scholarly journals The use of embolic protection device in the stenting of brachiocephalic arteries

2018 ◽  
Vol 24 (2) ◽  
pp. 44-51
Author(s):  
A.Yu. Polkovnikov ◽  
V.I. Pertsov ◽  
A.M. Materukhin ◽  
E.I. Savchenko
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Internal Carotid ◽  
Carotid Stenting ◽  
Protection Device ◽  
Embolic Protection Device ◽  
Embolic Protection ◽  
Brachiocephalic Trunk ◽  
Distal Protection ◽  
Brachiocephalic Arteries

Objective — to optimize the results of endovascular treatment of stenotic pathology of brachiocephalic arteries. Materials and methods. The results of surgical treatment of 112 patients, among whom there were 79 (70.5 %) men and 33 (29.5 %) women aged from 28 to 86 years with symptomatic stenotic lesions of brachiocephalic arteries treated in the neurosurgical department of the Zaporizhzhia regional hospital in the period from 2010 to 2018 were analyzed. Observations were divided into three groups depending on the localization of the defeat: internal carotid artery — 74 (66 %) cases (predominant stenosis of the mouth of the ICA (n = 71)), vertebral artery — 25 (22.4 %), a portion of the subclavian artery or brachiocephalic trunk — 13 (11.6 %). All patients underwent MRI of the brain in the preoperative period, as well as in 45 (40 %) cases of CTangiography. In all cases prior to surgery invasive angiography was performed with an assessment of the state and anatomy of the brachiocephalic and intracranial arteries, as well as the possibilities of collateral blood flow. Results. In the first group, which was conducted carotid stenting embolic protection device was used in 72 (97.2 %) cases. In the second group, distal protection device were used twice 2 (8 %) in the resolution of extended stenoses of the dominant vertebral artery mouth. In the third group, the distal protection device was used in 1 (7.7 %) case for stenting the critical extended stenosis of the brachiocephalic trunk with the transition to common carotid artery. Complications were noted in 9 observations. In one case there was a development of ischemic stroke, intraoperatively, in a patient with an echeloned lesion of the intracranial basin of a stenting internal carotid artery, probably against a background of hypotension of the stent developed during implantation. In 8 (7.1 %) cases the formation of the hematoma of the puncture site of the femoral artery was noted. Conclusions. The use of embolic protection device is mandatory in standard carotid stenting. The choice of method of protection depends on the severity of stenosis, as well as the individual features of collateral blood flow. When stenting subclavian artery, brachiocephalic trunk and vertebral artery, in some cases it is justified to use distal protection devices, the latter increases the safety of the operation.

scholarly journals What is the Real Risk of Dislodging Thrombi During Endovascular Revascularization of a Proximal Internal Carotid Artery Occlusion?

Neurosurgery ◽  
2011 ◽  
Vol 68 (4) ◽  
pp. 1084-1091
Author(s):  
Seung Kug Baik ◽  
Ungbae Jeon ◽  
Ki Seok Choo ◽  
Yong-Woo Kim ◽  
Kyung Pil-Park
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Protection Device ◽  
Complete Occlusion ◽  
Embolic Protection Device ◽  
Real Risk ◽  
Proximal Internal Carotid Artery ◽  
Protection Devices ◽  
Distal Protection ◽  
Occluded Segment

Abstract BACKGROUND: There is a theoretical concern that a thrombus may be dislodged distally when crossing the occluded segment during recanalization of a complete occlusion. OBJECTIVE: To assess the immediate postprocedural brain diffusion-weighted image (DWI) findings following endovascular recanalization using an embolic protection device for proximal internal carotid artery (ICA) occlusion. MATERIALS AND METHODS: We retrospectively identified 12 patients who underwent stent implantation for sudden symptomatic occlusion of the proximal ICA. In 8 patients, no additional intracranial occlusions were identified. In 4 patients, an additional intracerebral thrombus was detected in the middle cerebral artery. Distal protection devices were used in all cases. We evaluated the presence and amount of retrieved embolic fragments in the distal protection devices. The incidence and location of postprocedural emboli were determined using DWI. RESULTS: Recanalization of the proximal ICA was achieved in all patients. After complete occlusion of the proximal ICA was demonstrated, primary passage of the embolic protection device through the occluded ICA was gently navigated in 7 patients. However, this was not possible in 5 patients. Three patients developed new lesions on postprocedural DWI. Of the 12 patients in which distal protection devices were used, debris was detected in 7 patients. CONCLUSION: In endovascular revascularization of proximal ICA occlusion, postprocedural emboli occur less frequently than reported in a systematic review of the DWI literature. The real risk of dislodging thrombi appears to be from plaque fragment mobilization by angioplasty, rather than from crossing an occluded segment.

scholarly journals A case of tandem stenoses at the proximal common and internal carotid arteries treated with transbrachial stenting: a case report

