scholarly journals Carotid Stenting without Angioplasty

2002 ◽  
Vol 29 (2) ◽  
pp. 175-179 ◽  
Author(s):  
S. Men ◽  
S.P. Lownie ◽  
D.M. Pelz
Keyword(s):  
Balloon Angioplasty ◽  
Plain Film ◽  
Carotid Bifurcation ◽  
Carotid Stenting ◽  
Vessel Diameter ◽  
Moderate Increase ◽  
Atherosclerotic Stenosis ◽  
Hemodynamic Improvement ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Abstract:Background:Carotid angioplasty and stenting is gaining popularity as an alternative to carotid endarterectomy for the treatment of carotid bifurcation stenosis. The major concern with the procedure is the risk of embolic stroke which may be initiated by balloon angioplasty of friable atherosclerotic plaque. Elimination of angioplasty may result in a lower incidence of embolic complications.Method:We describe a case in which a self-expanding stent alone, without balloon angioplasty, was used to successfully dilate an atherosclerotic stenosis of the carotid bifurcation.Results:A moderate increase in vessel diameter, from 75% to 50%, was immediately observed after stent placement alone. No embolic complications were observed and follow-up plain film and ultrasound examinations showed progressive stent enlargement with excellent anatomic and hemodynamic results.Conclusions:In this case of severe carotid stenosis, the use of a self-expanding stent alone, without balloon angioplasty, resulted in excellent anatomic and hemodynamic improvement.

Transcervical Carotid Stenting with Flow Reversal for Neuroprotection: Technique, Results, Advantages, and Limitations

Vascular ◽  
2006 ◽  
Vol 14 (5) ◽  
pp. 245-255 ◽  
Author(s):  
Iraklis I. Pipinos ◽  
Matias Bruzoni ◽  
Jason M. Johanning ◽  
G. Matthew Longo ◽  
Thomas G. Lynch
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Carotid Bifurcation ◽  
Carotid Stenting ◽  
Flow Reversal ◽  
Transcervical Approach ◽  
Weighted Magnetic Resonance Imaging ◽  
Carotid Occlusive Disease ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Carotid angioplasty and stenting are progressively earning a role as a less invasive alternative in the treatment of carotid occlusive disease. The most common approach for carotid artery stenting involves transfemoral access and use of a filter or balloon device for neuroprotection. This approach has limitations related to both the site of access and the method of neuroprotection. Specifically, an aortoiliac segment with advanced occlusive or aneurysmal disease or an anatomically unfavorable or atheromatous arch and arch branches can significantly limit the safety of the retrograde transfemoral pathway to the carotid bifurcation. Additionally, data provided by the use of transcranial Doppler monitoring and diffusion-weighted magnetic resonance imaging in patients undergoing filter- or balloon-protected carotid artery stenting demonstrate that currently available devices are associated with a considerable incidence of cerebral embolization. To address these limitations, we, along with others, have employed a direct transcervical approach for carotid artery stenting that incorporates the principle of flow reversal for neuroprotection. The technique bypasses all of the anatomic limitations of transfemoral access and simplifies the application of flow reversal, which is one of the safest neuroprotection techniques. The purpose of this review is to describe our method of transcervical carotid artery stenting, review the accumulating outcomes data, and discuss the clinical advantages of and indications for this increasingly popular technique.

Carotid Angioplasty and Stenting is Safe in Women

2012 ◽  
Vol 63 (3_suppl) ◽  
pp. S18-S22 ◽  
Author(s):  
Nandavar Shobha ◽  
Mohammed A. Almekhlafi ◽  
Anjali Pandya ◽  
Philippe L. Couillard ◽  
William F. Morrish ◽  
...  
Keyword(s):  
Carotid Artery Disease ◽  
Carotid Stenting ◽  
Minor Stroke ◽  
Carotid Angioplasty ◽  
Symptomatic Carotid ◽  
Female Patients ◽  
Male Patients ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting ◽  
Major Stroke

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.

scholarly journals Brain Protection with Intracarotid Filter in Angioplasty and Stenting of the Cervical Carotid Bifurcation

2001 ◽  
Vol 7 (2) ◽  
pp. 103-110 ◽  
Author(s):  
G. Bonaldi ◽  
G. Minonzio ◽  
A. Lunghi
Keyword(s):  
Carotid Plaque ◽  
Solid Material ◽  
Carotid Bifurcation ◽  
Carotid Stenting ◽  
Brain Protection ◽  
Balloon Inflation ◽  
Technical Aspects ◽  
Functional Factors ◽  
Angioplasty And Stenting ◽  
Carotid Flow

We report our preliminary experience in five cases of carotid stenting and angioplasty performed under cerebral protection with new filter devices allowing carotid flow maintenance during the procedure. In four out of five cases solid material was found inside the filters after balloon inflation for angioplasty. The technical aspects are discussed with correlation to carotid plaque embolic behavior and to functional factors.

