Carotid Artery Stenting with Distal Protection Using the Carotid Wallstent and Filterwire Neuroprotection: Single-Center Experience of 380 Cases with Midterm Outcomes

Emerging data have supported the clinical efficacy of carotid artery stenting (CAS) in stroke prevention in high-risk surgical patients. This study was performed to evaluate the midterm clinical outcome of CAS using the Carotid Wallstent and FilterWire distal protection (both Boston Scientific, Natick, MA) at an academic institution. Risk factors for in-stent restenosis (ISR) were also analyzed. Clinical variables and treatment outcome of high-risk patients who underwent Carotid Wallstent placement with FilterWire EX/EZ neuroprotection were analyzed during a recent 54-month period. Three hundred eighty CAS procedures were performed in 354 patients. Technical success was achieved in 372 cases (98%), and symptomatic lesions existed in 85 (24%) patients. No patient experienced periprocedural mortality or neuroprotective device–related complication. The 30-day stroke and death rate was 2.7%, and the overall complication rate was 6.9%. The overall major or fatal stroke rates in symptomatic and asymptomatic patients were 4.6% and 1.3%, respectively (not significant). The overall stroke and death rates between the symptomatic and asymptomatic groups were 5.8% and 2.4%, respectively (not significant). The median follow-up period was 29 months (range 1–53 months). With Kaplan-Meier analysis, the rates of freedom from 60% or greater ISR after CAS procedures at 12, 24, 36, and 48 months were 97%, 94%, 92%, and 90%, respectively. The rates of freedom from all fatal and nonfatal strokes at 12, 24, 36, and 48 months were 97%, 91%, 89%, and 85%, respectively. Multivariable analysis of significant univariate predictors identified that postendarterectomy stenosis (odds ratio [OR] 3.98, p = .02) and multiple stent placement (OR 3.68, p = .03) were independent predictors of ISR. Our study yielded favorable short-term and midterm clinical results using Carotid Wallstent with FilterWire neuroprotection. Late follow-up results showed low rates of fatal and nonfatal stroke and favorable ISR rates compared with other carotid stent trials. Postendarterectomy and multiple stent placement were associated with subsequent ISR.

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Extracranial Carotid Artery Stenting in Surgically High-Risk Patients Using the Carotid Wallstent Endoprosthesis: Midterm Clinical and Ultrasound Follow-Up Results

CardioVascular and Interventional Radiology ◽

10.1007/s00270-003-0039-4 ◽

2003 ◽

Vol 26 (4) ◽

pp. 340-346 ◽

Cited By ~ 12

Author(s):

Geert Maleux ◽

Pauwel Bernaerts ◽

Vincent Thijs ◽

Kim Daenens ◽

Johan Vaninbroukx ◽

...

Keyword(s):

High Risk ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Extracranial Carotid Artery ◽

High Risk Patients ◽

Risk Patients ◽

Carotid Wallstent

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Imaging Follow-up after Carotid Artery Stenting with Carotid Wallstent Using Computed Tomographic Angiography

Surgery for Cerebral Stroke ◽

10.2335/scs.45.7 ◽

2017 ◽

Vol 45 (1) ◽

pp. 7-13

Author(s):

Tatsufumi NOMURA ◽

Daisuke SASAMORI ◽

Tadashi NONAKA ◽

Akira TAKAHASHI ◽

Yasuyuki YONEMASU ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Tomographic Angiography ◽

Carotid Wallstent

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Carotid artery angioplasty and stent placement for recurrent stenosis

Neurosurgical FOCUS ◽

10.3171/foc.2005.18.1.8 ◽

2005 ◽

Vol 18 (1) ◽

pp. 1-3 ◽

Cited By ~ 8

Author(s):

Christopher J. Koebbe ◽

Kenneth Liebman ◽

Erol Veznedaroglu ◽

Robert Rosenwasser

Keyword(s):

