Is Carotid Artery Stent Placement a Viable Option for Carotid Artery Stenosis in Patients Aged 80 years or Greater?

BackgroundStroke due to the release of embolic debris during the placement of a stent to correct carotid artery stenosis is a constant procedural and peri-procedural threat. The new all metal Casper stent has been created with two layers of nitinol, the inner layer of which has pores diminutive enough to prevent embolic release.ObjectiveTo evaluate the safety, effectiveness, and utility of the double layer nitinol Casper carotid artery stent in the treatment of patients with severe carotid artery stenosis.Methods19 patients with severe internal carotid artery stenosis, 14 symptomatic and 5 asymptomatic, were treated with the Casper stent. After stent placement, angiographic and cone beam CT images were recorded in all patients.ResultsThe unique low profile delivery system allowed for easy stent placement, re-sheathing, and repositioning of the stent. The large cell external layer produced excellent apposition to the artery wall. The inner layer prevented prolapse of atherosclerotic debris through the device. Plaque coverage was achieved; residual stenosis ranged from 0% to 20%. Long term angiographic follow-up in 5 patients showed wall apposition of the device covering the lesion and no restenosis. There were no procedure related complications. Two patients experienced a delayed ischemic stroke, likely related to inconsistent medical management.ConclusionsThe Casper has been an excellent stent for the treatment of internal carotid artery stenosis and its internal micromesh layer has been effective in preventing plaque prolapse. It provides the flexibility of large cell stents and the inner layer provides maximum protection against plaque prolapse.

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Carotid Stenting

Radial Access for Neurointervention ◽

10.1093/med/9780197524176.003.0008 ◽

2021 ◽

pp. 69-76

Author(s):

Omaditya Khanna ◽

Nikolaos Mouchtouris ◽

Eric C. Peterson ◽

Pascal M. Jabbour

Keyword(s):

Carotid Artery ◽

Radial Artery ◽

Stent Placement ◽

Carotid Artery Stenosis ◽

Large Scale ◽

Treatment Options ◽

Carotid Stenting ◽

Artery Stenosis ◽

Carotid Artery Stent ◽

Recovery Times

Several large-scale studies have corroborated the indications for carotid artery revascularization in patients who present with carotid artery stenosis. The two treatment options are carotid endarterectomy and carotid artery stent, both of which show equipoise in outcomes, and although the latter is associated with increased risk of periprocedural stroke, it confers the benefit of shorter procedural and recovery times. Currently, radial artery access is rarely used for placement of carotid artery stents, both among neurosurgeons and vascular surgeons. However, radial artery access for carotid stent placement has been shown to be safe and efficacious, and it confers the benefit of reduced access-site complications and improved patient satisfaction measures. In this chapter, aimed at practitioners who would like to incorporate radial artery access into their clinical practice, we review the evaluation and management of carotid artery stenosis and present an operative technique for carotid artery stent placement via radial artery access.

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An Ultrasound Model to Predict the Short-Term Effects of Endovascular Stent Placement in the Treatment of Carotid Artery Stenosis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2020.607367 ◽

2021 ◽

Vol 7 ◽

Author(s):

Sheng-Jiang Chen ◽

Rui-Rui Liu ◽

Yi-Ran Shang ◽

Yu-Juan Xie ◽

Xiao-Han Guo ◽

...

Keyword(s):

Carotid Artery ◽

Stent Placement ◽

Carotid Artery Stenosis ◽

Resistance Index ◽

Peak Systolic Velocity ◽

Artery Stenosis ◽

Endovascular Stent ◽

Improvement Rate ◽

Preoperative Ultrasound ◽

Endovascular Stent Placement

Purpose: The present study aimed to explore the predictive ability of an ultrasound linear regression equation in patients undergoing endovascular stent placement (ESP) to treat carotid artery stenosis-induced ischemic stroke.Methods: Pearson's correlation coefficient of actual improvement rate (IR) and 10 preoperative ultrasound indices in the carotid arteries of 64 patients who underwent ESP were retrospectively analyzed. A predictive ultrasound model for the fitted IR after ESP was established.Results: Of the 10 preoperative ultrasound indices, peak systolic velocity (PSV) at stenosis was strongly correlated with postoperative actual IR (r = 0.622; P < 0.01). The unstable plaque index (UPI; r = 0.447), peak eccentricity ratio (r = 0.431), and plaque stiffness index (β; r = 0.512) moderately correlated with actual IR (P < 0.01). Furthermore, the resistance index (r = 0.325) and the dilation coefficient (r = 0.311) weakly correlated with actual IR (P < 0.05). There was no significant correlation between actual IR and the number of unstable plaques, area narrowing, pulsatility index, and compliance coefficient. In combination, morphological, hemodynamic, and physiological ultrasound indices can predict 62.39% of neurological deficits after ESP: fitted IR = 0.9816 – 0.1293β + 0.0504UPI – 0.1137PSV.Conclusion: Certain carotid ultrasound indices correlate with ESP outcomes. The multi-index predictive model can be used to evaluate the effects of ESP before surgery.

