Abstract TP319: Duplex Assisted Carotid Artery Stenting Without Administration of Contrast Media

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Takashi Mizowaki ◽  
Atsushi Fujita ◽  
Taichiro Imahori ◽  
Atsushi Uyama ◽  
Satoshi Inoue ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Contrast Media ◽  
Carotid Artery Stenting ◽  
Longitudinal Section ◽  
Control Group ◽  
Technical Success ◽  
Technical Success Rate ◽  
Group 4 ◽  
Luminal Narrowing ◽  
Ckd Stage

Background: Conventional carotid artery stenting (CAS) with administration of contrast media carries a risk of adverse reactions such as contrast media-induced nephropathy or an allergic reaction. Objective We aimed to present a novel technique, that is, duplex-assisted CAS without administration of contrast media and validate its safety and feasibility. Methods: Fifteen patients with severe carotid stenosis (≥70 %) associated with chronic kidney disease (CKD) (stage ≥3) or allergy to contrast media underwent duplex-assisted CAS without administration of contrast media. The embolic protection device (EPD) placed in the common carotid artery (CCA) was clearly visible on the longitudinal section (Fig. A) and was then advanced into the internal carotid artery (ICA) by duplex-guidance (Fig. B). When starting the delivery of the stent, the position of the distal stent end is confirmed by duplex monitoring (Fig. C). Postdilatation was performed after the stent (Fig. D arrowheads) deployment if enough expansion of the carotid artery was not achieved. Adequate stent position (Fig. E arrowheads) and technical success was confirmed by duplex images and intravascular ultrasound (Fig. F). Conventional CAS was also performed in 165 patients and used as the control group. Results: The technical success rate was 100 % in duplex-assisted CAS group. Combined stroke or death rates during the post-procedural period did not differ significantly between the duplex assisted CAS group (0/15, 0 %) and conventional CAS group (4/165, 2.4 %). None of the 14 patients with CKD in the duplex-assisted CAS group experienced further deterioration of renal function. Conclusion: This method seemed to be a safe and effective treatment for patients with CKD or an allergy to contrast media. The most important factor for the indication of duplex-assisted CAS was to obtain the clear visualization of the luminal narrowing with minimal calcification on the longitudinal section of the duplex ultrasonography.

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 P0645EDARAVONE MAY DECREASE THE INCIDENCE OF CONTRAST INDUCED ACUTE KIDNEY INJURY (CI-AKI)

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Dmytro Ivanov ◽  
Mariia Ivanova ◽  
Illia Burlachenko
Keyword(s):  
Contrast Media ◽  
Kidney Injury ◽  
Peroxyl Radicals ◽  
Controlled Study ◽  
Control Group ◽  
Ckd Stage ◽  
Intravenous Hydration ◽  
Group A ◽  
Group B ◽  
And Control

Abstract Background and Aims Edaravone is a low-molecular-weight antioxidant drug targeting peroxyl radicals of reactive oxygen species and has shown clinical efficacy in patients with acute ischemic stroke. We have conducted a multicenter open prospective randomized controlled study to evaluate the efficacy of edaravone in preventing AKI in patients with CKD 3b-4 stages. Method The study included 2 groups of patients aged 46 to 68 (55 ± 3): group A (n=16) with CKD stage 3b or 4 (eGFR EPI 32 ± 4 ml/min) that received intravenous edaravone 30 mg bid on 0,1,2 day of contrast media infusion and control group B (n=20) with CKD stage 3b or 4 (eGFR EPI 33 ± 3 ml/min) with no edaravone intervention during CT coronarography. Patients of both groups received intravenous hydration with 0.9% sodium before CT. Primary endpoint: CIN onset in 48 hours after contrast media infusion and need for RRT. Secondary endpoint: serum potassium level above 5.5 mmol/l. Results CIN onset was obtained in 4 patients of group A and 12 patients of group B (p>0,05, RR 0.417, RRR 0.583, RD 0.350, NNT 2.857). Other results are presented in table

scholarly journals The periprocedural and 30-day outcomes of carotid stenting in patients with carotid artery near-occlusion

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Cheng-Hsuan Tsai ◽  
Ying-Hsien Chen ◽  
Mao-Shin Lin ◽  
Ching-Chang Huang ◽  
Chi-Sheng Hung ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Stenting ◽  
Technical Success ◽  
Prospective Data ◽  
Technical Success Rate ◽  
Hyperperfusion Syndrome ◽  
Primary Endpoints ◽  
Near Occlusion ◽  
Cas A

