Limiting Complications During Carotid Artery Stenting in Complex Lesions

2010 ◽  
Vol 5 (1) ◽  
pp. 66
Author(s):  
Fabrizio Fanelli ◽  
Emanuele Boatta ◽  
Pierleone Lucatelli ◽  
Roberto Passariello ◽  
◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Plaque Morphology ◽  
Permanent Disability ◽  
The Us ◽  
Protection Systems ◽  
Proximal Protection ◽  
Protection Devices ◽  
Distal Occlusion ◽  
Selection Of

Stroke is the third leading cause of death and permanent disability in the US and Europe. During the last decade, carotid artery stenting (CAS) has gained a role as an alternative option to carotid endoarterectomy (CEA). Both patient selection and plaque morphology are crucial to reduce the risk of complications. Technical aspects such as the employment and selection of different types of cerebral protection devices, distal occlusion balloons, filters, proximal protection systems and stent selection will be widely discussed.

Evaluation of proximal protection devices during carotid artery stenting as the first choice for embolic protection

2015 ◽  
Vol 10 (11) ◽  
pp. 1362-1367 ◽  
Author(s):  
Marius Hornung ◽  
Stefan C. Bertog ◽  
Jennifer Franke ◽  
Dani Id ◽  
Iris Grunwald ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Embolic Protection ◽  
First Choice ◽  
Proximal Protection ◽  
Protection Devices

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

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

Routine Use of Debris Aspiration Before Retrieval of Distal Filter Protection Devices in Carotid Arterial Stenting: Analysis of Captured Debris and Evaluation of Clinical Results

Neurosurgery ◽  
2010 ◽  
Vol 67 (5) ◽  
pp. 1260-1267 ◽  
Author(s):  
Takatoshi Sorimachi ◽  
Kazuhiko Nishino ◽  
Junsuke Shimbo ◽  
Kenichi Morita ◽  
Yasushi Ito ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cerebral Arteries ◽  
Clinical Results ◽  
Debris Particles ◽  
Protection Systems ◽  
Protection Devices ◽  
Distal Filter ◽  
Carotid Arterial ◽  
Arterial Stenting ◽  
Method Group

Abstract BACKGROUND: Distal filter protection allows for continuous cerebral perfusion during carotid artery stenting (CAS), although a higher risk of debris migrating into the cerebral arteries compared with other protection systems has been reported. OBJECTIVE: To improve the extent of debris capture, we used routine aspiration of blood located proximal to the filter in the internal carotid artery blood column before retrieval of the filter device. METHODS: Of 71 CAS procedures with distal filter protection, routine aspiration was performed in 41 procedures. The size and number of debris particles in each aspirated blood sample were measured under a stereoscopic microscope in 30 consecutive procedures with routine aspiration. Occurrence of periprocedural neurological events was compared between 41 procedures with routine aspiration and the other 30 without routine aspiration. RESULTS: In the aspirated blood, debris particles ≥500 μm and ≥1000 μm in the longest diameter were observed in 30 (100%) and 28 (93.3%) procedures, respectively. The number of particles ≥1000 μm was significantly larger in the second through fourth blood aspirates vs the first aspirate (P < .05). Occurrence of periprocedural neurological events was significantly less frequent in the routine aspiration group (0 of 41 procedures) than in the conventional method group (7 of 30 procedures) (P < .05). CONCLUSION: The use of routine aspiration during CAS with distal filter protection possibly reduced periprocedural neurological events by increasing the proportion of debris captured. To improve the capture of debris particles, at least 4 repeated aspirations are advisable during each CAS procedure.

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

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

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

2015 ◽  
Vol 187 ◽  
pp. 592-593 ◽  
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

scholarly journals Favorable Early Outcome of Carotid Artery Stenting Without Protection Devices

Stroke ◽  
2004 ◽  
Vol 35 (12) ◽  
pp. 2862-2866 ◽  
Author(s):  
László K. Sztriha ◽  
Erika Vörös ◽  
Katalin Sas ◽  
Réka Szentgyörgyi ◽  
Anna Pócsik ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Early Outcome ◽  
Protection Devices

Predictors of periprocedural complications of carotid artery stenting - a multivariate analysis of a single-centre experience

VASA ◽  
2016 ◽  
Vol 45 (5) ◽  
pp. 387-393 ◽  
Author(s):  
Mehmet Bulent Vatan ◽  
Bilgehan Atılgan Acar ◽  
Murat Aksoy ◽  
Yusuf Can ◽  
Ceyhun Varım ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Multivariate Regression Analysis ◽  
Neurological Complications ◽  
Lesion Length ◽  
Plaque Morphology ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Independent Risk Factors

Abstract. Background: Carotid artery stenting (CAS) is currently used as an alternative treatment to carotid endarterectomy (CEA). The objective of this study was to analyse our 5-year experience performing CAS. Secondarily, we sought to determine independent risk factors which predict periprocedural complications. Patients and Methods: A total of 146 patients who underwent 153 CAS procedures were analysed. The majority of patients (123, 84.2%) had symptomatic carotid stenosis. Demographic and interventional data, angiographic lesion characteristics, and periprocedural complications were recorded. Using univariate and multivariate logistic regression analyses, risk factors associated with adverse clinical outcomes were determined. Results: Periprocedural neurological complications, including four (2.7 %) major strokes, three (2 %) transient ischaemic attacks, one (0.7%) amaurosis fugax, and two (1.3 %) cases of hyperperfusion syndrome occurred in ten (6.8%) patients. The incidence of periprocedural complications significantly increased in female patients (r = 0.214, p = 0.009) and patients with longer lesions (r = 0.183, p = 0.027), contralateral stenosis ≥50 % (r = 0.222, p = 0.007), the presence of complicated plaques (r = 0.478, p < 0.001) and inadequate glycaemic control (r = 0.259, p = 0.002). Multivariate regression analysis also determined four variables to be potential independent risk factors for 30-day adverse events: higher age (Odds ratio [OR] = 1.283; 95 % CI, 1.051 to 1.566, p = 0.014); longer lesions (OR = 1.459, 95 % CI, 1.124 to 1.893, p = 0.004); higher tortuosity index (OR = 1.015, 95 % CI, 1.001 to 1.030, p = 0.034), and the presence of complicated plaque morphology (OR = 4.321, 95 % CI, 1.621 to 10.23, p = 0.001). Conclusions: Patient and lesion characteristics including age, lesion length, complicated plaque morphology and tortuosity index, may be associated with periprocedural complications.

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