Abstract 1122‐000245: Carotid Artery Revascularization Using Walrus Balloon Guide Catheter: Safety and Feasibility from US Multicenter Experience

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Mohamed Salem ◽  
Svetlana Kvint ◽  
Ammad A Baig ◽  
Andre Monteiro ◽  
Gustavo Cortez ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Flow Control ◽  
Femoral Access ◽  
Guide Catheter ◽  
Institutional Experience ◽  
Protection Devices ◽  
Procedural Success ◽  
Favorable Safety ◽  
New Generation

Introduction : The Walrus Balloon Guide Catheter (BGC) is a new generation of BGC, designed to eliminate conventional BGC limitations during mechanical thrombectomy (MT). We report a multi‐institutional experience using this BGC for proximal flow‐control (PFC) in the setting of carotid artery angioplasty/stenting (CAS) in elective (eCAS) and tandem strokes (tCAS). Methods : Prospectively maintained databases at 7 North‐American Centers were queried to identify patients with cervical carotid disease undergoing eCAS/tCAS with Walrus BGC. Results : 110 patients (median age 68, 64.6% males) undergoing 80 eCAS (72.7%) and 30 tCAS (27.3%) procedures were included (median cervical carotid stenosis 90%; 41.8% with contralateral stenosis). Utilizing proximal flow‐arrest technique in 87.2% and flow‐reversal in 12.8% of procedures, the Walrus was navigated into the common carotid artery (CCA) successfully in all cases despite challenging arch anatomy (28.2%), with preferred femoral access (93.6%) and in conscious sedation (81.8%). Angioplasty and distal embolic protection devices (EPD) were used in 83.7% and 52.7% of procedures, respectively. tCAS led to a mTICI 2b/3 in all cases. Periprocedural ischemic stroke (till 30‐days post‐operatively) rate was 0.9% and remote complications occurred in 1.8% of the cases. Last follow‐up mRS of 0–2 was seen in 95.3% of eCAS cohort, with no differences in complications in the eCAS subgroup between PFC only versus PFC and distal EPD (median follow‐up 4.1 months). Conclusions : Walrus BGC for proximal flow‐control is safe and effective during eCAS and tCAS. Procedural success was achieved in all cases, with favorable safety and functional outcomes on short term follow‐up.

scholarly journals Dissection-related carotid-cavernous fistula (CCF) following surgical revascularization of chronic internal carotid artery occlusion: a new subtype of CCF and proposed management

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Ao-Fei Liu ◽  
Chen Li ◽  
Wengui Yu ◽  
Li-Mei Lin ◽  
Han-Cheng Qiu ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
Surgical Removal ◽  
Procedural Success ◽  
Carotid Cavernous Fistulas

Abstract Background The development of carotid-cavernous fistulas (CCFs) during surgical recanalization of chronic internal carotid artery occlusion (ICAO) may be secondary to severe ICA dissection rather than a focal tear of the cavernous ICA seen in typical traumatic CCFs. The purpose of this study is to investigate the causal relationship between the CCFs and severe ICA dissections and to characterize technical outcomes after treatment with stenting. Methods Five patients underwent treatment with self-expanding stents due to intraprocedural CCF and ICA dissection following surgical removal of ICAO plaque. The stents were telescopically placed via true channel of the dissection. Safety of the procedure was evaluated with 30-day stroke and death rate. Procedural success was determined by the efficacy of CCF obliteration and ICAO recanalization with angiography. Results All CCFs were associated with spiral and long segmental dissection from the cervical to cavernous ICA. After stenting, successful dissection reconstruction with TICI 3 was achieved in all patients, with complete (n = 4) or partial CCF (n = 1) obliteration. No patient had CCF syndrome, stroke, or death during follow-up of 6 to 37 months; but one patient had pulsatile tinnitus, which resolved 1 year later. Angiography at 6 to 24 months demonstrated CCF obliteration in all 5 patients and durable ICA patency in 4 patients. Conclusions Intraprocedural CCFs with spiral and cervical-to-cavernous ICA dissection during ICAO surgery are dissection-related because of successful obliteration after stenting for dissection reconstruction. Self-expanding stenting through true channel of the dissection, serving as implanting stent-autograft, may be an optimal therapy for the atypical CCF complication from ICAO surgery.

scholarly journals Percutaneous Angioplasty of the Sole Patent Cerebral Artery in Two Patients with Takayasu's Aortoarteritis

2016 ◽  
Vol 10 ◽  
pp. CMC.S38329
Author(s):  
Kiron Varghese ◽  
Srilakshmi M. Adhyapak
Keyword(s):  
Carotid Artery ◽  
Cerebral Artery ◽  
Balloon Angioplasty ◽  
Common Carotid Artery ◽  
Critical Stenosis ◽  
Neurological Event ◽  
Protection Devices ◽  
Distal Protection ◽  
The Right

We report two female patients with Takayasu's aortoarteritis, who presented with symptoms of cerebral ischemia due to critical stenosis of the sole patent cerebral artery. Both had occlusion of both vertebral arteries and one carotid artery with critical stenosis of the other carotid artery and presented with hemiparesis contralateral to the patent but stenosed cerebral artery. They also had transient ischemic attacks attributable to the culprit vessel. In the first patient, balloon angioplasty alone was not successful, and hence, a self-expanding stent was deployed in the right common carotid artery. In the second patient, successful balloon angioplasty was performed for the left common carotid artery. Distal protection devices were not used, and neither patient experienced any periprocedural neurological event. Clinical follow-up at six months revealed no significant cerebral events.

