scholarly journals Stent-in-Stent Endovascular Correction in Right Internal Carotid Artery Restenosis: a Clinical Case

2021 ◽  
Vol 11 (1) ◽  
pp. 33-40
Author(s):  
T. N. Khafizov ◽  
R. R. Khafizov ◽  
I. E. Nikolaeva ◽  
I. A. Idrisov ◽  
E. E. Abkhalikova ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Clinical Case ◽  
Internal Carotid ◽  
Neointimal Hyperplasia ◽  
Stress Factors ◽  
Stent Restenosis ◽  
Correction Technique ◽  
Clinically Significant ◽  
In Stent Restenosis

Background. Carotid artery restenosis is a rare complication of carotid stenting. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) reveals an in-stent restenosis rate of 0–6 %, a fairly low value given an extensive study sampling of patients. Restenosis still lacks an adequate explanation in endovascular carotid surgery. Intravascular ultrasound visualisation, drug-coated balloons, stent reimplantation or reconstructive surgery have actively been used since relatively recently to tackle restenosis. Drug-coated balloons may fail in certain cases due to hampered restenosis angioplasty in a markedly rigid neointimal hyperplasia. Surgical reconstruction also possessed drawbacks, mostly due to obstacles in the stent removal and the procedure infeasibility in high-risk surgical patients.Materials and methods. The article describes a clinical case of stent-in-stent restenosis correction with drug-coated balloon-expandable re-stenting of right internal carotid artery and a long-term prognosis estimation with optical coherence tomography.Results and discussions. This tactic was adopted due to haemodynamically and clinically significant internal carotid artery restenosis, the patient’s denial of carotid endarterectomy and insufficiently effective balloon angioplasty. The choice of the correction technique was conclusive basing on a negative stent deformation testing that showed the lack of deforming stress factors at internal carotid artery restenosis. Intravascular imaging greatly enhances our ability to understand and assess endovascular processes.Conclusion. We consider clinically significant restenoses in previously stented carotid arteries as requiring further research effort, with the clinical case presented describing an individual solution.

Treatment and Predictors of Recurrent Internal Carotid Artery In-Stent Restenosis

2021 ◽  
Vol 55 (4) ◽  
pp. 374-381
Author(s):  
Zsuzsanna Mihály ◽  
Miklós Vértes ◽  
László Entz ◽  
Edit Dósa
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Protective Factor ◽  
Internal Carotid ◽  
Multiple Logistic Regression Analysis ◽  
Stent Restenosis ◽  
Imaging Characteristics ◽  
Treatment Type ◽  
Best Medical Treatment ◽  
In Stent Restenosis

Purpose: We aimed to examine the effectiveness of different therapeutic options for and to identify the possible risk factors of recurrent internal carotid artery (ICA) in-stent restenosis (ISR). Methods: Forty-six ICA ISRs, which were reintervened at least once, were retrospectively analyzed regarding clinical and imaging characteristics, as well as invasive treatment type (percutaneous transluminal angioplasty [PTA] with a plain balloon, PTA with a drug-eluting balloon [DEB], re-stenting) used. Results: The median follow-up was 29.5 months (IQR, 8.5-52.8 months) in patients who underwent reintervention for ICA ISR. Stent occlusion occurred in 3 patients (6.5%). One ISR recurrence was noted in 10 patients (21.7%); reintervention was carried out in 7 cases (7/10 [70%]; PTA, N = 5; PTA with a DEB, N = 1; re-stenting, N = 1), while 3 patients (3/10; 30%) received best medical treatment. Two ISR recurrences were observed in 3 patients (6.5%); all of them underwent reintervention (PTA, N = 1; PTA with a DEB, N = 2). Three ISR recurrences were seen in 1 patient (2.2%), who was treated with PTA. No recurrence was observed in those patients, who had DEB treatment. Multiple logistic regression analysis revealed statin therapy to be a protective factor against recurrent ISR (OR, 0.17; 95% CI, 0.03-0.84; P = .029). Conclusion: Our study suggests that PTA with a DEB is the most effective for the treatment of recurrent ISR, and confirms the importance of statin use in patients who have had a carotid reintervention.

Carotid Duplex Velocity Criteria Revisited for the Diagnosis of Carotid In-Stent Restenosis

Vascular ◽  
2007 ◽  
Vol 15 (3) ◽  
pp. 119-125 ◽  
Author(s):  
Ali F. AbuRahma ◽  
Damian Maxwell ◽  
Kris Eads ◽  
Sarah K. Flaherty ◽  
Tabitha Stutler
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ct Angiography ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Carotid Angiography ◽  
Residual Stenosis ◽  
Stent Restenosis ◽  
The Mean ◽  
In Stent Restenosis

