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

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, > 50% stenosis; asymptomatic, > 70% stenosis). Overall, 98 lesions (88.3%) had severe stenosis (< 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.

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CRT-300.04 Comparison of Devices in Carotid Artery Stenting: A Vascular Quality Initiative Analysis of Commonly Used Carotid Stents and Embolic Protection Devices

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2016.12.146 ◽

2017 ◽

Vol 10 (3) ◽

pp. S41

Author(s):

Ashwat S. Dhillon ◽

Sisi Li ◽

Juan Pablo Lewinger ◽

Leonardo C. Clavijo ◽

David M. Shavelle ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Embolic Protection ◽

Protection Devices

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

Stroke ◽

10.1161/str.46.suppl_1.wp17 ◽

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.

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Proximal embolic protection devices for high risk lesions/patients in "TARGET-CAS" registry of 1717 consecutive carotid artery stenting procedures

European Heart Journal ◽

10.1093/eurheartj/eht309.2597 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. 2597-2597

Author(s):

L. Tekieli ◽

P. Pieniazek ◽

P. Musialek ◽

T. Przewlocki ◽

A. Kablak-Ziembicka ◽

...

Keyword(s):

High Risk ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Embolic Protection ◽

Protection Devices ◽

Cas Registry

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Abstract No. 257: Carotid Artery Stenting without the Use of Balloon Angioplasty and Cerebral Protection Devices

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2007.12.288 ◽

2008 ◽

Vol 19 (2) ◽

pp. S97

Author(s):

S. Baldi ◽

T. Zander ◽

M. Rabellino ◽

I. Zerolo ◽

R. Llorens ◽

...

Keyword(s):

Carotid Artery ◽

Balloon Angioplasty ◽

Carotid Artery Stenting ◽

Cerebral Protection ◽

Protection Devices

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Embolic protection devices during carotid artery stenting: Is there a difference between proximal occlusion and distal filter?

International Journal of Cardiology ◽

10.1016/j.ijcard.2015.03.435 ◽

2015 ◽

Vol 187 ◽

pp. 592-593 ◽

Cited By ~ 2

Author(s):

Giuseppe Gargiulo ◽

Eugenio Stabile ◽

Anna Sannino ◽

Cinzia Perrino ◽

Bruno Trimarco ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Embolic Protection ◽

Protection Devices ◽

Proximal Occlusion ◽

Distal Filter

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

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s38329 ◽

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.

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Expression of P-selectin, von Willebrand and endothelin-1 after carotid artery stenting

VASA ◽

10.1024/0301-1526/a000094 ◽

2011 ◽

Vol 40 (3) ◽

pp. 199-204 ◽

Cited By ~ 8

Author(s):

Xia ◽

Yang ◽

Qu ◽

Cheng ◽

Wang

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Endothelin 1 ◽

Significant Difference ◽

Group 2 ◽

One Year ◽

Von Willebrand ◽

The Impact ◽

Group 1

Background: This study was designed to investigate the impact of carotid artery stenting (CAS) on plasma levels of P-selectin, von Willebrand (vWF) and endothelin-1. Patients and methods: Sixty-seven patients who received CAS were divided into group 1 (one stent for a simple lesion, n = 38) and group 2 (two stents for complex lesions, n = 29). The levels of P-selectin, vWF and endothelin-1 were measured before CAS, 1 h, 6h, 24 h and 2 weeks after the stenting. Results: Sixty-one patients completed one-year follow up. Restenosis was noted in 14 (23 %) patients, among these three (4.8 %) had a restenosis of > 50 % of the vascular lumen. In all patients, the levels of P-selectin, vWF and endothelin-1 increased immediately after CAS (P < 0.05 or < 0.01). The levels of vWF and endothelin-1 in group 2 were higher than in group 1 (P < 0.05 or 0.01). There was no significant difference in P-selectin and endothelin-1 between the restenosis and non-restenosis group (P > 0.05). The 24 h vWF in patients with restenosis were higher than in non-restenosis group (P < 0.05). Conclusions: CAS results in a significant increase in plasma P-selectin, vWF and endothelin-1. The post-CAS levels of P-selectin, vWF and endothelin-1 are related to the extent of endothelial injury. Whether they are associated with restenosis 12 months after the treatment requires further investigation.

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

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000174 ◽

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.

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