Carotid Artery Stenting Before CABG: A Better Alternative to Treat Concomitant Coronary and Carotid Artery Disease

Carotid artery atherosclerotic disease impacts over 2 million Americans annually. Since the advent of the carotid endarterectomy by Debakey in 1953, the surgical management of carotid artery stenosis has prevented cerebrovascular accidents. The technology utilized to manage carotid artery stenosis continued to evolve with the utilization of carotid artery stenting in 1989 and more recently transcarotid artery revascularization (TCAR). This review discusses the modern management of carotid artery stenosis with an emphasis on transcarotid artery revascularization (TCAR) and reversal of flow for reversal of flow for embolic protection.

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Carotid artery stenting in occlusive carotid artery disease: An appraisal

Neurology India ◽

10.4103/0028-3886.273616 ◽

2019 ◽

Vol 67 (6) ◽

pp. 1429

Author(s):

KamleshSingh Bhaisora ◽

Suyash Singh ◽

KuntalKanti Das

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Carotid Artery Disease ◽

Artery Disease

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COMPARISON OF CAROTID ARTERY STENTING IN PATIENTS WITH SINGLE VERSUS BILATERAL CAROTID ARTERY DISEASE AND FACTORS AFFECTING OUTCOME

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(11)61957-8 ◽

2011 ◽

Vol 57 (14) ◽

pp. E1957

Author(s):

Josef Veselka ◽

Petra Zimolova ◽

Lucie Martinkovicova ◽

Miloslav Spacek ◽

Jiri Fiedler ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Carotid Artery Disease ◽

Factors Affecting ◽

Bilateral Carotid ◽

Artery Disease ◽

Single Versus ◽

Bilateral Carotid Artery

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Selection of Treatment for Patients with Carotid Artery Disease: Medication, Carotid Endarterectomy, or Carotid Artery Stenting

Vascular ◽

10.2310/6670.2005.00057 ◽

2005 ◽

Vol 13 (02) ◽

pp. 92

Author(s):

Marc Bosiers ◽

Patrick Peeters ◽

Koen Deloose ◽

Jürgen Verbist ◽

L. Richard Sprouse

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenting ◽

Carotid Artery Disease ◽

Artery Disease ◽

Selection Of

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Abstract WP28: Long-Term Outcome of Carotid Artery Stenting in Patients of Atherosclerotic Carotid Artery Disease : A 10-year Experience of a Single Tertiary Center in Korea

Stroke ◽

10.1161/str.44.suppl_1.awp28 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Chang-Hun Kim ◽

Wi-Sun Ryu ◽

Mi-Young Oh ◽

Seung-Hoon Lee ◽

Hyun-Seung Kang ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Carotid Artery Disease ◽

Asian Population ◽

Long Term Results ◽

Term Outcome ◽

Long Term Outcome ◽

Tertiary Center ◽

Artery Disease

Background & Objective Considering an increasing incidence of carotid artery disease in Asian subjects, the data showing long-term outcome of carotid artery stenting(CAS) from Asian population is mandatory. However, long-term outcome of CAS in Asian population have rarely been reported. The purpose of this study is to evaluate long-term results of CAS from the 10-year experience of a single center. Methods Patients undergoing CAS between May 2002 and May 2012 in our hospital were retrospectively reviewed. We abstracted demographic, clinical, and medical factors. In addition, plaque characteristics and angiographic factors were also evaluated. Neck CT angiography was followed-up every 6 months after CAS. We investigated the cumulative long-term incidence of carotid restenosis and risk factors for the development of restenosis. Results A total of 262 arteries (248 patients, mean age of 72.1±7.6 years, 81.7% male) were analysed. The degree of mean carotid stenosis was 70.9±17.5%. Symptomatic lesions were 178 (67.9%), and 84 (32.1%) arteries were asymptomatic. Predilatation (97.3%) and post-dilatation (42.4%) was performed during procedures. Embolic protection devices were used in 233 (88.9%) cases. During procedures, In-situ thrombosis with embolic infarction or TIA occurred in 6 (2.3%) and 10 (3.8%) cases, respectively. During a median follow-up time of 27.5 months, restenosis (> 50% stenosis) was detected in 18 (6.9%) of 262 arteries (asymptomatic, 16; symptomatic, 2). Restenotic lesions were treated in 6 (2.3%) cases with angioplasty including 2 symptomatic patients. The percentage of residual stenosis after stenting was significantly related to a risk of restenosis (p<0.02). Discussion Restenosis rate in this study was comparable to those of other single or multi-center trials in Western population. Our long-term results may validate CAS as a durable procedure for stroke prevention in patients with carotid artery stenosis in Korea.

