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.

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.

scholarly journals Long-Term Management of Recurrent Cholecystitis after Initial Conservative Treatment: Endoscopic Transpapillary Gallbladder Stenting

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Hideki Kamada ◽  
Hideki Kobara ◽  
Naohito Uchida ◽  
Kiyohito Kato ◽  
Takayuki Fujimori ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Technical Success ◽  
Technical Success Rate ◽  
High Risk Patients ◽  
Risk Patients

Background. Endoscopic transpapillary gallbladder stenting (ETGBS) is an effective procedure for treating high-risk patients with acute cholecystitis and severe comorbidities. However, the efficacy of ETGBS for recurrent cholecystitis (RC) remains unclear. This study aimed to explore its efficacy in patients with RC for whom cholecystectomy is contraindicated because of its high surgical risk.Methods. Data on 19 high-risk patients who had undergone ETGBS for RC after initial conservative therapy in our institution between June 2006 and May 2012 were retrospectively examined. The primary outcome was the clinical success rate, which was defined as no recurrences of acute cholecystitis after ETGBS until death or the end of the follow-up period. Secondary outcomes were technical success rate and adverse events (AEs).Results. The clinical success rate of ETGBS was 100%, the technical success rate 94.7%, and AE rate 5%: one patient developed procedure-related mild acute pancreatitis. The clinical courses of all patients were as follows: four died of nonbiliary disease, and the remaining 15 were subsequently treated conservatively. The median duration of follow-up was 14.95 months (range 3–42 months).Conclusions. ETGBS is an effective alternative for managing RC in high-risk patients with severe comorbidities.

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.

scholarly journals The Role of Intraarterial Chemotherapy in the Management of Retinoblastoma

2020 ◽  
Vol 2020 ◽  
pp. 1-16 ◽  
Author(s):  
Aleksandra Pekacka
Keyword(s):  
Success Rate ◽  
Retention Rate ◽  
Intraarterial Chemotherapy ◽  
Treatment Modalities ◽  
Technical Success ◽  
Secondary Neoplasms ◽  
Systemic Complications ◽  
Technical Success Rate

Introduction. Retinoblastoma is the most common primary intraocular neoplasm in children. With the advances in medicine, the armamentarium of available treatment modalities has grown. Intraarterial chemotherapy is a relatively new treatment method with promising outcomes. The purpose of this literature review is to evaluate its role in the management of retinoblastoma. Methods. A systematic online search was conducted using Ovid Embase and Ovid Medline. The final results included 23 studies. The studies were published between 2011 and 2019. The studies evaluated the technical success rate of IAC, globe salvage rate, and ocular and systemic complications, as well as the occurrence of deaths, metastasis, and secondary neoplasms. In total, 1827 eyes with retinoblastoma were analysed. The follow-up was between 0 and 252 months. Results. Overall globe retention rate ranged from 30% to 100%. Sixteen out of 23 studies reported ocular salvage between 60 and 80%. Eyelid oedema and erythema were the most commonly reported ocular complications following IAC. The most common systemic complications included nausea, vomiting, and neutropenia. Metastases and deaths were reported in 6 out of 23 studies. Three studies reported the development of secondary neoplasms. The technical success rate of IAC procedure ranged from 91% to 100%. Discussion. The studies have shown that IAC is a safe and effective treatment for advanced retinoblastoma, especially group D. It allows to save the globe without compromising patients’ survival. Local and systemic complications are acceptable. The role of IAC in less advanced tumours is yet to be established. Future work should focus on conducting larger prospective studies with longer follow-up. Multiple novel therapies for the management of retinoblastoma are currently being tested, including angiogenic inhibitors and targeted agents. The results seem to be promising. Future advances require a further in-depth understanding of unique genetics of retinoblastoma and complex interactions between tumour cells and their microenvironment.

scholarly journals CAROTID ARTERY STENTING IN OCTOGENARIANS: SUCCESS RATE, COMPLICATIONS AND LONG-TERM FOLLOW-UP OF A SINGLE-CENTER COHORT

2016 ◽  
Vol 67 (13) ◽  
pp. 299
Author(s):  
Juergen Kammler ◽  
Hermann Blessberger ◽  
Alexander Kypta ◽  
Michael Lichtenauer ◽  
Thomas Lambert ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Success Rate ◽  
Carotid Artery Stenting ◽  
Single Center ◽  
Long Term Follow Up

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.

scholarly journals Long-term outcomes of fluoroscopy-guided tracheal stents removal under fluoroscopy guidance: comparison of tracheal fistulas and tracheal stenosis

2020 ◽  
Author(s):  
Yonghua Bi ◽  
Jindong Li ◽  
Liangliang Bai ◽  
Xinwei Han ◽  
Jianzhuang Ren
Keyword(s):  
Success Rate ◽  
Tracheal Stenosis ◽  
Survival Rates ◽  
Technical Success ◽  
Technical Success Rate ◽  
Stent Removal ◽  
Total Incidence ◽  
Significant Difference

Abstract Background: Endoscopic removal is the most common method for removal of tracheal stents. Few studies have reported the technique of fluoroscopy-guided stent removal for tracheal fistula and tracheal stenosis. We aimed to study the safety and efficacy of fluoroscopy-guided stent removal as well as the optimal duration for stent usage.Methods: We conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Reasons for stent implantation were tracheal fistula in 85 patients (TF group), and tracheal stenosis in 67 patients (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, and survival rate were compared between the two groups.Results: The technical success rate of stent removal was 98.9% and 97.4%, respectively for the TF and TS group. Removal was routine for half of patients, and in the remainder, excessive granulation tissue was the common indications for stent removal, which was found after stenting at 142.1±25.9 days in the TF group, and at 89.9±15.0 day in the TS group. The total incidence of complications was 21.1% and 22.4%, respectively, for the TF and TS groups. Perioperative death occurred in one patient in the TF group, and two patients in the TS group. Recurrence of fistula or stenosis requiring re-stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3%, 59.6%, and 36.1% for TF group, and 80.4%, 75.7%, 75.7% for TS group.Conclusions: Fluoroscopic removal of tracheal stents is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference in outcomes. Recurrence of fistula or stenosis requiring re-stenting was the most common complication.

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.

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