Abstract 66: Predictors of Vascular Events or Death within One Year of Carotid Artery Stenting: Investigation on Devices and Anti-platelet Therapy for Carotid Artery Stenting (IDEALCAST)

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Hiroshi Yamagami ◽  
Nobuyuki Sakai ◽  
Yoshihiro Matsubara ◽  
Yasushi Okada ◽  
Hiroyoshi Yokoi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Primary Endpoint ◽  
Carotid Artery Stenting ◽  
Older Age ◽  
Antiplatelet Drugs ◽  
Vascular Events ◽  
Factors Affecting ◽  
Multivariate Proportional Hazard ◽  
One Year ◽  
Distal Filter

Background and Purpose: Carotid artery stenting (CAS) using distal filter protection device has been approved in April 2008 in Japan. However, factors affecting the development of vascular events and deaths after CAS have not been clarified in our country. The present study was conducted to identify the predictive factors for the development of vascular events or death after CAS. Methods: CAS was indicated for patients with at least one risk factor for carotid endarterectomy and with > 50 % stenosis in symptomatic or > 80% stenosis in asymptomatic carotid arteries. Between June 2008 and June 2010, we enrolled 949 patients who were planning to undergo elective CAS in 43 Japanese centers. Patients were followed at 30days and 12 months after stenting. The primary endpoint was the composite of death, any stroke, transient ischemic attack, myocardial infarction, and serious systemic bleeding. Results: Of the 934 patients (818 men, 72 ± 7 years old) followed for 1 year after stenting, primary endpoint was observed in 109 (11.7%) patients, including 18 (1.9%) deaths, 52 (5.6%) ischemic strokes, 7 (0.8%) hemorrhagic strokes, 16 (1.7%) transient ischemic attacks, 4 (0.4%) myocardial infarctions, and 11 (1.2%) serious systemic bleeding. In a multivariate proportional hazard model, older age (hazard ratio [HR], 1.24 per 5 years; 95% confidence interval [CI], 1.07 to 1.44; P=0.005), history of ischemic stroke (HR, 1.68; 95% CI, 1.10 to 2.62; P=0.015), combination of pre-procedural antiplatelet drugs (P=0.03), usage of diabetes drugs (HR, 1.93; 95% CI, 1.29 to 2.88, P=0.002), femoral artery puncture (HR,0.36; 95% CI 0.18 to 0.80; =0.015), use of guiding catheter system (HR, 1.69; 95% CI 1.08 to 2.71, P=0.021) and use of Angioguard XP in the procedure (HR, 1.92; 95% CI, 1.16 to 3.40, P=0.011) were associated with the development of vascular events or death. Conclusions: In addition to older age and medical history, selection of pre-procedural antiplatelet drugs and procedural devices can predict vascular events or death after CAS.

Comparison of periprocedural and long term outcomes of proximal versus distal cerebral protection method during carotid artery stenting

VASA ◽  
2015 ◽  
Vol 44 (4) ◽  
pp. 297-304 ◽  
Author(s):  
Zeynep Bastug Gul ◽  
Emre Akkaya ◽  
Ertan Vuruskan ◽  
Ozgur Akgul ◽  
Hamdi Pusuroglu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Cerebral Protection ◽  
Protection System ◽  
One Year ◽  
Distal Filter ◽  
Flow Blockage

Abstract. Background: The aim of this study was to assess the periprocedural and one-year outcomes of two different cerebral protection systems used during carotid artery stenting (CAS). Patients and methods: We enrolled 90 consecutive patients with carotid artery stenosis who underwent CAS with a proximal flow blockage protection system (mean age 69.7 ± 8) or distal protection with a filter (mean age 70.8 ± 7). Results: CAS was performed successively on 89 patients (99 %). Adverse events were defined as major stroke, minor stroke, transient ischemic attack (TIA), myocardial infarction, and death. Two strokes, one TIA, one death, and one myocardial infarction were observed in-hospital. There were no significant differences in safety or benefits between the proximal flow blockage embolic protection system (n = 45) and the distal filter protection system (n = 45) in terms of clinically apparent cerebral embolism, TIA, death, or myocardial infarction during the periprocedural stage or during the one-year follow-up period. Conclusions: Although it has been shown that the proximal flow blockage cerebral protection system decreases the risk of silent cerebral embolism, it has no advantage over the distal filter protection system in terms of adverse cerebrovascular or cardiac events during the periprocedural stage or during the long-term follow-up period.