Abstract TP4: Early Recanalization Followed By CEA Improves Functional Independence Compared To Carotid Angioplasty And Stenting

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mohammed J Humayun ◽  
Sharjeel Panjwani ◽  
Mouhammed A Jumaa ◽  
Syed F Zaidi
Keyword(s):  
Carotid Stenting ◽  
Functional Independence ◽  
Hemorrhagic Transformation ◽  
Favorable Outcome ◽  
High Rate ◽  
Treatment Modalities ◽  
Vessel Occlusion ◽  
Proximal Lesion ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Background: Concomitant acute cervical ICA and intracranial large vessel occlusion (ILVO) has a high rate of morbidity and mortality. The most appropriate treatment strategy for the extracranial culprit lesion remains unclear. We report our institutional outcomes with the 2 approaches, emergent carotid endartectomy (CEA) vs. stenting (CAS). Methods: Between July 2012 to April 2016, 34 patients with concomitant complete ICA origin occlusion and occlusion of either intracranial ICA, MCA M1 or M2 segments underwent thrombectomy at our center. Demographics, risk factors, treatment modalities, imaging and clinical outcomes were reviewed from a prospectively maintained database. Recanalization, hemorrhagic transformation (HT) with clinical decline of >4 points on the NIHSS and favorable outcome rates mRs of < 2 at 90 days were compared. Results: Of the 34 identified subjects, in 6 patients the proximal lesion was not treated either due to failed MT (N=3), ICA re-occlusion prior to CEA (N=2) or MCA recanalization via trans-circulation access with symptomatic resolution (N=1). Of the remaining 28 patients, 10 (35.7%) underwent emergent CEA within 12 hours following MT, while the remainder 18 (64.3%) had carotid stenting performed during the MT. Rate of IV tPA treatment was higher in CAS (61% vs 10%, p<0.01). Successful TICI 2B/3 recanalization was achieved in 90% of the CEA and 94.1% of stenting patients (p=0.6). Following CAS, 3 patients developed HT while none were noted in the CEA arm. At 90 days, 80% (8/10) of the CEA patients were functionally independent compared to 58.8% (10/18) in the stenting group, although this difference was not statistically different (p=0.3). No deaths in the CEA group were noted as compared to 4 (23.5%) in the stenting arm (p=0.09). Conclusions: Our study indicates that for concomitant cervical ICA and ILVO, MT followed by emergent CEA is feasible and may be accompanied with less risk for HT and improved rate of favorable outcome. Further prospective studies are warranted.

scholarly journals Outcomes after Carotid Angioplasty and Stenting in Symptomatic Octogenarians

2011 ◽  
Vol 38 (3) ◽  
pp. 446-451 ◽  
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.

Preliminary Experience With Proximal Flow Reversal During Intracranial Balloon Angioplasty and Stenting for Symptomatic, Severe Intracranial Stenosis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Branden J Cord ◽  
Corrado Santarosa ◽  
Nanthiya Sujijantarat ◽  
Adam Kundishora ◽  
Guido Falcone ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Recurrent Stroke ◽  
Carotid Bifurcation ◽  
Flow Reversal ◽  
Intracranial Stenosis ◽  
Artery Embolism ◽  
Proximal Protection ◽  
Maximal Medical Therapy ◽  
A Minor ◽  
Angioplasty And Stenting