AbstractThe safety of endovascular revascularization in patients with carotid artery near occlusion (CANO) is unknown. We aimed to evaluate the peri-procedural risk in CANO patients receiving carotid artery stenting (CAS). A prospective data base with retrospective review was performed to identify patients who underwent CAS with CANO from July 2006 to July 2020, and had at least 1-month clinical follow-up data. The primary endpoints were stroke, hyperperfusion syndrome, and death within 30 days after CAS. A total of 198 patients with carotid artery stenosis were enrolled including 92 patients with CANO and 106 age and sex-matched patients with 70–99% conventional carotid stenosis. Full distal carotid collapse was found in 45 CANO patients (45/92, 49%). The technical success rate was 100%. The CANO patients had significantly longer lesion lengths compared with those of the non-CANO group. The incidence of hyperperfusion syndrome was comparable (CANO: 2.2%, non-CANO: 0.9%, P = 0.598). The risks of ischemic stroke and death within 30 days were 1.1% and 0% in the CANO group; and 1.9% and 0.9%, in the non-CANO group, respectively, without statistical difference. In conclusion, CAS is safe for patients with CANO, with a similar low 30-day peri-procedural event rate comparable to those of non-CANO.

Effects of Atorvastatin on Vascular Intimal Hyperplasia: An Experimental Rodent Model

Angiology ◽  
2008 ◽  
Vol 60 (3) ◽  
pp. 370-377 ◽  
Author(s):  
Unal Aydin ◽  
Murat Ugurlucan ◽  
Funda Gungor ◽  
Sedat Ziyade ◽  
Bekir Inan ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Smooth Muscle Cell ◽  
Muscle Cell ◽  
Intimal Hyperplasia ◽  
Aortic Injury ◽  
Control Group ◽  
Group 4 ◽  
Luminal Narrowing ◽  
Cell Accumulation ◽  
Group 1

Introduction Vascular intimal hyperplasia is associated with increased mortality and morbidity. The authors investigated the effects of atorvastatin on vascular intimal hyperplasia. Materials and methods Rats were divided into 4 groups. Groups 1, 2, and 3 had experimental aortic injury and received intraperitoneal injection of atorvastatin, solvent, or 0.9% NaCl, respectively. Group 4 was a nonintervention (laparotomy only) control group. Animals were sacrificed after 3 weeks. Blood samples and injured aortic segment were analyzed. Results Atorvastatin administration significantly lowered total and low-density lipoprotein cholesterol levels ( P = .012 and P = .001, respectively), intima—media ratio ( P = .002), and intimal smooth muscle cell accumulation ( P < .05) in group 1. Luminal narrowing in animals in group 1 was significantly lower than that in animals in groups 2 and 3, but was higher than in animals in group 4 ( P = .009). Conclusions Atorvastatin suppresses intimal hyerplasia and aids in intimal regeneration by lowering blood lipids and intimal smooth muscle cell accumulation.

scholarly journals The feasibility of pancreatic duct stenting using a novel 4-Fr plastic stent with a 0.025-in. guidewire

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kazumasa Nagai ◽  
Atsushi Sofuni ◽  
Takayoshi Tsuchiya ◽  
Kentaro Ishii ◽  
Reina Tanaka ◽  
...  
Keyword(s):  
Propensity Score ◽  
Pancreatic Duct ◽  
Propensity Score Matching ◽  
Statistical Significance ◽  
Control Group ◽  
Amylase Level ◽  
Technical Success ◽  
Plastic Stent ◽  
Technical Success Rate ◽  
Pancreatic Duct Stenting

AbstractPancreatic duct stenting is a well-established method for reducing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. However, there is no consensus on the optimal type of plastic stent. This study aimed to evaluate the feasibility and safety of a new 4-Fr plastic stent for pancreatic duct stenting. Forty-nine consecutive patients who placed the 4-Fr stent into the pancreatic duct (4Fr group) were compared with 187 consecutive patients who placed a conventional 5-Fr stent (control group). The primary outcome was technical success. Complications rate, including post-ERCP pancreatitis (PEP) were the secondary outcomes. Propensity score matching was introduced to reduce selection bias. The technical success rate was 100% in the 4Fr group and 97.9% in the control group (p = 0.315). Post-ERCP amylase level was significantly lower in the 4-Fr group than the control group before propensity score matching (p = 0.006), though without statistical significance after propensity score matching (p = 0.298). The rate of PEP in the 4Fr group (6.1%) was lower than the control group (15.5%), though without statistical significance before (p = 0.088) and after (p = 1.00) propensity score matching. Pancreatic duct stenting using a novel 4-Fr plastic stent would be at least similar or more feasible and safe compared to the conventional plastic stent.