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Selection of Treatment for Patients with Carotid Artery Disease: Medication, Carotid Endarterectomy, or Carotid Artery Stenting

Vascular ◽

10.1258/rsmvasc.13.2.92 ◽

2005 ◽

Vol 13 (2) ◽

pp. 92-97 ◽

Cited By ~ 3

Author(s):

Marc Bosiers ◽

Patrick Peeters ◽

Koen Deloose ◽

Jürgen Verbist ◽

L. Richard Sprouse

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Medical Therapy ◽

Carotid Artery Stenting ◽

Carotid Artery Disease ◽

Limiting Factors ◽

Treatment Modalities ◽

Asymptomatic Patients ◽

Artery Disease ◽

Selection Of

Patients presenting with atherosclerosis of the extracranial carotid arteries may be offered carotid endarterectomy (CEA), carotid artery stenting (CAS), or medical therapy to reduce their risk of stroke. In many cases, the choice between treatment modalities remains controversial. An algorithm based on patients' neurologic symptoms, comorbidities, limiting factors for CAS and CEA, and personal preferences was developed to determine the optimal treatment in each case. This algorithm was then employed to determine therapy in 308 consecutive patients presenting to a single institution during one calendar year. Ninety-five (30.8%) patients presented with an asymptomatic carotid stenosis of more than 80% and 213 (69.2%) with a symptomatic stenosis of more than 50%. According to our algorithm, 59 (62.1%) of the 95 asymptomatic patients received CAS, 20 (21.1%) received CEA, and 16 (16.8%) received medical therapy. All symptomatic patients underwent intervention; 153 (71.8%) were treated with CAS and 60 (28.2%) with CEA. Combined 30-day stroke and death rates after CAS were 1.7% in asymptomatic patients and 2.6% in symptomatic patients. After CEA, these rates were 0% and 3.3%, respectively. Careful selection of treatment modality according to predetermined criteria can result in improved outcomes.

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The Role of White Matter Damage in the Risk of Periprocedural Diffusion-Weighted Lesions after Carotid Artery Stenting

Cerebrovascular Diseases Extra ◽

10.1159/000452717 ◽

2017 ◽

Vol 7 (1) ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Paola Maggio ◽

Claudia Altamura ◽

Domenico Lupoi ◽

Matteo Paolucci ◽

Riccardo Altavilla ◽

...

Keyword(s):

White Matter ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Carotid Artery Disease ◽

Restricted Diffusion ◽

Common Finding ◽

White Matter Damage ◽

Lesion Load ◽

Diffusion Weighted ◽

Artery Disease

Background: White matter hyperintensities (WMH) are a common finding in aged individuals affected by carotid artery disease and are a risk factor for first-ever and recurrent stroke. We investigated if white matter damage increases the risk of brain microembolism during carotid artery stenting (CAS), as evaluated by the appearance of new areas of restricted diffusion on diffusion-weighted images (DWI). Methods: We evaluated 47 patients with severe internal carotid artery (ICA) stenosis undergoing CAS, comparing preprocedural clinical, ultrasound and radiological characteristics. WMH volume was computed on FLAIR images before CAS. After CAS, the DWI scan was looked over for areas of restricted diffusion (DWI lesions). A first univariate analysis was adopted to compare groups according to the occurrence of DWI lesions. Then, the variable DWI lesion was modelled by means of a logistic regression model. Results: Seventeen patients developed at least 1 DWI lesion after CAS. Compared with non-DWI, DWI patients were more commonly treated in the left ICA (p = 0.007) and had a more severe WMH damage (p = 0.027). Indeed, the risk of a DWI lesion was higher in left versus right stenosis (OR = 9.0, 95% CI 1.9-42.7, p = 0.005) and increased for each log-unit of WMH lesion load (OR = 7.05, 95% CI 1.07-46.49, p = 0.042). A WMH lesion load of at least 5.25 cm3 had a 50% probability of occurrence of a new DWI lesion. Conclusions: Treated side and preexisting white matter damage are risk conditions for brain microembolism during CAS. This should be taken into account to optimize severe carotid artery disease management.

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