Abstract W P17: Spontaneous Dilatation of Stents at Three Months After Carotid Artery Stenting Without Post-Carotid Artery Stenting Balloon Dilatation

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Yuhei Tanno ◽  
Takahisa Mori ◽  
Tomonori Iwata ◽  
Yoshinori Aoyagi ◽  
Shigen Kasakura ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Balloon Dilatation ◽  
Conventional Angiography ◽  
Minimum Width ◽  
Lateral Projection ◽  
Closed Cell ◽  
Dilatation Rate ◽  
Stent Diameter

Objective: The aim of our retrospective study was to investigate how wide stents were spontaneously dilated at three months after carotid artery stenting (CAS) without post-CAS balloon dilatation (BT). Methods: We included in our analysis patients 1) who underwent elective CAS without post-CAS BT from January 2012 to March 2014, 2) who underwent follow-up conventional angiography at 3 months after CAS, Patients’ baseline characteristics, stent types (open cell: OP or closed cell: CL), stent diameter (SD) at the site with minimum width on the lateral projection immediately and at 3 month after CAS were evaluated. Results: Sixty-two lesions in fifty-nine patients were analyzed. Their average age was 74.9 years old, median SD immediately after CAS was 3.27mm(3.08_3.64:interquartile range), median SD at 3 months was 3.99mm(3.58-4.27), and thus SD was spontaneously dilated (p<0.0001). In OP types (18 cases), median SD changed from 3.59 to 4.05 mm and in CL types (44 cases) from 3.22 to 3.85 mm. Median SD after deployment was wider in OP type anytime (p<0.05), whereas dilatation rate seemed to be bigger in CL type. Conclusion: Stents were spontaneously dilated about 10 to 20% without post-CAS balloon dilatation. SD at 3 months was wider in OP type, whereas dilatation rate at 3 months was bigger in CL type.

Effect of Open- vs Closed-Cell Stent Design on Periprocedural Outcomes and Restenosis After Carotid Artery Stenting: A Systematic Review and Comprehensive Meta-analysis

2018 ◽  
Vol 25 (4) ◽  
pp. 523-533 ◽  
Author(s):  
Pavlos Texakalidis ◽  
Stefanos Giannopoulos ◽  
Damianos G. Kokkinidis ◽  
Giuseppe Lanzino
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Stent Design ◽  
Open Cell ◽  
Stent Restenosis ◽  
Closed Cell ◽  
Ischemic Attack ◽  
In Stent Restenosis

Purpose:To compare periprocedural complications and in-stent restenosis rates associated with open- vs closed-cell stent designs used in carotid artery stenting (CAS). Methods: A systematic search was conducted to identify all randomized and observational studies published in English up to October 31, 2017, that compared open- vs closed-cell stent designs in CAS. Identified studies were included if they reported the following outcomes: stroke, transient ischemic attack (TIA), myocardial infarction (MI), hemodynamic depression, new ischemic lesions detected on imaging, and death within 30 days, as well as the incidence of in-stent restenosis. A random-effects model meta-analysis was employed. Model results are reported as the odds ratio (OR) and 95% confidence interval (CI). The I2 statistic was used to assess heterogeneity. Results: Thirty-three studies (2 randomized trials) comprising 20, 291 patients (mean age 71.3±3.0 years; 74.6% men) were included. Patients in the open-cell stent group had a statistically significant lower risk of restenosis ⩾40% (OR 0.42, 95% CI 0.19 to 0.92; I2=0%) and ⩾70% (OR 0.23, 95% CI 0.10 to 0.52; I2=0%) at a mean follow-up of 24 months. No statistically significant differences were identified for periprocedural stroke, TIA, new ischemic lesions, MI, hemodynamic depression, or death within 30 days after CAS. Sensitivity analysis of the 2 randomized controlled trials only did not point to any significant differences either. Conclusion: Use of open-cell stent design in CAS is associated with a decreased risk for restenosis when compared to the closed-cell stent, without significant differences in periprocedural outcomes.