Carotid Artery ◽

Stent Placement ◽

Cardiac Complications ◽

Endovascular Management ◽

Invasive Strategy ◽

Recurrent Stenosis ◽

Procedural Complications ◽

Drug Eluting ◽

Distal Protection

Object The use of endovascular management for recurrent carotid artery (CA) stenosis is rapidly expanding due to the increased surgical risk associated with repeated carotid endarterectomy (CEA). Carotid artery angioplasty and stent placement for recurrent CA stenosis offers a less invasive strategy with fewer procedural complications and may provide a more durable treatment. The authors report on their experience with this procedure in the management of recurrent CA stenosis. Methods A retrospective review was performed to evaluate clinical and ultrasound imaging outcomes after CA angioplasty and stent placement. Twenty-three vessels in 22 patients with severe recurrent stenosis (> 80%) post-CEA were treated with balloon angioplasty and stent placement without distal protection. There were no perioperative neurological or cardiac complications in this series. Over a mean follow-up period of 36 months, one patient (5%) suffered recurrent stenosis requiring retreatment with angioplasty alone. Conclusions The use of CA angioplasty and stent placement provides a safe and effective treatment for recurrent CA stenosis. The use of drug-eluting and/or bioactive stents in the future will likely further improve the efficacy of this procedure for recurrent CA stenosis.

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Carotid artery angioplasty and use of stents in high-risk patients with contralateral occlusions

Journal of Neurosurgery ◽

10.3171/jns.1999.90.6.1031 ◽

1999 ◽

Vol 90 (6) ◽

pp. 1031-1036 ◽

Cited By ~ 77

Author(s):

Robert A. Mericle ◽

Stanley H. Kim ◽

Giuseppe Lanzino ◽

Demetrius K. Lopes ◽

Ajay K. Wakhloo ◽

...

Keyword(s):

High Risk ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Stent Placement ◽

Death Rate ◽

Minor Stroke ◽

Content Type ◽

Symptomatic Carotid ◽

Fine Print

Object. The risks associated with carotid endarterectomy (CEA) are increased in the presence of contralateral carotid artery (CA) occlusion. The 30-day stroke and death rate for patients in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) who had contralateral CA occlusion was 14.3%. The authors analyze their experience with angioplasty and/or stent placement in patients with contralateral CA occlusion to determine the safety and efficacy of endoluminal revascularization in this subgroup.Methods. Twenty-six procedures were evaluated in 23 patients with high-grade CA stenosis and contralateral CA occlusion. The first 15 procedures were evaluated retrospectively, and the next 11 prospectively. All patients had severe medical comorbidities and were considered too high risk for CEA, even without considering the contralateral occlusion. Clinical follow-up review was performed an average of 18 months later (median 15 months).Conclusions. The average ipsilateral CA stenosis according to NASCET criteria was 78% preprocedure and 5% postprocedure. There were no changes in neurological or functional outcome immediately postoperatively in any patient. The 30-day postoperative stroke and death rates were zero. However, there was one symptomatic femoral hematoma that resolved without surgery. At follow up, there were three patients who had suffered stroke or death. One patient died secondary to respiratory arrest at 2 months; one died secondary to prostate carcinoma at 12 months; and one patient experienced a minor stroke contralateral to the treated artery at 41 months. Despite the substantial preoperative risk factors in patients in this series, the 30-day stroke and death rate for angioplasty and/or stent placement appears to be lower than that of CEA in patients with contralateral occlusions.

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Three-year outcomes after carotid artery revascularization: Gender-related differences

Vascular ◽

10.1177/1708538119836312 ◽

2019 ◽

Vol 27 (5) ◽

pp. 459-467

Author(s):

Renato Casana ◽

Chiara Malloggi ◽

Valerio Stefano Tolva ◽

Andrea Odero Jr ◽

Richard Bulbulia ◽

...

Keyword(s):

Myocardial Infarction ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Long Term Outcomes ◽