Carotid percutaneous transluminal angioplasty/stenting has become an accepted treatment modality for carotid artery stenosis in high-risk patients. There has been an ongoing debate regarding which duplex ultrasound (DUS) criteria to use to determine the rate of in-stent restenosis. This prospective study revisits DUS criteria for determining the rate of in-stent restenosis. In analyzing a subset of 12 patients (pilot study) who had both completion carotid angiography and DUS within 30 days, 10 patients with normal post-stenting carotid angiography (< 30% residual stenosis) had peak systolic velocities (PSVs) of the stented internal carotid artery (ICA) of ≤ 155 cm/s and two patients with ≥ 30% residual stenosis had internal carotid artery (ICA) PSVs of > 155 cm/s. Eighty-three patients who underwent carotid stenting as part of clinical trials were analyzed. All patients underwent post-stenting carotid DUS that was done at 1 month and every 6 months thereafter. PSVs and end-diastolic velocities of the ICA and common carotid artery were recorded. Patients with PSVs of the ICA of > 140 cm/s underwent carotid computed tomographic (CT) angiography. The perioperative stroke rate was 1.2%. When the old DUS velocity criteria for nonstented carotid arteries were applied, 54% of patients had ≥ 30% restenosis (PSV of > 120 cm/s), but when our new proposed DUS velocity criteria for stented arteries were applied (PSV of > 155 cm/s), 33% had ≥ 30% restenosis at a mean follow-up of 18 months ( p = .007). The mean PSVs for patients with normal stented carotid arteries based on CT angiography, were 122 cm/s versus 243 cm/s for ≥ 30% restenosis and 113 cm/s versus 230 cm/s for ≥ 30% restenosis based on our new criteria. The mean PSVs of in-stent restenosis of 30 to < 50%, 50 to < 70%, and 70 to 99%, based on CT angiography, were 205 cm/s, 264 cm/s, and 435 cm/s, respectively. Receiver operating curve analysis demonstrated that an ICA PSV of > 155 cm/s was optimal for detecting ≥ 30% in-stent restenosis, with a sensitivity of 100%, a specificity of 90%, a positive predictive value of 74%, and a negative predictive value of 100%. The currently used carotid DUS velocity criteria overestimated the incidence of in-stent restenosis. We propose new velocity criteria for the ICA PSV of > 155 cm/s to define ≥ 30% in-stent restenosis.

Retinal macroaneurysm after carotid endarterectomy in patient with chronic ischemic retinopathy associated with hemodynamically significant stenosis of the internal carotid artery (clinical case)

2021 ◽  
pp. 274-277
Author(s):  
V.V. Tuzlaev ◽  
◽  
O.V. Kolenko ◽  
V.V. Egorov ◽  
I.Z. Kravchenko ◽  
...  
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Clinical Case ◽  
Internal Carotid ◽  
Significant Stenosis ◽  
Ischemic Retinopathy ◽  
Retinal Macroaneurysm ◽  
Intraretinal Hemorrhages

Purpose. To present a clinical case of development of retinal macroaneurysm after carotid endarterectomy (CE) in patient with chronic ischemic retinopathy (CIR) associated with hemodynamically significant stenosis of the internal carotid artery (ICA). Material and methods. Patient R., 74 years old, diagnosed with CIR of the 1st degree of severity of the right eye. In addition to standard ophthalmic examination methods, Doppler ultrasound with registration of blood flow in the orbital artery and spiral computed tomography of the ICA were performed. Results. Panretinal photocoagulation (PRP) of the retina led to obliteration of the retinal macroaneurysm, resorption of intraretinal hemorrhages, and stabilization of the course of CIR after CE of the ICA. Conclusion. The appearance of retinal macroaneurysm and intraretinal hemorrhages after CE in patient with CIR associated with hemodynamically significant ICA stenosis can be regarded as reperfusion complications after restoration of blood flow in the orbital artery, which requires timely retinal PRP of the retina. Key words: chronic ischemic retinopathy, retinal macroaneurysm, internal carotid artery, carotid endarterectomy.

scholarly journals Kinking of the internal carotid artery in otorhinolaryngologist’s practice

2021 ◽  
Author(s):  
O. V. Zeleva ◽  
P. M. Zelter ◽  
A. V. Tsoy ◽  
M. N. Myakotnyh
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Clinical Case ◽  
Internal Carotid ◽  
Vascular Surgeon

Аnomalies of internal carotid artery can occur not only in the practice of vascular surgeon, but also in other specialties. This article discusses a clinical case in the practice of an otorhinolaryngologist kinking of the internal carotid artery, which simulated pathology of pharynx. 

scholarly journals Pseudostroke as a manifestation of mediastinal choriocarcinoma in an elderly man

2021 ◽  
Vol 15 (4) ◽  
pp. 93-98
Author(s):  
Yuliya S. Korneva ◽  
Natalya N. Maslova ◽  
Yana A. Rudenko ◽  
Maxim A. Miloserdov ◽  
Oksana A. Shisterova
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Lymph Node ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Clinical Case ◽  
Internal Carotid ◽  
Neurological Symptoms ◽  
Carotid Artery Compression ◽  
Lymph Node Secondary

We describe a rare clinical case: onset of acute neurological symptoms suggestive of a pesudostroke, caused by an imbalance in cerebral blood flow as a result of internal carotid artery compression by an enlarged lymph node secondary to metastases from a disseminated non-gestational mediastinal choriocarcinoma. This was accompanied by decompensation due to paraneoplastic coagulopathy.

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