scholarly journals The Change of GFAP or S100B Concentration in Serum Before and After Carotid Artery Stenting

2020 ◽  
Author(s):  
Xiaofan Yuan ◽  
Shu Yang ◽  
Lei Guo ◽  
Duozi Wang ◽  
Jie Huang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stent Implantation ◽  
Carotid Artery Stenting ◽  
Statistical Significance ◽  
Control Group ◽  
Blood Samples ◽  
Before And After ◽  
Operative Evaluation ◽  
Symptomatic Stenosis

Abstract Background：This study explored the role of GFAP and S100B as cerebral biomarkers in the pre-operative evaluation and post-operative efficacy in monitoring of carotid stent implantation. Method：32 with unilateral carotid stenosis who underwent carotid artery stenting (CAS) enrolled in the CAS group. The blood samples of operation patients were collected on three different time points: T1: the day before operation; T2: 24 hours after operation; T3, 72 hours after operation. 32 who were excluded for carotid artery stenosis by Digital Subtraction Angiography (DSA) were selected as the control group. The blood samples of patients in control group were collected at D1 (before DSA) and D2 (24 hours after DSA). Results：(1). The serum concentrations of GFAP and S100B was higher in the CAS group before operation than those in DSA group（P<0.05）. (2). In the operation group, GFAP and S100B increased significantly on the first day after operation (T2) and decreased gradually on the third day after operation (T3) but increased compared with that before operation (T1) with statistical significance (P < 0.05). (3). For patients with symptomatic stenosis before operation, the concentrations of GFAP and S100B in serum were higher than those in patients without symptomatic stenosis (P < 0.05). Conclusions： The cerebral biochemical markers GFAP and S100B have a certain change trend after CAS, which can be used as a method to evaluate and monitor the curative effect before and after carotid artery stent implantation combined with imaging tools.

NSE, S100B and MMP9 Expression Following Reperfusion after Carotid Artery Stenting

2019 ◽  
Vol 16 (2) ◽  
pp. 129-134 ◽  
Author(s):  
Xiaofan Yuan ◽  
Jianhong Wang ◽  
Duozi Wang ◽  
Shu Yang ◽  
Nengwei Yu ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Neuron Specific Enolase ◽  
Artery Stenosis ◽  
Cerebral Injury ◽  
Control Group ◽  
Blood Samples ◽  
Mmp9 Expression ◽  
Significant Difference

Objective: Previous studies have shown that the neuron-specific- enolase (NSE), S100B protein (S100B) and matrix metalloproteinase-9 (MMP9) are specific markers for studying cerebral injury. This study was aimed to demonstrate these biomarkers for their correlation with reperfusion after carotid artery stenting (CAS). Methods: In this study, a total of 44 patients who were diagnosed unilateral carotid artery stenosis by digital subtraction angiography (DSA) and underwent CAS, were selected as the operation groups. The patients' blood samples were collected at three different time points: T1, prior to operation; T2, next morning after operation (24 hours); T3, three days after operation (72 hours); All of the patients with the operation received computed tomography perfusion (CTP) at T1 and T3. The second group of 12 patients, who were excluded for carotid artery stenosis by DSA, were assigned to be the control group; Blood samples of these patients were collected at T1. The concentrations of NSE, S100B and MMP9 in serum from patients of both groups were detected by ELISA. Results: All of the operations were implanted in stents successfully without complications. (1) After CAS, rCBF increased while rMTT and rTTP decreased. (2) The concentrations of NSE, S100B and MMP9 in the serum decreased gradually (T1>T2>T3). There was no significant difference between the control group and the operation group at T1 (P>0.05) on their concentrations of NSE, S100B and MMP9 in the serum. When compared among the operation groups, the concentrations of NSE, S100B and MMP9 in the serum at T1 and T3 showed significant difference (P < 0.05). (3) Correlation analysis among the operation groups indicated that NSE, S100B, MMP9 and rCBF were positively correlated before operation (r = 0.69, 0.58 and 0.72, respectively, P < 0.05), as well as after operation (r = 0.75, 0.65 and 0.60, respectively, P < 0.05). Conclusion: We concluded that the concentrations of NSE, S100B and MMP9 in serum decreased with the improvement of cerebral reperfusion after CAS. NSE, S100B and MMP9 can be used as laboratory biochemical markers to evaluate the improvement of reperfusion after CAS. The results very well complement the imaging methods, such as CTP.