2018 ◽  
Vol 25 (2) ◽  
pp. 225-229
Author(s):  
Hidemichi Ito ◽  
Masashi Uchida ◽  
Taigen Sase ◽  
Yuichiro Kushiro ◽  
Tetsuya Ikeda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Common Carotid Artery ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Protection Device ◽  
Embolic Protection Device ◽  
Embolic Protection ◽  
Carotid Stenoses ◽  
The Common

The transfemoral approach is a common technique for carotid artery stenting. However, it has the risk of distal embolism when stenting for a stenosis of the proximal common carotid artery because of poor stability of the guiding catheter resulting in difficulty in setting the embolic protection device prior to stenting. We present a novel therapeutic approach and technique for the treatment of tandem carotid stenoses including the proximal common carotid artery. A 63-year-old man presented with double stenoses at the common carotid artery and internal carotid artery. We used a transbrachial sheath guide that had a 6 Fr (2.24 mm, 0.088 inch) internal diameter and was 90 cm long, and was specifically designed for direct cannulation to the common carotid artery, like a modified Simmons catheter. Because the sheath guide positioned in the aortic arch made it possible to introduce safely the embolic protection device distal to the internal carotid artery stenosis without touching the plaque at the stenosis with no use of any coaxial catheters or guidewires, carotid artery stenting for tandem stenoses could be successfully carried out. The postoperative course was uneventful. In carotid artery stenting, especially for stenosis of the proximal common carotid artery, the sheath guide designed for transbrachial carotid cannulation was useful in stenting the tandem carotid stenoses.

Abstract P540: Safety of Carotid Artery Stenting Without Embolic Protection: A Single Centre Experience

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Christine Hawkes ◽  
Aviraj Deshmukh ◽  
Brian van Adel
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Atheromatous Plaque ◽  
Stroke Rate ◽  
Protection Device ◽  
Single Centre ◽  
Stent Occlusion ◽  
Embolic Protection Device ◽  
Embolic Protection

Introduction: One of the most feared complications of carotid revascularization, including carotid artery stenting (CAS), is peri-procedural ischemic stroke. Several studies suggest that the use of a distal embolic protection device (EPD), as well as over-sized pre- and post-stenting balloon angioplasty, may increase the risk of dislodgement of atheromatous plaque in patients undergoing CAS. The CREST trial, that mandated the use of an EPD, had a peri-procedural ischemic stroke rate of 4.1%. We hypothesize that our technique of stenting without the use of an EPD and sub-maximal angioplasty will have a low risk of peri-procedural complications. Methods: A retrospective review was conducted of consecutive cases of ICA stenting without use of an embolic protection device between January 2012 and June 2020 at a Canadian stroke centre. Data was extracted from the patient electronic medical record and Picture Archives and Communications Systems (PACS). Both symptomatic and asymptomatic CAS cases were included. Results: A total of 220 patients were included in the study, with a median age of 70 years (range 39-93 years), and 83 patients (38%) were female. The vast majority of patients were symptomatic (216 patients [98%]). A large portion of patients had a contralateral ICA occlusion or near occlusion (56 patients [25%]). In the majority of cases, a Precise Cordis RX carotid stent (Cordis) was placed. There were four patients with peri-procedural ischemic strokes (1.8%), with two occurring 8-30 days after stenting. There was one case of acute stent occlusion associated with an ischemic stroke. Two patients (less than 1%) had hyperperfusion syndrome after CAS. Median length of stay following the procedure was one day. Conclusions: In this single centre series, the peri-procedural risks of CAS without using an EPD are low. The ischemic stroke rate is less than 2%, lower than what has been reported in large randomized controlled trials using embolic protection.

scholarly journals Retinal artery occlusion during carotid artery stenting with distal embolic protection device

2018 ◽  
Vol 31 (5) ◽  
pp. 504-508 ◽  
Author(s):  
Kotaro Kohara ◽  
Tatsuya Ishikawa ◽  
Tomonori Kobayashi ◽  
Takakazu Kawamata
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
External Carotid Artery ◽  
External Carotid ◽  
Protection Device ◽  
Embolic Protection Device ◽  
Retinal Artery

Retinal artery occlusion associated with carotid artery stenosis is well known. Although it can also occur at the time of carotid artery stenting, retinal artery occlusion via the collateral circulation of the external carotid artery is rare. We encountered two cases of retinal artery occlusion that were thought to be caused by an embolus from the external carotid artery during carotid artery stenting with a distal embolic protection device for the internal carotid artery. A 71-year-old man presented with central retinal artery occlusion after carotid artery stenting using the Carotid Guardwire PS and a 77-year-old man presented with branch retinal artery occlusion after carotid artery stenting using the FilterWire EZ. Because additional new cerebral ischaemic lesions were not detected in either case by postoperative diffusion-weighted magnetic resonance imaging, it was highly likely that the debris that caused retinal artery occlusion passed through not the internal carotid artery but collaterals to retinal arteries from the external carotid artery, which was not protected by a distal embolic protection device. It is suggested that a distal protection device for the internal carotid artery alone cannot prevent retinal artery embolisation during carotid artery stenting and protection of the external carotid artery is important to avoid retinal artery occlusion.

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