Single Centre ◽

Men And Women ◽

Asymptomatic Patients ◽

Carotid Artery Endarterectomy

Objectives Carotid artery stenosis is thought to cause up to 10% of ischemic strokes. Historically, carotid artery endarterectomy has shown a higher risk of perioperative adverse events for women. More recent trials reported conflicting results regarding the benefit of carotid artery endarterectomy and carotid artery stenting for men and women. The aim of the present retrospective study was to investigate the influence of gender on the short- (30 days) and long-term (3 years) outcomes of carotid artery endarterectomy and carotid artery stenting in a single centre. Methods From 2010 to 2017, 912 consecutive symptomatic and asymptomatic patients who underwent carotid artery endarterectomy (389, 42.7%) or carotid artery stenting (523, 57.3%) in a single institution had been evaluated to determine the influence of sex (540 men, 59.2%, vs. 372 women, 40.8%) on the outcomes after both revascularization procedures during three years of follow-up. The primary endpoint was the incidence of death, stroke, myocardial infarction, and restenosis in the short-term follow-up. The secondary endpoint was the incidence of death, stroke, myocardial infarction, and restenosis in the long-term follow-up. Results Mean clinical follow-up was 21.1 (16.1) months. Women had internal and common carotid artery diameters significantly smaller with respect to men. For peri-procedural outcomes, women undergoing carotid artery stenting had a higher risk of moderate (50–70%) restenosis (6 women, 2.9%, vs. 3 men, 1.0%). For long-term outcomes, women undergoing carotid artery endarterectomy had a higher rate of moderate restenosis (16 women, 16.3%, vs. 11 men, 7.6%). No significant differences in long-term outcomes were observed between men and women undergoing carotid artery stenting, even after stratification for baseline risk factors. Conclusions Contrary to previous reports, from this single-centre study, long-term risk of events seems to be higher in women who underwent carotid artery endarterectomy than in those who underwent carotid artery stenting, while fewer differences were observed in men.

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Update on current registries and trials of carotid artery angioplasty and stent placement

Neurosurgical FOCUS ◽

10.3171/foc.2005.18.1.3 ◽

2005 ◽

Vol 18 (1) ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Sunit Das ◽

Bernard R. Bendok ◽

Christopher C. Getch ◽

Issam A. Awad ◽

H. Hunt Batjer

Keyword(s):

High Risk ◽

Carotid Artery ◽

Stent Placement ◽

Effective Means ◽

First Line ◽

Carotid Revascularization ◽

First Line Therapy ◽

Asymptomatic Patients ◽

The Us

Stroke remains the leading cause of disability in adults and the third leading cause of death in the US. Carotid artery (CA) occlusive disease is the primary pathophysiological source of 10 to 20% of all strokes. Carotid endarterectomy (CEA) has been shown to reduce the risk of stroke in patients with both symptomatic and asymptomatic extracranial CA stenosis. Carotid artery angioplasty and stent placement has recently emerged as an alternative to CEA for primary and secondary prevention of stroke related to CA stenosis. With the advent of the embolic protection device, the safety of CA angioplasty and stent placement has approached, if not surpassed, that of CEA. In particular, the former has come to be considered as a first-line therapy in the management of CA stenotic disease in individuals at high risk for complications related to surgical intervention. Preliminary data from multiple registries have demonstrated that CA angioplasty and stent placement is an effective means of treating CA stenosis. The results of the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy trial have demonstrated that this modality has a significant role in the management of CA disease in symptomatic and asymptomatic patients with risk factors for high rates of surgery-related morbidity or mortality. With the completion of the Carotid Revascularization Endarterectomy versus Stent Trial, the role of CA angioplasty and stent placement in the prevention of stroke in all individuals with significant CA stenosis should be better demarcated. This treatment modality promises to assume a central role in stroke prophylaxis in patients with CA disease who are at high risk for complications related to surgery.

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Toward clinical equipoise: the current case for carotid angioplasty and stent placement

Neurosurgical FOCUS ◽

10.3171/foc.2005.18.1.4 ◽

2005 ◽

Vol 18 (1) ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Elad I. Levy ◽

Robert D. Ecker ◽

James J. Thompson ◽

Peter A. Rosella ◽

Ricardo A. Hanel ◽

...

Keyword(s):

High Risk ◽

Stent Placement ◽

Treatment Options ◽

Occlusive Disease ◽

Clinical Equipoise ◽

Current Case ◽

Asymptomatic Patients ◽

Risk Patients ◽

History Of ◽

Distal Protection

Recent advances in carotid artery (CA) stent placement procedures have propelled this technology into the forefront of treatment options for both symptomatic and asymptomatic patients with CA stenosis. Until recently, endarterectomy was the only surgical option for patients with CA occlusive disease. For high-risk surgical candidates, periprocedural stroke rates remained unacceptable and were significantly higher than those associated with the natural history of the disease. Advances in stent technology and improvements in antiplatelet and antithrombotic regimens, in conjunction with distal protection devices, have significantly lowered the risk of periprocedural complications for high-risk surgical candidates requiring CA revascularization. In this paper the authors review data gleaned from the important recent CA stent trials and address questions concerning the safety, efficacy, and durability of stent-assisted angioplasty for extracranial CA occlusive disease. Additionally, they review the role of noninvasive imaging modalities for the diagnosis and surveillance of CA disease in these high-risk patients.

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