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Contralateral High-Grade Carotid Artery Stenosis or Occlusion Is Not Associated with Increased Risk for Poor Neurologic Outcome after Elective Carotid Stent Placement

Radiology ◽

10.1148/radiol.2301021371 ◽

2004 ◽

Vol 230 (1) ◽

pp. 70-76 ◽

Cited By ~ 31

Author(s):

Schila Sabeti ◽

Martin Schillinger ◽

Wolfgang Mlekusch ◽

Tassilo Nachtmann ◽

Wilfried Lang ◽

...

Keyword(s):

Carotid Artery ◽

Stent Placement ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Neurologic Outcome ◽

High Grade ◽

Carotid Stent ◽

Increased Risk

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Snare-Assisted Trans-Brachial Stenting for the Cervical Internal Carotid Artery Stenosis of Patient with Aorto-Iliac Occlusion

Interventional Neuroradiology ◽

10.1177/15910199060120s141 ◽

2006 ◽

Vol 12 (1_suppl) ◽

pp. 221-228

Author(s):

H. Oowaki ◽

N Matsuura ◽

M. Ishikawa

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Stent Placement ◽

Carotid Artery Stenosis ◽

Internal Carotid ◽

Internal Carotid Artery Stenosis ◽

Artery Stenosis ◽

Femoral Access ◽

Cervical Internal Carotid Artery ◽

Iliac Occlusion

We describe a case of endo-luminal stent placement with Snare-assist for a cervical internal carotid artery stenosis in which percutaneous access was obtained via the brachial artery. A 68-year-old man with known disease of the carotid, peripheral, and coronary arteries, with Human T-cell Lymphotrophic Virus type-1 (HTLV-1) Associated Myelopathy (HAM) presented for endoluminal revascularization of a severe, progressive right internal carotid artery stenosis, but with aorto-iliac occlusion. Transfemoral access was complicated by an aorto-iliac occlusion. A trans-brachial approach was successfully attempted, and a SMARTer stent (Cordis Endovascular, Miami Lakes, FL) was successfully placed through a 7-French Shuttle-SL guide sheath (Cook, Bloomington) under Snare-assist. The trans-brachial approach is becoming an increasingly viable alternative route for stent placement in patients with contra-indicated or complicated femoral access routes. As devices become increasingly more pliable and smaller, the trans-brachial route will be used with increasing frequency in the select patient population for stenting of both the cervical and intracranial circulation.

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Follow-up Results of Stent Placement for Extracranial Carotid Artery Stenosis

Korean Circulation Journal ◽

10.4070/kcj.1998.28.11.1820 ◽

1998 ◽

Vol 28 (11) ◽

pp. 1820

Author(s):

Young-Sup Yoon ◽

Bum-Kee Hong ◽

Dong-Hoon Choi ◽

Sun-Ho Kim ◽

Dong-Ik Kim ◽

...

Keyword(s):

Carotid Artery ◽

Stent Placement ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Extracranial Carotid Artery

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Glioblastoma multiform with ipsilateral carotid artery stenosis: carotid artery stent promote tumor growth?

World Journal of Surgical Oncology ◽

10.1186/s12957-016-0782-z ◽

2015 ◽

Vol 14 (1) ◽

Author(s):

Ziqi Xu ◽

Benyan Luo ◽

Qidong Wang ◽

Zhiyi Peng ◽

Hui Liang

Keyword(s):

Carotid Artery ◽

Tumor Growth ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Glioblastoma Multiform ◽

Carotid Artery Stent ◽

Promote Tumor Growth

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Effects of Carotid Artery Stent and Carotid Endarterectomy on Cognitive Function in Patients with Carotid Stenosis

BioMed Research International ◽

10.1155/2020/6634537 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Pan Huang ◽

Xiao-ying He ◽

Min Xu

Keyword(s):

Cognitive Function ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Stent Implantation ◽

