.030, p = 0.034), and the presence of complicated plaque morphology (OR = 4.321, 95 % CI, 1.621 to 10.23, p = 0.001). Conclusions: Patient and lesion characteristics including age, lesion length, complicated plaque morphology and tortuosity index, may be associated with periprocedural complications.

Hypotension and Bradycardia after Elective Carotid Stenting: Frequency and Risk Factors

2003 ◽  
Vol 10 (5) ◽  
pp. 851-859 ◽  
Author(s):  
Wolfgang Mlekusch ◽  
Martin Schillinger ◽  
Schila Sabeti ◽  
Tassilo Nachtmann ◽  
Wilfried Lang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Carotid Stenting ◽  
Hemodynamic Instability ◽  
Neurological Complications ◽  
Severe Hypotension ◽  
Artery Disease

Purpose: To investigate the frequency of and risk factors for hypotension and bradycardia in response to elective carotid stenting and their association with neurological complications. Methods: A retrospective analysis was conducted of 471 patients (321 men; median age 72 years, interquartile range 64–77) who underwent elective carotid artery stenting without cerebral protection for high-grade (>70%) symptomatic (n = 147) or asymptomatic (n=324) internal carotid artery stenosis at a single center. Frequency and potential risk factors for severe hypotension (systolic blood pressure <80 mmHg) or bradycardia (heart rate <50 bpm) were studied. Results: Thirty-four (7%) patients had severe hypotension (n=23), bradycardia (n=2), or both (n=9) despite routine premedication with atropine and adequate fluid balance. Intravenous catecholamines (dopamine) were necessary in 8 patients with prolonged hypotension; none of the patients with bradycardia needed pacemaker support. Neurological complications (transient ischemic attack, minor stroke, major stroke, death) occurring in 33 (7%) patients were not significantly associated with hemodynamic instability (4/34 [12%] versus 29/437 [7%], p = 0.26). Age >77 years (fourth quartile; OR 6.40, 95% CI 1.80 to 22.78, p=0.004) and coronary artery disease (OR 2.81, 95% CI 1.29 to 6.14, p=0.010) were associated with an increased adjusted risk for hypotension or bradycardia. Conclusions: Hemodynamic instability due to hypotension and bradycardia in response to carotid artery stenting occurs in a relatively low proportion of patients. Elderly patients and those with coronary artery disease are at highest risk. Although the rate of neurological complications was not significantly increased in patients with hemodynamic instability, the higher frequencies of neurological complications in these patients admonish us to be careful.

Management of Neurological Complications of Carotid Artery Stenting

2001 ◽  
Vol 8 (4) ◽  
pp. 341-353 ◽  
Author(s):  
Michael H. Wholey ◽  
Mark H. Wholey ◽  
Walter A. Tan ◽  
Boulis Toursarkissian ◽  
Steven Bailey ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Neurological Complications

Management of Neurological Complications of Carotid Artery Stenting

2001 ◽  
Vol 8 (4) ◽  
pp. 341-353 ◽  
Author(s):  
Michael H. Wholey ◽  
Mark H. Wholey ◽  
Walter A. Tan ◽  
Boulis Toursarkissian ◽  
Steven Bailey ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Neurological Complications

Finite Element Design of Nitinol Embolic Protection Filters Based on Parametric Modelling With PyFormex: A Feasibility Study

2009 ◽  
Author(s):  
M. De Beule ◽  
M. Conti ◽  
P. Mortier ◽  
D. Van Loo ◽  
P. Verdonck ◽  
...  
Keyword(s):  
Finite Element ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Neurological Complications ◽  
Parametric Modelling ◽  
High Grade ◽  
Design Improvement ◽  
Embolic Protection ◽  
Vessel Injury ◽  
Widespread Acceptance

The widespread acceptance of Carotid Artery Stenting (CAS) to treat a stenosed carotid vasculature and its effectiveness compared with its surgical counterpart, carotid endarterectomy (CEA) is still a matter of debate [1]. A major concern related to CAS is embolization distal to the site of treatment potentially leading to stroke or other severe neurological complications. Embolization associated with CAS is mainly due to the plaque debris and thrombi generated during the dilatation of the stenosis and stent positioning. Consequently, embolic protection filters have been developed to capture this released debris and they appear to have a significant favorable impact on the success of CAS [2,3]. Currently, several embolic filter designs are available on a rapidly growing dedicated market. However, some drawbacks such as filtering failure, inability to cross tortuous high-grade stenoses, malpositioning and vessel injury still remain and require further design improvement.