scholarly journals Endovascular treatment of basilar tip aneurysms in the era of endosaccular flow disruption: a comparative study

2020 ◽  
Author(s):  
Yigit Ozpeynirci ◽  
Bettina Hutschenreuter ◽  
Robert Forbrig ◽  
Hartmut Brückmann ◽  
Thomas Liebig ◽  
...  
Keyword(s):  
Control Group ◽  
Procedure Time ◽  
Unfavourable Outcome ◽  
Technical Success ◽  
Patient Demographics ◽  
Group 4 ◽  
Time Treatment ◽  
Treatment Concepts ◽  
Basilar Tip Aneurysm

Abstract Purpose This study aims to compare endosaccular flow disruptor (EFD) for treatment of basilar tip aneurysm (BTA) with coiling in terms of safety and efficacy. Methods We retrospectively reviewed patients treated with an EFD for BTAs at our institution between 2013 and 2019 to standard coiling from the same period (control group). Patient demographics, aneurysm characteristics, procedural data, complications and clinical and angiographic outcome were compared between groups. Results Twenty-three (56%) patients were treated with an EFD and eighteen (44%) patients were treated with coiling. Average aneurysm size was 8 mm in the EFD group and 6.9 mm in the coiling group, respectively (P = 0.2). Average fluoroscopy time, treatment DAP and air kerma were 33 min, 76 Gycm2 and 1.7 Gy in the EFD group and 81 min, 152 Gycm2 and 3.8 Gy in the coiling group, respectively (P < 0.001). In the EFD group, clinically relevant thromboembolic complications occurred in one patient (4%) vs. in 5 patients (28%) in the coiling group (P = 0.07). In each group, 4 patients had an unfavourable outcome at discharge (P = 0.7). Adequate occlusion rates were 96% in the EFD group and 100% and coiling group. Six (26%) patients were prescribed long-term antiplatelet therapy in the EFD group vs. eleven (61%) patients in the coiling group (P = 0.02). Conclusion Both treatment concepts provided similar technical success and safety. However, procedure time, radiation exposure and a need for long-term antiaggregation were lower with EFD.

Thirty-Day Results of the Novel CGuard-Covered Stent in Patients Undergoing Carotid Artery Stenting

2021 ◽  
pp. 152660282110074
Author(s):  
Konstantinos Tigkiropoulos ◽  
Ioakeim Papoutsis ◽  
Manolis Abatzis-Papadopoulos ◽  
Panagiotis Kousidis ◽  
Dimitrios Mpismpos ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Artery Stenosis ◽  
External Carotid ◽  
The Novel ◽  
Technical Success ◽  
Embolic Protection ◽  
Tertiary Center

Objective: The aim of this study was to provide early-term evaluation, safety, and efficacy of the novel CGuard (Inspire MD, Tel Aviv, Israel) micromesh self-expanding stent with embolic protection system (EPS) during carotid artery stenting (CAS) procedure. Materials and Methods: All patients who underwent CAS with CGuard carotid stent system from January 2018 to September 2020 in a tertiary center were prospectively evaluated. Primary endpoints included technical success and perioperative neurological events (0–48 hours). Secondary endpoint was the rate of neurologic, cardiac events, and death (major adverse event or MAE) at 30 days. Patency of CGuard, peak systolic velocity (PSV), and end diastolic velocity (EDV) were evaluated at 30 days with duplex ultrasound. Results: A total of 103 patients underwent CAS procedure. Forty patients were symptomatic, and 63 patients were asymptomatic with stenosis greater than 70%. Technical success was 100%. Local anesthesia was applied in 94 patients (93%). Embolic protection devices were used in 6 patients (5.8%). Access site complications were 1.9%. Mean internal carotid artery stenosis diameter reduced from 79.47% to 14.68%. Two patients had transient ischemic attack (1.9%) and 1 patient experienced a cerebral hyperperfusion syndrome (CHS) perioperatively. External carotid artery (ECA) occlusion occurred in 1.9%. Four patients experienced jaw claudication (3.8%) postoperatively. Mean time of operation was 41 minutes. Mean duration of hospitalization was 3.1 days. The 30-day rate of MAE was 0%. CGuard patency was 100%, mean internal carotid PSV was reduced from 251.57 to 77.29 cm/s, and mean internal carotid EDV was reduced from 154.62 to 24.63 cm/s at 30 days. Conclusion: Our study shows that CGuard stent with EPS is an effective and safe device for treatment of carotid artery stenosis with acceptable low perioperative neurologic events, even with low embolic protection device usage. Larger multicenter and randomized studies are necessary to confirm its long-term efficacy.

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