Endovascular Treatment for Tandem Internal Carotid Stenosis

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 208-211
Author(s):  
T. Terada ◽  
H. Yokote ◽  
Y. Kinoshita ◽  
M. Tsuura ◽  
O. Masuo ◽  
...  
Keyword(s):  
Percutaneous Transluminal Angioplasty ◽  
Internal Carotid ◽  
Balloon Catheter ◽  
Transluminal Angioplasty ◽  
Digital Subtraction ◽  
Cerebrovascular Events ◽  
Carotid Stenoses ◽  
Second Procedure ◽  
Percutaneous Transluminal

Three patients with tandem internal carotid stenoses were treated in one operation including carotid endarterectomy (CEA) for the proximal stenosis and percutaneous transluminal angioplasty (PTA) for the distal stenosis. We devised a Y-shaped shunt tube which we used for CEA, while a PTA balloon catheter was introduced via the tube to perform PTA guided by portable digital subtraction angiography (DSA). No cerebrovascular events occurred during follow-up. Our approach avoids the risk of a second procedure while effectively treating tandem stenoses.

scholarly journals Clinical Results and Problems of Percutaneous Transluminal Angioplasty and Stenting for Extracranial Internal Carotid Stenoses

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 41-44
Author(s):  
M. Tsuura ◽  
T. Terada ◽  
O. Masuo ◽  
H. Matsumoto ◽  
T. Itakura ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Balloon Catheter ◽  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Symptomatic Case ◽  
Carotid Stenoses ◽  
Angioplasty And Stenting ◽  
Ica Stenosis ◽  
Percutaneous Transluminal ◽  
Extracranial Ica

110 patients with extracranial ICA stenosis were treated by PTA or stenting. In 21 of 55 cases of only PTA and in 40 of 55 cases of stenting, we used our blocking balloon systems to prevent distal embolism. The morbidity and the mortality rates were 5.4% and 0%, respectively. There was only one embolic complication in cases of PTA or stenting where blocking balloon systems were used. In contrast, distal embolism occurred in 3 of 34 cases of PTA without blocking balloon systems (one symptomatic case) and in 4 of 15 cases of stenting without blocking balloon systems (3 symptomatic cases). Our blocking balloon catheter system is a useful device to reduce the risk of symptomatic distal embolism.

scholarly journals Intracranial Atheromatosis Disease (ICAD) and Stent Supported Angioplasty

2018 ◽  
Vol 23 (2) ◽  
pp. 131-137
Author(s):  
Guilherme Cabral De Andrade ◽  
Mirto Nelson Prandini ◽  
Helvercio F. Polsaque Alves ◽  
Eduardo Rafael Pereira ◽  
Valter M. Climaco ◽  
...  
Keyword(s):  
Percutaneous Transluminal Angioplasty ◽  
Internal Carotid ◽  
Single Case ◽  
Transluminal Angioplasty ◽  
Anticoagulation Treatment ◽  
Stenosis Rate ◽  
Average Residual ◽  
Percutaneous Transluminal

Objectives: The symptomatic intracranial atheromatous disease has unfavorable prognosis. The endovascular treatment with percutaneous transluminal angioplasty (PTA) assisted with stent must be held in accordance with the efficacy, safety, complications and the risk of restenosis in the long term. Materials and methods: A study conducted between 1996 and 2008 includes 28 patients with stenosis located in the internal carotid artery (11), basilar artery (14) and vertebral artery (5). All cases were symptomatic even under anticoagulation treatment and stenosis> 60% (average 83.5%). Results: There was a significant reduction in the degree of stenosis (less than50%) with average residual stenosis of 36.8%. There were two complications, with reperfusion hematoma (6.6%). In the longterm follow-up, a single case of reestenosis was found and no patient had a transient or permanent ischemic stroke. Conclusion: The treatment of intracranial stenosis with stentassisted angioplasty is effective, with low complication and stenosis rate in this series. 

Failure of Transluminal Angioplasty in the Treatment of Myointimal Hyperplasia of the Internal Carotid Artery: Case Report

Neurosurgery ◽  
1991 ◽  
Vol 28 (1) ◽  
pp. 148-151 ◽  
Author(s):  
Frank Culicchia ◽  
Robert F. Spetzler ◽  
Richard A. Flom
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Transluminal Angioplasty ◽  
Angiographic Study ◽  
Vessel Lumen ◽  
Percutaneous Transluminal

Abstract Recurrent stenosis of the carotid arteries after a carotid endarterectomy for atherosclerosis can occur as a result of myointimal hyperplasia. This condition was treated by percutaneous transluminal angioplasty. Excellent dilatation of the vessel lumen was documented after balloon dilatation. A 6-month follow-up angiographic study, however, demonstrated recurrent high-grade stenosis at the same level in both carotid arteries. Presumably, the failure of percutaneous transluminal angioplasty and the treatment of myointimal hyperplasia of the internal carotid artery results in the same condition after the original endarterectomy, that is, additional myointimal hyperplasia.