scholarly journals One-day, sequential carotid artery stenting followed by cardiac surgery in patients with severe carotid and cardiac disease

2019 ◽  
Vol 24 (5) ◽  
pp. 431-438 ◽  
Author(s):  
Karolina Dzierwa ◽  
Jacek Piatek ◽  
Piotr Paluszek ◽  
Tadeusz Przewlocki ◽  
Lukasz Tekieli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Carotid Artery ◽  
Cardiac Disease ◽  
Carotid Artery Stenting ◽  
Artery Bypass ◽  
Neurological Complications ◽  
Class Iii ◽  
Sequential Approach ◽  
Ica Stenosis

Optimal management of patients with internal carotid artery (ICA) stenosis concurrent with severe cardiac disease remains undefined. The aim of this study is to evaluate the safety and feasibility of the one-day, sequential approach by carotid artery stenting (CAS) immediately followed by cardiac surgery. The study included 70 consecutive patients with symptomatic > 50% or ⩾ 80% asymptomatic ICA stenosis coexisting with severe coronary/valve disease, who underwent one-day, sequential CAS + cardiac surgery. The majority of patients (85.7%) had CSS class III or IV angina and 10% had non-ST elevation myocardial infarction. The EuroSCORE II risk was 2.4% (IQR 1.69–3.19%). All CAS procedures were performed according to the ‘tailored’ algorithm with a substantial use of proximal neuroprotection devices of 44.3%. Closed-cell (75.7%) and mesh-covered (18.6%) stents were implanted in most cases. The majority of patients underwent isolated coronary artery bypass grafting (88.6%) or isolated valve replacement (7.1%). No major adverse cardiac and cerebrovascular events (MACCE) occurred at the CAS stage. There were three (4.3%) perioperative MACCE: one myocardial infarction and two deaths. All MACCE were related to cardiac surgery and were due to the high surgical risk profile of the patients. Up to 30 days, no further MACCE were observed. No perioperative or 30-day neurological complications occurred. In this patient series, one-day, sequential CAS and cardiac surgery was relatively safe and did not result in neurological complications. Thus, a strategy of preoperative CAS could be considered for patients with severe or symptomatic ICA stenosis who require urgent cardiac surgery.

scholarly journals Robot-Assisted Carotid Artery Stenting: A Safety and Feasibility Study

2021 ◽  
Author(s):  
Ben Jones ◽  
Celia Riga ◽  
Colin Bicknell ◽  
Mohamad Hamady
Keyword(s):  
Carotid Artery ◽  
Hospital Stay ◽  
Carotid Artery Stenting ◽  
Open Surgery ◽  
Clinical Success ◽  
Neurological Complications ◽  
Robotic System ◽  
Stent Insertion ◽  
Average Hospital

Abstract Purpose Endovascular robotics is an emerging technology within the developing field of medical robotics. This was a prospective evaluation to assess safety and feasibility of robotic-assisted carotid artery stenting. Materials and Methods Consecutive cases of carotid artery stenting cases performed over period of 24 months, from May 2015 to October 2016, using the Magellan Robotic System (Hansen, Mountain View, CA) were included. All cases utilised the robotic system to navigate the arch, obtain a stable position in the common carotid artery, followed by manual manipulation of Embolic Protection Devices and self-expandable stents through the robotic catheter. Patients demographics, clinical indications, anatomical features, technical and clinical success, complication rate and hospital stay were prospectively recorded. Results Thirteen patients, 10 males (78.5%), with an average age of 68.7 years were treated. Mean follow up time was 30 months. Ten patients (91%) were symptomatic at presentation. Anatomical indications for endovascular stent insertion were previous open surgery to the neck ± radiotherapy (87.5%) and hostile anatomy for open surgery (12.5%). Technical success was 100% and the robotic system demonstrates enhanced stability during arch and lesion crossing. There were no neurological complications post-operatively. Average hospital stay was 3 days (range 2–6 days) and a change in serum creatinine of −7.8 μmol/L. There was no documented case of in stent restenosis, new or worsening neurology during follow-up. Conclusion These results illustrate safety and feasibility of robotic endovascular revascularisation for carotid disease and demonstrates potential to enhance peri-procedural safety through improved control and stability.

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