A Technical Strategy for Carotid Artery Stenting: Suboptimal Prestent Balloon Angioplasty Without Poststenting Balloon Dilatation

Neurosurgery ◽  
2010 ◽  
Vol 67 (5) ◽  
pp. 1438-1443 ◽  
Author(s):  
Sung-Chul Jin ◽  
O-Ki Kwon ◽  
Chang Wan Oh ◽  
Cheolkyu Jung ◽  
Moon Gu Han ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Balloon Angioplasty ◽  
Carotid Artery Stenting ◽  
Balloon Dilatation ◽  
Embolic Protection ◽  
Acceptable Risks ◽  
Protection Devices ◽  
Group 2 ◽  
Cas A

Abstract BACKGROUND: Traditional carotid artery stenting (CAS) consists of predilatation, optional deployment of embolic protection devices, stenting, and poststent angioplasty. Each step carries a risk of thromboembolism. OBJECTIVE: To design a new and simplified procedural protocol, suboptimal balloon angioplasty without routine poststenting balloon dilatation, and to describe the efficacy this protocol in terms of procedural risks and angiographic and clinical outcomes. METHODS: Over a period of 6 years, 161 carotid artery stenoses in 156 consecutive patients were treated by CAS with embolic protection devices. Among them, 110 lesions in 107 patients (68.3%) were treated by our simplified method (symptomatic, &gt; 50% stenosis; asymptomatic, &gt; 70% stenosis). Overall, 98 lesions (88.3%) had severe stenosis (&lt; 70%). RESULTS: The mean stenosis was reduced from 77% to 10% after CAS. A persistent neurological deficit developed in 2 patients from thromboembolism. Hemodynamic insufficiency developed in 14 lesions during CAS (12.7%). The ipsilateral stroke and mortality rate was 4.5% within 1 month after CAS (asymptomatic, 3.6%; symptomatic, 4.8%). Over a mean of 19 months of follow-up, additive angioplasty was performed in 2 patients as a result of progressive restenosis (≥ 50%). A comparison of the balloon sizes of the prestent angioplasty for group 1 (balloon, ≤ 4 mm) and group 2 (balloon, ≥ 5 mm) showed no difference in restenosis between the groups at 15 months of follow-up after CAS. CONCLUSION: Our CAS technique with suboptimal prestenting angioplasty without routine use of poststenting dilatation is safe, simple, and efficient with acceptable risks.

scholarly journals Carotid Artery Stenting Using a Closed-Cell Stent-in-Stent Technique for Unstable Plaque

2019 ◽  
Vol 26 (4) ◽  
pp. 565-571 ◽  
Author(s):  
Kaoru Myouchin ◽  
Katsutoshi Takayama ◽  
Takeshi Wada ◽  
Toshiteru Miyasaka ◽  
Toshihiro Tanaka ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Success Rate ◽  
Carotid Artery Stenting ◽  
Technical Success ◽  
Unstable Plaque ◽  
Technical Success Rate ◽  
Closed Cell ◽  
Lumen Narrowing ◽  
Ischemic Complications

Purpose: To examine whether carotid artery stenting (CAS) of stenoses with unstable plaque using a closed-cell stent-in-stent technique prevents plaque protrusion. Materials and Methods: Between December 2014 and August 2018, 35 consecutive patients (mean age 75.8 years; 29 men) with carotid artery stenosis (20 symptomatic) and unstable plaque diagnosed by magnetic resonance imaging were prospectively analyzed. Mean diameter stenosis was 83.5%. All CAS procedures were performed with stent-in-stent placement of Carotid Wallstents using an embolic protection device and conservative postdilation. The technical success rate, incidence of plaque protrusion, ischemic stroke rate within 30 days, and new ipsilateral ischemic lesions on diffusion-weighted imaging (DWI) within 48 hours after CAS were prospectively assessed. Follow-up outcomes included the incidences of ipsilateral stroke and restenosis. Results: The technical success rate was 100%. No plaque protrusion or stroke occurred in any patient. New ischemic lesions were observed on DWI in 10 (29%) patients. During the mean 11.6-month follow-up, no ipsilateral strokes occurred. Two (6%) patients developed asymptomatic restenosis recorded as 53% lumen narrowing and occlusion, respectively. Conclusion: CAS using a closed-cell stent-in-stent technique for unstable plaque may be useful for preventing plaque protrusion and ischemic complications.

scholarly journals Stent Design, Restenosis and Recurrent Stroke After Carotid Artery Stenting in the International Carotid Stenting Study

