Reduction of cerebral DWI lesion burden after carotid artery stenting using the CASPER stent system

IntroductionDespite various measures to protect against distal embolization during carotid artery stenting (CAS), periprocedural ischemic lesions are still encountered.ObjectiveTo evaluate the periprocedural cerebral diffusion weighted imaging (DWI) lesion burden after CASPER stent placement.MethodsPatients who underwent CAS using the CASPER stent system were reviewed. Degrees of carotid stenosis and plaque configuration were determined. All patients were pretreated with dual antiplatelet agents and cerebral pre- and postprocedural MRI was obtained. All CAS procedures were performed by a single operator.ResultsA total of 110 patients with severe carotid artery stenosis (median degree of stenosis 80%, median length of stenosis 10 mm) were treated with CAS. Hypoechogenic or heterogeneous, mostly hypoechogenic, plaques were documented in 48.6% (52/107) of patients. Carotid ulceration was present in 15.9% (17/107). Postprocedurally, 7.3% (8/110) of patients were found to have ischemic DWI lesions. They were asymptomatic in all patients. Follow-up at 90 days was available in 88.2% (97/110) of patients with excellent functional outcome (modified Rankin Scale score 0–1) in 95.9% (93/97).ConclusionCarotid artery stenting using the new CASPER stent in combination with a distal embolic protection device is safe and results in a lower rate of periprocedural DWI lesion burden compared with reported results for historic controls.

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Carotid artery stenting in a single center, single operator, single type of device and 15 years of follow-up

CVIR Endovascular ◽

10.1186/s42155-018-0008-2 ◽

2018 ◽

Vol 1 (1) ◽

Cited By ~ 1

Author(s):

Victoria Mayoral Campos ◽

José Andrés Guirola Órtiz ◽

Carlos Tejero Juste ◽

María José Gimeno Peribáñez ◽

Carolina Serrano ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Single Type ◽

Single Center ◽

Single Operator

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Carotid Artery Stenting Without Embolic Protection Device: A Single-Center Experience

Journal of Endovascular Therapy ◽

10.1177/1526602818816656 ◽

2018 ◽

Vol 26 (1) ◽

pp. 121-127 ◽

Cited By ~ 2

Author(s):

Luca Garriboli ◽

Gianguido Pruner ◽

Tommaso Miccoli ◽

Andrea Recchia ◽

Paolo Tamellini ◽

...

Keyword(s):

Myocardial Infarction ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Secondary Outcome ◽

Protection Device ◽

Safety And Efficacy ◽

Embolic Protection Device ◽

Embolic Protection ◽

Ica Stenosis

Purpose: To evaluate the safety and efficacy of carotid artery stenting (CAS) performed without an embolic protection device (EPD) in a selected group of asymptomatic patients with primary internal carotid artery (ICA) stenosis or restenosis after carotid endarterectomy (CEA). Materials and Methods: Between May 2015 and May 2018, 77 patients (mean age 77 years; 60 men) underwent CAS without any embolic protection device. Forty-seven (61%) patients had primary ICA stenosis and were excluded from CEA because of high surgical risk; the other 30 (39%) patients had post-CEA restenosis (n=26) or a distal ICA flap after eversion CEA (n=4). The mean ICA stenosis was 82%. All procedures were performed from a femoral artery access. Pre- and/or postdilation were used in 64 patients. The primary outcome was the incidence of major complications (death, stroke, or myocardial infarction) during the procedure and within 30 days; the secondary outcome was the incidence of restenosis in follow-up. Results: No relevant bradycardia was encountered during CAS. The combined rate of stroke, death, or myocardial infarction at 30 days was 1.3%. The single stroke patient recovered fully after 2 months. Over a follow-up that ranged to 3 years (mean 24±18 months), no further neurological events were recorded. One (1.3%) patient had a >70% restenosis after 6 months; the lesion was dilated, successfully restoring the lumen contour. Conclusion: In our series, endovascular treatment of carotid stenosis without the use of protection devices in patients with primary stenosis or postsurgical restenosis can achieve satisfactory safety and efficacy outcomes. The choice of performing CAS without using EPDs should follow a tailored approach based on the appropriate patient anatomy and specific clinical parameters to minimize neurological complications.