Abstract TP140: Impact of Pre-procedural Antiplatelet Therapy on Vascular Events After Carotid Artery Stenting: Investigation on Devices and Anti-platelet Therapy for Carotid Artery Stenting (IDEALCAST)

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Hiroshi Yamagami ◽  
Nobuyuki Sakai ◽  
Yoshihiro Matsubara ◽  
Yasushi Okada ◽  
Hiroyoshi Yokoi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Antiplatelet Therapy ◽  
Primary Endpoint ◽  
Carotid Artery Stenting ◽  
Controlled Trial ◽  
Antiplatelet Drug ◽  
Vascular Events ◽  
Multicenter Observational Study ◽  
Significant Difference ◽  
History Of

Background and Purpose: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is recommended for a standard pre-procedural management for carotid artery stenting (CAS). However, impact of other pre-procedural antiplatelet drug on vascular events after CAS is still unknown. Methods: In a prospective, multicenter, observational study, we analyzed data from 934 patients underwent elective CAS for > 50 % stenosis in symptomatic or > 80% stenosis in asymptomatic carotid arteries. Data on pre-procedural antiplatelet drugs was obtained at patients’ enrollment, and all patients were followed for 1 year after the stenting. The primary endpoint was the composite of death, any stroke, transient ischemic attack, myocardial infarction, and serious systemic bleeding. Results: Of the 934 patients (818 men, 72 ± 7 years old), 476 patients were treated with aspirin and clopidogrel (51.0%, A+CLP group), 162 with aspirin and cilostazol (17.3%, A+CSZ group), 62 with clopidogrel and cilostazol (6.6%, CLP+CSZ group), 118 with asprin, clopidogrel and cilostazol (12.6%, TAPT group), and 116 with other combinations (12.4%, Other group). As patients background, a history of ischemic stroke was more frequent in A+CSZ and CLP+CSZ groups, and a history of ischemic heart disease or revascularization was more frequent in A+CLP and TAPT groups than in other groups. There was no significant difference in other factors. Incidences of primary endpoint were as follows: 12.6% in A+CLP, 5.6% in A+CSZ, 8.1% in CLP+CSZ, 14.4% in TAPT, and 15.5% in Other group. In multivariate analysis, combination of aspirin and cilostazol was associated with lower risk for primary endpoint compared with aspirin and clopidogrel (hazard ratio, 0.39; 95% confidence interval, 0.18 to 0.75, P=0.004). Conclusions: Combination of aspirin and cilostazol can decrease the risk of vascular events or death after CAS. A prospective randomized controlled trial is necessary to clarify the effect of pre-procedural antiplatelet therapy on vascular events after CAS.

scholarly journals The effect of carotid artery stenting on capillary transit time heterogeneity in patients with carotid artery stenosis

2018 ◽  
Vol 3 (3) ◽  
pp. 263-271 ◽  
Author(s):  
Ethem M Arsava ◽  
Mikkel B Hansen ◽  
Berkan Kaplan ◽  
Ahmet Peker ◽  
Rahsan Gocmen ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Transit Time ◽  
Carotid Artery Stenting ◽  
Cerebral Blood Volume ◽  
Mean Transit Time ◽  
Oxygen Extraction Fraction ◽  
Consecutive Series ◽  
Dynamic Susceptibility ◽  
Dynamic Susceptibility Contrast ◽  
Vascular Events