2D-TOF MRA Follow-up Study of Percutaneous Transluminal Angioplasty for Severely Stenotic Cervical Internal Carotid Artery

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 187-189
Author(s):  
T. Ueda ◽  
S. Yoshimura ◽  
Y. Kaku ◽  
S. Shirakami ◽  
T. Andoh ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Internal Carotid ◽  
Transluminal Angioplasty ◽  
Intimal Flap ◽  
Follow Up Study ◽  
Percutaneous Transluminal ◽  
Cervical Internal Carotid Artery

Percutaneous transluminal angioplasty (PTA) for severe arteriosclerotic stenosis in the cervical internal carotid artery (ICA) was successfully carried out in 23 cases between December 1994 and August 1996. In order to analyze the condition of the cervical ICA in the early stage after PTA, 12 stenotic lesions of 11 cases were exposed to follow-up study of stenotic cervical ICA after PTA with magnetic resonance angiography (MRA) 1 to 150 days postoperatively. In six lesions, the diameter of the cervical ICA was dilated sequentially. In another four lesions, the diameter of the cervical ICA was decreased in the first three weeks and dilated over the next three weeks. Angiographically, these lesions had a small intimal flap at the balloon dilated portion, which was speculated to cause the turbulent flow in the first stage. In the remaining 2 lesions, restenotic changes in cervical ICAs were observed within three weeks after PTA. Follow-up angiography was performed over three months after PTA in five cases of this series and compared with MRA. Consequently, the diameters of the cervical ICA between angiography and MRA were closely correlated. The evaluation of the lesion after PTA of the cervical ICA demonstrated that MRA is beneficial, but within three weeks after PTA, caution should be paid for underestimation of the small intimal flap on MRA.

ANGIOGRAPHIC PATTERNS OF WINGSPAN IN-STENT RESTENOSIS

Neurosurgery ◽  
2008 ◽  
Vol 63 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Felipe C. Albuquerque ◽  
Elad I. Levy ◽  
Aquilla S. Turk ◽  
David B. Niemann ◽  
Beverly Aagaard-Kienitz ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Internal Carotid ◽  
Transluminal Angioplasty ◽  
Stent Restenosis ◽  
Stenosis Severity ◽  
Percutaneous Transluminal ◽  
In Stent Restenosis ◽  
Supraclinoid Internal Carotid Artery

ABSTRACT OBJECTIVE A classification system developed to characterize in-stent restenosis (ISR) after coronary percutaneous transluminal angioplasty with stenting was modified and applied to describe the appearance and distribution of ISR occurring after Wingspan (Boston Scientific, Fremont, CA) intracranial percutaneous transluminal angioplasty with stenting. METHODS A prospective, intention-to-treat, multicenter registry of Wingspan treatment for symptomatic intracranial atherosclerotic disease was maintained. Clinical and angiographic follow-up results were recorded. ISR was defined as greater than 50% stenosis within or immediately adjacent (within 5 mm) to the implanted stent(s) and greater than 20% absolute luminal loss. ISR lesions were classified by angiographic pattern, location, and severity in comparison with the original lesion treated. RESULTS Imaging follow-up (3–15.5 months) was available for 127 intracranial stenotic lesions treated with Wingspan percutaneous transluminal angioplasty with stenting. Forty-one lesions (32.3%) developed either ISR (n = 36 [28.3%]) or complete stent occlusion (n = 5 [3.9%]) after treatment. When restenotic lesions were characterized using the modified classification system, 25 of 41 (61.0%) were focal lesions involving less than 50% of the length of the stented segment: three were Type IA (focal stenosis involving one end of the stent), 21 were Type IB (focal intrastent stenosis involving a segment completely contained within the stent), and one was Type IC (multiple noncontiguous focal stenoses). Eleven lesions (26.8%) demonstrated diffuse stenosis (>50% of the length of the stented segment): nine were Type II with diffuse intrastent stenosis (completely contained within the stent) and two were Type III with proliferative ISR (extending beyond the stented segment). Five stents were completely occluded at follow-up (Type IV). Of the 36 ISR lesions, 16 were less severe or no worse than the original lesion with respect to severity of stenosis or length of the segment involved; 20 lesions were more severe than the original lesion with respect to the segment length involved (n = 5), actual stenosis severity (n = 6), or both (n = 9). Nine of 10 supraclinoid internal carotid artery ISR lesions and nine of 13 middle cerebral artery ISR lesions were more severe than the original lesion. CONCLUSION Wingspan ISR typically occurs as a focal lesion. In more than half of ISR cases, the ISR lesion was more extensive than the original lesion treated in terms of lesion length or stenosis severity. Supraclinoid internal carotid artery and middle cerebral artery lesions have a propensity to develop more severe posttreatment stenosis.