Carotid Artery Stenosis ◽

Mmse Score ◽

Artery Stenosis ◽

Carotid Artery Stent ◽

Significant Difference ◽

Moca Score

Background. Carotid artery stenosis is closely related to cognitive dysfunction, in which decreased cerebral perfusion is one of the important factors. Both carotid artery stent implantation and carotid endarterectomy can relieve stenosis and increase cerebral perfusion. In this study, we aimed to compare the effects of carotid artery stent implantation and endarterectomy on cognitive function. Methods. A total of 98 patients with carotid artery stenosis hospitalized in our hospital from July 2015 to January 2017 were included. Among them, 50 cases underwent carotid artery stent implantation treatment as stent implantation group (CAS group), and 48 cases underwent carotid artery endarterectomy treatment as carotid endarterectomy group (CEA group). Using the Mini-Mental State Examination Scale (MMSE Scale) and the Montreal Cognitive Assessment Scale (MoCA Scale), the cognitive function scores of the two groups of patients before and after 3 and 6 months of operation were measured, and the patients were also measured before and after surgery, after the serum NSE, hs-CRP content. Results. The serum NSE, hs-CRP content, MMSE score, and MoCA score of the two groups before treatment were not statistically significant ( P > 0.05 ). The MMSE score and MoCA score of the two groups of patients before treatment were lower than the normal value, suggesting carotid artery stenosis combined with different degrees of cognitive dysfunction. Carotid artery stenosis is different, and patients’ cognitive function is also different. The MMSE score and MoCA score of the two groups at 3 and 6 months after operation were higher than before treatment, and there was a statistically significant difference between 6 and 3 months after operation ( P < 0.05 ), but at each time There was no statistically significant difference between the two groups ( P > 0.05 ). The NSE content of the two groups of patients after operation decreased compared with that before treatment, and the decrease in 6 months after operation was more obvious than that in March ( P < 0.05 ). However, the difference between the two groups at each time point was not statistically significant ( P > 0.05 ). The content of hs-CRP in the two groups of patients was higher than that before the operation, and the CAS group was significantly higher than the CEA group; the difference was statistically significant ( P < 0.05 ). Conclusion. Carotid artery stent and carotid endarterectomy are effective in improving the cognitive function of patients with carotid stenosis, but there is no significant difference between the two.

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Snare-Assisted Trans-brachial Stenting for the Cervical Internal Carotid Artery Stenosis of Patient with Aorto-Iliac Occlusion

Rivista di Neuroradiologia ◽

10.1177/197140099500800641 ◽

1995 ◽

Vol 8 (6) ◽

pp. 221-228

Author(s):

H. Oowaki ◽

N Matsuura ◽

M. Ishikawa

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Stent Placement ◽

Carotid Artery Stenosis ◽

Internal Carotid ◽

Internal Carotid Artery Stenosis ◽

Artery Stenosis ◽

Femoral Access ◽

Cervical Internal Carotid Artery ◽

Iliac Occlusion

We describe a case of endo-luminal stent placement with Snare-assist for a cervical internal carotid artery stenosis in which percutaneous access was obtained via the brachial artery. A 68-year-old man with known disease of the carotid, peripheral, and coronary arteries, with Human T-cell Lymphotrophic Virus type-1 (HTLV-1) Associated Myelopathy (HAM) presented for endoluminal revascularization of a severe, progressive right internal carotid artery stenosis, but with aorto-iliac occlusion. Transfemoral access was complicated by an aorto-iliac occlusion. A trans-brachial approach was successfully attempted, and a SMARTer stent (Cordis Endovascular, Miami Lakes, FL) was successfully placed through a 7-French Shuttle-SL guide sheath (Cook, Bloomington) under Snare-assist. The trans-brachial approach is becoming an increasingly viable alternative route for stent placement in patients with contra-indicated or complicated femoral access routes. As devices become increasingly more pliable and smaller, the trans-brachial route will be used with increasing frequency in the select patient population for stenting of both the cervical and intracranial circulation.

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Percutaneous transluminal angioplasty and stent placement for recurrent carotid artery stenosis

Journal of Neurosurgery ◽

10.3171/jns.1999.90.4.0688 ◽

1999 ◽

Vol 90 (4) ◽

pp. 688-694 ◽

Cited By ~ 94

Author(s):

Giuseppe Lanzino ◽

Robert A. Mericle ◽

Demetrius K. Lopes ◽

Ajay K. Wakhloo ◽

Lee R. Guterman ◽

...

Keyword(s):

Carotid Artery ◽

Stent Placement ◽

Carotid Artery Stenosis ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Artery Stenosis ◽

Content Type ◽

Percutaneous Transluminal ◽

Fine Print

Object. Treatment consisting of percutaneous transluminal angioplasty (PTA) and stent placement has recently been proposed as an alternative to surgical reexploration in patients with recurrent carotid artery stenosis following endarterectomy. The authors retrospectively reviewed their experience after performing 25 procedures in 21 patients to assess the safety and efficacy of PTA with or without stent placement for carotid artery restenosis.Methods. The mean interval between endarterectomy and the endovascular procedures was 57 months (range 8–220 months). Seven arteries in five patients were treated by PTA alone (including bilateral procedures in one patient and repeated angioplasty in the same vessel in another). Early suboptimum results and recurrent stenosis in some of these initial cases prompted the authors to combine PTA with stent placement in the treatment of 18 arteries over the past 3 years. No major periprocedural deficits (neurological or cardiac complications) or death occurred. There was one periprocedural transient neurological event, and in one patient a pseudoaneurysm of the femoral artery (at the access site) required surgical repair. In the 16 patients who each underwent at least 6 months of follow-up review, no neurological events ipsilateral to the treated artery had occurred after a mean follow-up period of 27 months (range 6–57 months). Three of five patients who underwent PTA alone developed significant (> 50%) asymptomatic restenoses that required repeated angioplasty in one and PTA with stent placement in two patients. Significant restenosis (55%) was observed in only one of the vessels treated by combined angioplasty and stent placement.Conclusions. Endovascular PTA and stenting of recurrent carotid artery stenosis is both technically feasible and safe and has a satisfactory midterm patency. This procedure can be considered a viable alternative to surgical reexploration in patients with recurrent carotid artery stenosis.

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