Introduction Carotid revascularisation improves haemodynamic compromise in cerebral circulation as an additional benefit to the primary goal of reducing future thromboembolic risk. We determined the effect of carotid artery stenting on cerebral perfusion and oxygenation using a perfusion-weighted MRI algorithm that is based on assessment of capillary transit-time heterogeneity together with other perfusion and metabolism-related metrics. Patients and methods A consecutive series of 33 patients were evaluated by dynamic susceptibility contrast perfusion-weighted MRI prior to and within 24 h of the endovascular procedure. The level of relative change induced by stenting, and relationship of these changes with respect to baseline stenosis degree were analysed. Results Stenting led to significant increase in cerebral blood flow ( p < 0.001), and decrease in cerebral blood volume ( p = 0.001) and mean transit time ( p < 0.001); this was accompanied by reduction in oxygen extraction fraction ( p < 0.001) and capillary transit-time heterogeneity ( p < 0.001), but an overall increase in relative capillary transit-time heterogeneity (RTH: CTH divided by MTT; p = 0.008). No significant change was observed with respect to cerebral metabolic rate of oxygen. The median volume of tissue with MTT > 2s decreased from 24 ml to 12 ml ( p = 0.009), with CTH > 2s from 29 ml to 19 ml ( p = 0.041), and with RTH < 0.9 from 61 ml to 39 ml ( p = 0.037) following stenting. These changes were correlated with the baseline degree of stenosis. Discussion: Stenting improved the moderate stage of haemodynamic compromise at baseline in our cohort. The decreased relative transit-time heterogeneity, which increases following stenting, is probably a reflection of decreased functional capillary density secondary to chronic hypoperfusion induced by the proximal stenosis. Conclusion: Carotid artery stenting, is not only important for prophylaxis of future vascular events, but also is critical for restoration of microvascular function in the cerebral tissue.

Embolic protection devices during carotid artery stenting: Is there a difference between proximal occlusion and distal filter?

2015 ◽  
Vol 187 ◽  
pp. 592-593 ◽  
Author(s):  
Giuseppe Gargiulo ◽  
Eugenio Stabile ◽  
Anna Sannino ◽  
Cinzia Perrino ◽  
Bruno Trimarco ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Embolic Protection ◽  
Protection Devices ◽  
Proximal Occlusion ◽  
Distal Filter

scholarly journals TRANSRADIAL AND TRANSFEMORAL ACCESS FOR CAROTID ARTERY STENTING WITH AN EMPHASIS ON THE DETECTION OF MICROEMBOLIZATION WITH DIFFUSION WEIGHTED MAGNETIC RESONANCE IMAGING (TACTILE TRIAL).

2018 ◽  
Vol 7 (3) ◽  
pp. 83-93
Author(s):  
D. U. Malaev ◽  
E. I. Kretov ◽  
V. I. Baystrukov ◽  
R. A. Naidenov ◽  
A. A. Prokhorikhin ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Carotid Artery ◽  
Primary Endpoint ◽  
Carotid Artery Stenting ◽  
Carotid Stenting ◽  
Resonance Imaging ◽  
Diffusion Weighted ◽  
Weighted Magnetic Resonance Imaging ◽  
Procedural Success

Aim. To compare transradial (TR) and transfemoral (TF) approach for carotid artery stenting (CAS) with an emphasis on the detection of micro-embolization with diffusion-weighted magnetic resonance imaging (DW-MRI).Methods. 96 patients were included in the study in the period from January 2015 to October 2017 with further randomized 1 : 1 to the TR and TF groups. The inclusion criteria were the following: symptomatic stenosis ICA >70%; or asymptomatic stenosis ICA >80%. The positive history of stroke, myocardial infarction or open heart surgery <1 month were the exclusion criteria for the study. The primary endpoint was the incidence of new cerebral ischemic lesions as assessed by DW-MRI. All CAS procedures were performed by two experienced operators according to the approved protocol.Results. Procedural success with TR approach was 46 (96%) versus 48 (100%) with TF approach (p = 0.495). Crossover rate was 4% in the TR group. The rate of primary endpoint in the TR and TF groups was 50 and 52%, respectively. The absolute risk difference was -2% (95% CI [-0.21, 0.17], p (non-inferiority) = 0.03). An «on-treatment» analysis revealed a tendency towards a reduced microembolic foci when intervening on the right ICA via TR approach compared to TF (44% vs. 68%, p = 0.478), and a reverse trend when intervening on the left ICA via TR compared to TF approach (57% versus 36%, respectively, p = 0.437).Conclusion. Carotid stenting via transradial approach is noninferior for cerebral embolism to transfemoral approach. The rates of MACCE and vascular complications were similar in both groups. There was no significant difference in the procedural success rate in the transfemoral and transradial groups. The fluoroscopy time during transradial carotid stenting was higher in comparison with transfemoral carotid stenting, though the procedure duration was similar in both groups.

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