Endovascular therapy for stenosis of the petrous or cavernous portion of the internal carotid artery: percutaneous transluminal angioplasty compared with stent placement

2003 ◽  
Vol 98 (3) ◽  
pp. 491-497 ◽  
Author(s):  
Tomoaki Terada ◽  
Mitsuharu Tsuura ◽  
Hiroyuki Matsumoto ◽  
Osamu Masuo ◽  
Tomoyuki Tsumoto ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stent Placement ◽  
Percutaneous Transluminal Angioplasty ◽  
Internal Carotid ◽  
Treated Group ◽  
Transluminal Angioplasty ◽  
Content Type ◽  
Percutaneous Transluminal ◽  
Fine Print

Object. The effects of percutaneous transluminal angioplasty (PTA) and stent placement for stenosis of the petrous or cavernous portion of the internal carotid artery (ICA) were compared. Methods. Twenty-four patients with symptomatic, greater than 60% stenosis of the petrous or cavernous portion of the ICA were treated using PTA or stent placement; 15 were treated with PTA and nine with stent insertion. Initial and follow-up results (> 3 months posttreatment) were compared in each group. Stenotic portions of the ICA were successfully opened in 13 of 15 patients in the PTA group, and in all nine patients in the stent-treated group. In one case in the PTA group stent delivery was attempted; however, the device could not pass through the vessel's tortuous curve, and PTA alone was performed in this case. Postoperatively, the mean stenotic ratio decreased from 72.1 to 29.6% in the PTA group, and from 75.6 to 2.2% in the stent-treated group. In four patients in the PTA group, stenoses greater than 50% were demonstrated on follow-up angiography performed at 3 to 6 months after PTA. In the stent-treated group, no restenosis was encountered, although in one case acute occlusion of the stent occurred; the device was recanalized with PTA and infusion of tissue plasminogen activator. This case was the only one of the 24 in which any neurological deficits related to the endovascular procedure occurred. Stent placement brought a greater gain in diameter than did PTA at the initial and late follow-up period; this gain was statistically significant. Conclusions. Stent placement is more effective than PTA for stenosis of the petrous or cavernous portion of the ICA from the viewpoint of initial and late gain in diameter.

Treatment of Restenosis after PTA for Internal Carotid Stenosis

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 45-48
Author(s):  
T. Terada ◽  
H. Yokote ◽  
Y. Kinoshita ◽  
M. Tsuura ◽  
O. Masuo ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Percutaneous Transluminal Angioplasty ◽  
Arterial Wall ◽  
Internal Carotid ◽  
Treated Group ◽  
Transluminal Angioplasty ◽  
Arterial Calcification ◽  
Carotid Stenoses ◽  
Percutaneous Transluminal ◽  
Severe Calcification

Thirteen cases of restenosis occurred after percutaneous transluminal angioplasty (PTA) in 63 cases of internal carotid stenoses. They were treated by PTA or carotid endarterectomy. The patients were sufficiently informed of each treatment. Seven of them were initially treated by repeated PTA. The stenosis ratio improved from 82% to 30% after repeated PTA on average. However, one case in the PTA treated group resulted in restenosis and then carotid endarterectomy was performed. The other case also caused restenosis and was treated by PTA. Six cases were initially treated by carotid endarterectomy and all cases were successfully treated without difficulty. The success rate of the PTA was 2/7 (29%) in restenosis cases. One case causing re-restenosis had severe calcification in the arterial wall. PTA was thought to be effective for the restenosis cases after initial PTA if the arterial calcification was not severe.

Percutaneous Transluminal Angioplasty for Intracranial Atherosclerotic Stenosis

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 53-56 ◽  
Author(s):  
S. Mandai ◽  
H. Matsushita ◽  
S. Akamatsu ◽  
Y. Maeda ◽  
Y. Gohda ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Internal Carotid ◽  
Posterior Cerebral Artery ◽  
Transluminal Angioplasty ◽  
Atherosclerotic Stenosis ◽  
Permanent Neurological Deficit ◽  
Percutaneous Transluminal ◽  
Stenotic Lesions

Eleven patients with symptomatic intracranial atherosclerotic stenotic lesions underwent percutaneous transluminal angioplasty (PTA). Seven patients had stenosis in M1 segment of the middle cerebral artery (MCA), two in the cavernous internal carotid artery, one in M2 segment of the MCA and one in the P2 segment of the posterior cerebral artery. Initial successful dilatation (less than 50% residual stenosis) was obtained in nine patients (81.8%). Permanent neurological deficit related to PTA was seen in one patient and transient symptoms were observed in two. Re-stenosis was revealed in two cases (18.2%) in the early follow-up period. All patients with successful dilatation and without re-stenosis never had TIA or stroke after PTA. Intracranial PTA is an effective procedure, but several problems remain to be solved.

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