Abstract 1122‐000174: Stroke Risk of Carotid Artery Stenting Using Balloon‐Guide Catheter Versus Distal Embolic Protection Devices

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Michael I Nahhas ◽  
Grant J Meeks ◽  
Juan Carlos Martinez‐Gutierrez ◽  
Gary R Spiegel ◽  
Yazan Alderazi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Focal Neurological Deficit ◽  
Embolic Protection ◽  
Guide Catheter ◽  
Primary Means ◽  
Protection Devices ◽  
Distal Protection ◽  
Proximal Occlusion

Introduction : Prevention of distal embolization during carotid artery stenting (CAS) is a key element of procedural technique and is standardly performed using distal protection devices (DPDs). Data in support of DPDs, however, are limited. Here, we present our experience of proximal occlusion using a balloon guide catheter (BGC) during CAS as the primary method of distal embolic protection. Methods : We conducted a retrospective review of patients undergoing CAS at our healthcare system between January of 2018 to March of 2021. Procedures were categorized by embolic protection strategy: DPD or BGC (with or without DPD). Emergent cases were defined as patients receiving CAS within <24 hours of presenting with an ischemic stroke or TIA ipsilateral to the carotid disease side. Severe stenosis was defined as 70–99% per NASCET criteria. The primary outcome was rate of procedural ischemic stroke between the DPD and BGC groups, and was defined as acute focal neurological deficit lasting for ≥ 24 hours following CAS related to an embolic event during the procedure. Results : A total of 126 CAS procedures were performed during the study period. 91 cases were performed under proximal BGC protection (of which 24 also included DPD usage) and 35 CAS cases via DPD as a primary mean for embolic protection. The median age for the cohort was 68 [IQR 62‐76], 37% females, 31% (n = 39) cases were treated emergently, and elective cases were 69% (n = 87). Baseline characteristics were similar in both groups except for hyperlipidemia (BGC vs DPD, 71.4% vs 42.9%; p = 0.003) and history of smoking (BGC vs DPD, 56% vs 34.4%; p = 0.029). Severe carotid stenosis was present in 80.2% BGC group and 77.1% in DPD (p = 0.573). Post‐stenting balloon angioplasty was more frequent in the BGC group as compared with DPD (54% vs. 26%, BGC vs. DPD, p = 0.005). Procedural embolic stroke rates were low in both groups, and not significantly different (1.1% vs. 2.9%, BGC vs. DPD, p = 0.48). Conclusions : CAS with BGC as the primary means of distal embolic protection showed comparable, low rates of procedural embolic ischemic events compared to those with DPD. These findings suggest BGC embolic strategies may be a viable alternative to DPD usage.

Carotid artery stenting with a new-generation double-mesh stent in three high-volume Italian centres: 12-month follow-up results

2018 ◽  
Vol 14 (10) ◽  
pp. 1147-1149 ◽  
Author(s):  
Roberto Nerla ◽  
Antonio Micari ◽  
Fausto Castriota ◽  
Eligio Miccichè ◽  
Maria Antonella Ruffino ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
High Volume ◽  
New Generation

Procedural success with radial access for carotid artery stenting: systematic review and meta-analysis

2019 ◽  
Vol 12 (1) ◽  
pp. 87-93 ◽  
Author(s):  
Tanaporn Jaroenngarmsamer ◽  
Kartik Dev Bhatia ◽  
Hans Kortman ◽  
Emanuele Orru ◽  
Timo Krings
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Radial Artery ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Minor Stroke ◽  
Access Site ◽  
Femoral Access ◽  
Radial Access ◽  
Procedural Success