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Efficacy of Carotid Artery Stenting

Interventional Neuroradiology ◽

10.1177/15910199070130s113 ◽

2007 ◽

Vol 13 (1_suppl) ◽

pp. 94-99

Author(s):

H. Sato ◽

K. Matsuo ◽

H. Miwa ◽

T. Hirohata ◽

M. Kohno ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Transluminal Angioplasty ◽

Transfemoral Approach ◽

Stenotic Lesion ◽

Balloon Catheters ◽

Stent System ◽

Number Of Patients ◽

Long Term Follow Up

Carotid Artery Stenting(CAS) was performed for 51 lesions in 46 patients for almost clinically symptomatic stenotic (>70%)lesions of cervical carotid arteries. The lesions involved the contralateral occlusion cases in eight cases, the bilateral stenotic cases in six cases and the ipsilateral internal carotid artery stenotic cases in two cases. In all cases, endovascular technique was performed from a transfemoral approach under local anesthesia primarily. Under systemic heparinization, CAS was performed using a self-expanding stent system. For the pre-stenting and post-stenting dilatation, percutaneous transluminal angioplasty (PTA) balloon catheters were used. The balloon was inflated up to the pressure of six to ten atoms for 20 to 30 seconds. After CAS, stenotic lesion dilated successfully in all cases (0–20% residual stenosis; mean, 5.5%) even if in the case of the contra-lateral occlusion cases, more than 90% severe stenotic cases, and the tortuous artery cases. The cerebral protection system was always used, mainly distal blocking balloon type. Only one symptomatic complication occurred after CAS. Follow-up ultrasonic carotid echogram was performed in 30 cases. No cases showed restenosis (more than 50% restenosis). Clinical follow up was performed in all cases for one to 41 months (mean, 15.2 months) and no clinical deterioration such as TIA or stroke occurred. CAS is technically feasible and can be performed with relatively low morbidity even if complicated stenotic cases. It may be useful, but the increase the number of patients and the long-term follow-up are necessary to evaluate the safety and usefulness of this method.

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External carotid artery stenting in patients with ipsilateral internal carotid artery occlusion: Peri‐operative and 12‐month follow‐up

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.29563 ◽

2021 ◽

Author(s):

Hui Dong ◽

Xiongjing Jiang ◽

Yubao Zou ◽

Yang Chen ◽

Jining He ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Artery Stenting ◽

Internal Carotid ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

External Carotid Artery ◽

Internal Carotid Artery Occlusion ◽

External Carotid

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Carotid artery stenting and follow-up: Value of 64-MSCT angiography as complementary imaging method to color-coded duplex sonography

European Journal of Radiology ◽

10.1016/j.ejrad.2010.12.007 ◽

2012 ◽

Vol 81 (1) ◽

pp. 89-94 ◽

Cited By ~ 11

Author(s):

Richard Nolz ◽

Andreas Wibmer ◽

Dietrich Beitzke ◽

Stephan Gentzsch ◽

Andrea Willfort-Ehringer ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Duplex Sonography ◽

Imaging Method ◽

Color Coded Duplex Sonography ◽

Msct Angiography

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Abstract P540: Safety of Carotid Artery Stenting Without Embolic Protection: A Single Centre Experience

Stroke ◽

10.1161/str.52.suppl_1.p540 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Christine Hawkes ◽

Aviraj Deshmukh ◽

Brian van Adel

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Atheromatous Plaque ◽

Stroke Rate ◽

Protection Device ◽

Single Centre ◽

Stent Occlusion ◽

Embolic Protection Device ◽

Embolic Protection

Introduction: One of the most feared complications of carotid revascularization, including carotid artery stenting (CAS), is peri-procedural ischemic stroke. Several studies suggest that the use of a distal embolic protection device (EPD), as well as over-sized pre- and post-stenting balloon angioplasty, may increase the risk of dislodgement of atheromatous plaque in patients undergoing CAS. The CREST trial, that mandated the use of an EPD, had a peri-procedural ischemic stroke rate of 4.1%. We hypothesize that our technique of stenting without the use of an EPD and sub-maximal angioplasty will have a low risk of peri-procedural complications. Methods: A retrospective review was conducted of consecutive cases of ICA stenting without use of an embolic protection device between January 2012 and June 2020 at a Canadian stroke centre. Data was extracted from the patient electronic medical record and Picture Archives and Communications Systems (PACS). Both symptomatic and asymptomatic CAS cases were included. Results: A total of 220 patients were included in the study, with a median age of 70 years (range 39-93 years), and 83 patients (38%) were female. The vast majority of patients were symptomatic (216 patients [98%]). A large portion of patients had a contralateral ICA occlusion or near occlusion (56 patients [25%]). In the majority of cases, a Precise Cordis RX carotid stent (Cordis) was placed. There were four patients with peri-procedural ischemic strokes (1.8%), with two occurring 8-30 days after stenting. There was one case of acute stent occlusion associated with an ischemic stroke. Two patients (less than 1%) had hyperperfusion syndrome after CAS. Median length of stay following the procedure was one day. Conclusions: In this single centre series, the peri-procedural risks of CAS without using an EPD are low. The ischemic stroke rate is less than 2%, lower than what has been reported in large randomized controlled trials using embolic protection.

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