Abstract INTRODUCTION The frequency of balloon-angioplasty and stenting for symptomatic intracranial stenosis was drastically reduced after publication of the negative SAMMPRIS trial. In part, this was due to a higher than expected periprocedural complication rate (14.7% 30-d stroke or death) compared to maximal medical therapy (5.8%). Although the cause of periprocedural stroke was not defined, intraprocedural artery-to-artery embolism is a likely contributor. The Silk Road ENROUTE Transcarotid Neuroprotection System (TCNS) was designed as an alternative revascularization strategy for carotid bifurcation disease. It provides direct transcarotid access and proximal protection through flow reversal. We adapted this system as a proximal protection strategy for balloon angioplasty and stenting of severe, symptomatic intracranial stenosis. METHODS From May-2017 to May-2019, 7 patients underwent intracranial balloon angioplasty and stenting for symptomatic intracranial stenosis using the TCNS. Baseline demographics, comorbidities, procedure-related parameters, and outcomes were assessed. RESULTS A total of 7 patients (mean age 63, SEM 4.7 yr, 57% female) with severe (84% +/− 5%) supraclinoid internal carotid artery (ICA) and/or M1 stenosis presented with recurrent strokes (86% left sided) despite dual antiplatelet therapy (DAPT). Angiographically, cessation or reversal of flow was seen in the supraclinoid ICA in all patients, with confirmation by transcranial doppler in selected cases, after the institution of flow reversal by the TCNS. A noncompliant balloon was used to perform submaximal angioplasty, followed by stenting with intracranial stents. All procedures were technically successful with no evidence of periprocedural thromboembolic complications. Follow-up ranged from 6 to 12 mo. One patient suffered a fatal reperfusion hemorrhage on POD 3. One patient suffered from a minor recurrent stroke at 7 mo (after the cessation of DAPT) and was restarted on DAPT. CONCLUSION Traditional methods of intracranial balloon angioplasty and stenting suffer from high periprocedural ischemic stroke rates. TCNS can be adapted to provide a means of proximal protection during the treatment of these high-risk lesions. This procedural innovation warrants further investigation.

The Role of Carotid Stenting

2007 ◽  
Vol 14 (5) ◽  
pp. 705-711 ◽  
Author(s):  
Ian M. Loftus ◽  
Matthew M. Thompson
Keyword(s):  
Randomized Trials ◽  
Carotid Stenting ◽  
Carotid Disease ◽  
Exclusion Criteria ◽  
Everyday Clinical Practice ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting ◽  
Asymptomatic Disease ◽  
Periprocedural Stroke

Despite a number of randomized trials, debate continues about the role of carotid angioplasty and stenting (CAS) for both symptomatic and asymptomatic disease. None of the trials has shown superiority of one treatment modality over the other, but protagonists of stenting have encouraged a shift away from conventional surgery. The minimally invasive nature of CAS is appealing, but concerns have been raised about the periprocedural stroke rate in the randomized trials. To counter this evidence, there are increasing numbers of registries and series, many partly or wholly sponsored by the endovascular industry, some of which demonstrate reasonable results. These need to be studied with caution, as patients deemed high risk of carotid endarterectomy may actually be at very low risk of stroke. Furthermore, strict inclusion and exclusion criteria mean that results may not be a true reflection of everyday clinical practice. The aim of this review is to document the evidence to date, predominantly from the randomized trials, for both symptomatic and asymptomatic carotid disease and establish the current role of carotid stenting.

Periprocedural risk and long-term outcome of intracranial angioplasty based on a single-centre experience

VASA ◽  
2013 ◽  
Vol 42 (4) ◽  
pp. 264-274
Author(s):  
Dagmar Krajíčková ◽  
Antonín Krajina ◽  
Miroslav Lojík ◽  
Martina Mulačová ◽  
Martin Vališ
Keyword(s):  
Death Rate ◽  
Long Term Outcomes ◽  
Single Centre ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis ◽  
Angioplasty And Stenting ◽  
Aggressive Medical Management ◽  
Stroke Death

Background: Intracranial atherosclerotic stenosis is a major cause of stroke and yet there are currently no proven effective treatments for it. The SAMMPRIS trial, comparing aggressive medical management alone with aggressive medical management combined with intracranial angioplasty and stenting, was prematurely halted when an unexpectedly high rate of periprocedural events was found in the endovascular arm. The goal of our study is to report the immediate and long-term outcomes of patients with ≥ 70 % symptomatic intracranial atherosclerotic stenosis treated with balloon angioplasty and stent placement in a single centre. Patients and methods: This is a retrospective review of 37 consecutive patients with 42 procedures of ballon angioplasty and stenting for intracranial atherosclerotic stenosis (≥ 70 % stenosis) treated between 1999 and 2012. Technical success (residual stenosis ≤ 50 %), periprocedural success (no vascular complications within 72 hours), and long-term outcomes are reported. Results: Technical and periprocedural success was achieved in 90.5 % of patients. The within 72 hours periprocedural stroke/death rate was 7.1 % (4.8 % intracranial haemorrhage), and the 30-day stroke/death rate was 9.5 %. Thirty patients (81 %) had clinical follow-up at ≥ 6 months. During follow-up, 5 patients developed 6 ischemic events; 5 of them (17 %) were ipsilateral. The restenosis rate was 27 %, and the retreatment rate was 12 %. Conclusions: Our outcomes of the balloon angioplasty/stent placement for intracranial atherosclerotic stenosis are better than those in the SAMMPRIS study and compare favourably with those in large registries and observational studies.

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