BackgroundFemoral access is the traditional approach for endovascular carotid artery stenting. Radial access is increasingly used as an alternative approach due to its known anatomical advantages in patients with unfavorable aortic arch morphology via the femoral approach and its excellent access site safety profile. Our objective was to analyze procedural success using radial access for carotid artery stenting as reported in the literature.MethodsThree online databases were systematically searched following PRISMA guidelines for studies (n ≥20) using radial artery access for carotid artery stenting (1999–2018). Random-effects meta-analysis was used to pool the procedural success (successful stent placement with no requirement for crossover to femoral access), mortality, and complication rates associated with radial access.ResultsSeven eligible studies reported procedural success outcomes with a pooled meta-analysis rate of 90.8% (657/723; 95% CI 86.7% to 94.2%; I2=53.1%). Asymptomatic radial artery occlusion occurred in 5.9% (95% CI 4.1% to 8.0%; I2=0%) and forearm hematoma in 1.4% (95% CI 0.4% to 2.9%; I2=0%). Risk of minor stroke/transient ischemic attack was 1.9% (95% CI 0.6% to 3.8%; I2=42.3%) and major stroke was 1.0% (95% CI 0.4% to 1.8%; I2=0%). There were three deaths across the seven studies (0.6%; 95% CI 0.2% to 1.3%; I2=0%). The meta-analysis was limited by statistically significant heterogeneity for the primary outcome of procedural success.ConclusionRadial access for carotid artery stenting has a high procedural success rate with low rates of mortality, access site complications, and cerebrovascular complications. The potential benefits of this approach in patients with unfavorable aortic arch access should be explored in a prospective randomized trial.

Endovascular Stenting of the Cervical Internal Carotid Artery

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 79-81 ◽  
Author(s):  
K. Hosotani ◽  
S. Okamoto ◽  
K. Yamashita
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Experimental Studies ◽  
Occlusive Vascular Disease ◽  
Conventional Angioplasty ◽  
Procedural Success ◽  
Late Restenosis ◽  
Cervical Internal Carotid Artery

The purpose of this study was to determine the value of stenting in the treatment of occlusive vascular disease involving the cervical internal carotid artery. Clinical and angiographical results of stenting were compared those of conventional angioplasty alone up to 20 months of follow-up. The Palmaz-Schatz stent was implanted in two patients with acute intimal dissection, whereas conventional angioplasty alone was performed in seven patients with arteriosclerotic stenosis. Initial procedural success was achieved in all the patients, and acute or subacute complications were not encountered at all. One of the patients (14%) treated with conventional angioplasty alone developed late restenosis at three-month follow-up. The patients treated with stenting revealed satisfactory results clinically and angiographically. The present results may suggest that stenting is an effective and safe method to treat dissection of cervical internal carotid artery, but larger clinical trials as well as experimental studies would be necessary to define the indications and refine the stents.

Recanalization of a Symptomatic Extracranial Internal Carotid Artery Near Occlusion with Proximal and Distal Protection

Neurosurgery ◽  
2007 ◽  
Vol 61 (1) ◽  
pp. E174-E174 ◽  
Author(s):  
Randall C. Edgell ◽  
Dileep R. Yavagal ◽  
Celso Agner ◽  
Matthew Adamo ◽  
Alan S. Boulos
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Extracranial Internal Carotid Artery ◽  
Symptomatic Carotid ◽  
Guide Catheter ◽  
Protection Devices ◽  
Near Occlusion

Abstract OBJECTIVE To describe a novel approach to recanalizing symptomatic extracranial internal carotid artery near occlusion using proximal and distal emboli protection devices. METHODS Patients presenting with symptomatic extracranial internal carotid artery near occlusion who underwent endovascular recanalization between October 2004 and July 2005 were included in this study. During these procedures, a 9-French Concentric Balloon Guide Catheter (Concentric Medical, Mountain View, CA) was advanced into the common carotid artery proximal to the site of occlusion. During the prestent angioplasty of the lesion, the proximal balloon was inflated and aspiration was performed. After initial angioplasty and before stent placement, a distal filter protection device was placed in the distal internal carotid artery. Stent placement and repeat angioplasty were performed with both protection devices active. All patients were placed on dual antiplatelet therapy. RESULTS There were four patients treated with a mean age of 74 years; three of these four patients were men. All patients had signs of ischemia and carotid occlusion or near occlusion on noninvasive imaging. Three right internal carotid arteries were treated. All patients were successfully recanalized. No procedurally related complications or deaths occurred. CONCLUSION This series demonstrates the feasibility of recanalization of symptomatic carotid artery occlusion or near occlusion using proximal and distal emboli protection devices. Such an approach may provide an added level of safety during carotid recanalization procedures.

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.

Hybrid Endovascular Repair of Thoracoabdominal Aorta: Early Results

2014 ◽  
Vol 17 (3) ◽  
pp. 146
Author(s):  
Osman Tansel Darcin ◽  
Mehmet Kalender ◽  
Ayse Gul Kunt ◽  
Okay Guven Karaca ◽  
Ata Niyazi Ecevit ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Therapeutic Option ◽  
Complete Recovery ◽  
Aortic Aneurysms ◽  
Thoracoabdominal Aorta ◽  
Mortality And Morbidity ◽  
Early Results ◽  
The Mean ◽  
Procedural Success

<p><b>Background:</b> Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure.</p><p><b>Methods:</b> From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter.</p><p><b>Results:</b> All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination.</p><p><b>Conclusion:</b> Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.</p>

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