scholarly journals Safety Outcomes Using a Proximal Protection Device in Carotid Stenting of Long Carotid Stenoses

2016 ◽  
Vol 5 (3-4) ◽  
pp. 123-130 ◽  
Author(s):  
Kunakorn Atchaneeyasakul ◽  
Priyank Khandelwal ◽  
Sudheer Ambekar ◽  
Kevin Ramdas ◽  
Luis Guada ◽  
...  

Background: Embolic protection devices can prevent atherosclerotic emboli during carotid stenting. Newer proximal protection devices reverse flow in the internal carotid artery (ICA), leading to reduction in perioperative microemboli. The risk of stroke is high for carotid stenting of ICA lesions with a length >10 mm and/or angiographic string sign. Objective: We aimed to evaluate the safety outcomes of proximal embolic protection device usage in this high-risk group. Methods: This is a retrospective analysis of patients who underwent carotid stenting procedures with proximal embolic protection devices at a tertiary care center. High-risk features for adverse events with carotid stenting were identified. Peri- and postprocedural outcomes were recorded. We further compared outcomes in patients with a carotid stenosis length >10 mm to those with shorter stenosis. Results: From January 2011 to December 2014, we included 27 patients; 96.3% were symptomatic and 3.7% were asymptomatic. There was a stent placement technical success rate of 100%. No major stroke or coronary events were recorded. One minor stroke event developed in one patient. A carotid lesion length >10 mm and/or angiographic string sign was noted in 21/27 patients, with an average lesion length of 14.4 mm. One patient (4.8%) in this group developed a minor stroke event. Neither a coronary nor a major stroke event was recorded in this group. There was no significant difference in the complication rate between the long lesion and the control group. Conclusion: In our patient cohort, it was found that a proximal embolic protection device is safe for patients with carotid stenosis, including those with a carotid lesion length >10 mm and/or angiographic string sign.

2018 ◽  
Vol 4 (02) ◽  
pp. 057-064
Author(s):  
Pankaj Banode ◽  
Ashutosh Kharche

Abstract Objectives To assess the use of proximal protection devices in consecutive patients as the preferred means of cerebral embolic protection for primary carotid stenting. Methods and Results This was a prospective single-center study to evaluate the technical and clinical success of proximal protection devices as the first choice for embolic protection in symptomatic (≥ 50%) and asymptomatic (≥ 70%) carotid stenosis. Proximal protection devices were used for embolic protection in 115 consecutive patients. No patients were excluded for anatomical reasons. The filter used was of diameters 6 mm in all cases (Emboshield NAV filter device, Abbotts Healthcare Pvt. Ltd. [Lake Bluff, Il]). In all cases, self-expanding closed-cell designed stent was used (X-act closed-cell self-expanding nitinol carotid-tapered stent, Abbotts Healthcare Pvt. Ltd.). Plaque characterization was done by using real-time high-resolution ultrasound (HR USG) equipment (Aloka Prosound Alpha 7 [Chiyoda, Tokyo, Japan]) using high-frequency linear transducers (> 7 MHz). Follow-up duration was 30 days. Mean age was 61.9 ± 8.27 years. There was male predominance observed in study accounting for 73 out of total 115 studied population. Fifty-six of 115 (48.89%) treated stenoses were symptomatic. Technical success was achieved in 115 of 115 (100%) cases. In both the cases, additional distal filter devices were used. Carotid stenting was successful in 115 (100%) lesions. This study observed higher number of debris in symptomatic and high-risk plaques. This study also observed higher sensitivity, specificity, and accuracy of updated classification for assessing risk of microembolism (captured debris) (sensitivity 73.91%, specificity 95.65%, positive predictive value [PPV] 91.89%, negative predictive value [NPV] 84.62%, accuracy 86.95%). In our study, minor stroke was seen in three (2.61%) patients within 48 hours, and no adverse events were seen within 48 hours to 1 month. Conclusion Proximal protection is a safe method as the first choice for embolic protection. It can be used with a high rate of technical success.


2017 ◽  
Vol 10 (12) ◽  
pp. 1257-1265 ◽  
Author(s):  
Christoph Knappich ◽  
Andreas Kuehnl ◽  
Pavlos Tsantilas ◽  
Sofie Schmid ◽  
Thorben Breitkreuz ◽  
...  

2012 ◽  
Vol 63 (3_suppl) ◽  
pp. S18-S22 ◽  
Author(s):  
Nandavar Shobha ◽  
Mohammed A. Almekhlafi ◽  
Anjali Pandya ◽  
Philippe L. Couillard ◽  
William F. Morrish ◽  
...  

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.


2012 ◽  
Vol 80 (1) ◽  
pp. 112-119 ◽  
Author(s):  
Jan Van der Heyden ◽  
Frank J. Wolters ◽  
Nathalie Garin ◽  
Snezana Andrejevic Blant ◽  
Marc Inglin ◽  
...  

2020 ◽  
Vol 76 (17) ◽  
pp. B158-B159
Author(s):  
José Sousa ◽  
Luís Puga ◽  
Luís Paiva ◽  
Joana Silva ◽  
Marco Costa ◽  
...  

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