Stroke ◽  
2019 ◽  
Vol 50 (11) ◽  
pp. 3013-3020 ◽  
Author(s):  
Mandy D. Müller ◽  
John Gregson ◽  
Dominick J.H. McCabe ◽  
Paul J. Nederkoorn ◽  
H. Bart van der Worp ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Recurrent Stroke ◽  
Carotid Stenting ◽  
Hazard Ratio ◽  
Stent Design ◽  
Open Cell ◽  
Closed Cell

Background and Purpose— Open-cell carotid artery stents are associated with a higher peri-procedural stroke risk than closed-cell stents. However, the effect of stent design on long-term durability of carotid artery stenting (CAS) is unknown. We compared the medium- to long-term risk of restenosis and ipsilateral stroke between patients treated with open-cell stents versus closed-cell stents in the ICSS (International Carotid Stenting Study). Methods— Patients with symptomatic carotid stenosis were randomized to CAS or endarterectomy and followed with duplex ultrasound for a median of 4.0 years. We analyzed data from patients with completed CAS procedures, known stent design, and available ultrasound follow-up. The primary outcome, moderate or higher restenosis (≥50%) was defined as a peak systolic velocity of >1.3 m/s on ultrasound or occlusion of the treated internal carotid artery and analyzed with interval-censored models. Results— Eight hundred fifty-five patients were allocated to CAS. Seven hundred fourteen patients with completed CAS and known stent design were included in the current analysis. Of these, 352 were treated with open-cell and 362 with closed-cell stents. Moderate or higher restenosis occurred significantly less frequently in patients treated with open-cell (n=113) than closed-cell stents (n=154; 5-year risks were 35.5% versus 46.0%; unadjusted hazard ratio, 0.68; 95% CI, 0.53–0.88). There was no significant difference in the risk of severe restenosis (≥70%) after open-cell stenting (n=27) versus closed-cell stenting (n=43; 5-year risks, 8.6% versus 12.7%; unadjusted hazard ratio, 0.63; 95% CI, 0.37–1.05). The risk of ipsilateral stroke beyond 30 days after treatment was similar with open-cell and closed-cell stents (hazard ratio, 0.78; 95% CI, 0.35–1.75). Conclusions— Moderate or higher restenosis after CAS occurred less frequently in patients treated with open-cell stents than closed-cell stents. However, both stent designs were equally effective at preventing recurrent stroke during follow-up. Clinical Trial Registration— URL: http://www.isrctn.com/ . Unique identifier: ISRCTN25337470.

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

2012 ◽  
Vol 81 (1) ◽  
pp. 89-94 ◽  
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

scholarly journals Imaging Follow-up after Carotid Artery Stenting with Carotid Wallstent Using Computed Tomographic Angiography

2017 ◽  
Vol 45 (1) ◽  
pp. 7-13
Author(s):  
Tatsufumi NOMURA ◽  
Daisuke SASAMORI ◽  
Tadashi NONAKA ◽  
Akira TAKAHASHI ◽  
Yasuyuki YONEMASU ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Computed Tomographic Angiography ◽  
Computed Tomographic ◽  
Tomographic Angiography ◽  
Carotid Wallstent

Cognitive Performance in Elderly Patients Undergoing Carotid Endarterectomy or Carotid Artery Stenting: A Twelve-Month Follow-Up Study

2010 ◽  
Vol 30 (3) ◽  
pp. 244-251 ◽  
Author(s):  
F.T. Feliziani ◽  
M.C. Polidori ◽  
P. De Rango ◽  
F. Mangialasche ◽  
R. Monastero ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Elderly Patients ◽  
Carotid Endarterectomy ◽  
Cognitive Performance ◽  
Carotid Artery Stenting ◽  
Follow Up Study

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

2018 ◽  
Vol 11 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Erasmia Broussalis ◽  
Christoph Griessenauer ◽  
Sebastian Mutzenbach ◽  
Slaven Pikija ◽  
Hendrik Jansen ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Antiplatelet Agents ◽  
Protection Device ◽  
Median Length ◽  
Distal Embolization ◽  
Stent System ◽  
Single Operator ◽  
Excellent Functional Outcome

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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