scholarly journals Stenting of ultraembolic hazardous carotid stenotic lesions using the technique of triple antiembolic protection

2021 ◽  
Vol 36 (2) ◽  
pp. 14-24
Author(s):  
Yu.V. Cherednichenko ◽  
M.O. Zorin ◽  
A.Yu Miroshnichenko ◽  
N.O. Cherednichenko
Keyword(s):  
Carotid Stenosis ◽  
Clinical Signs ◽  
Carotid Stenting ◽  
Early Postoperative Period ◽  
Ischemic Brain ◽  
Protection Systems ◽  
Carotid Stenoses ◽  
Distal Protection ◽  
The Brain

Objective ‒ to develop a technique of triple antiembolic protection with the simultaneous use of proximal antiembolic protection systems, distal antiembolic filters and two-layer micromesh carotid stents for carotid stenting of ultraembolic hazardous carotid stenosis. Evaluate its effectiveness and safety.Materials and methods. Since 2016, 23 carotid stenting of ultraembolic hazardous carotid stenoses has been performed using the technique of triple antiembolic protection (proximal antiembolic protection systems, distal antiembolic filters and two-layer micromesh carotid stents). All patients had symptomic stenosis: transient ischemic attacks in a certain carotid pool (n = 7), ischemic strokes (n = 16). The age of patients was from 57 to 84 years. Men prevailed among patients (n = 15). Postoperative follow-up included magnetic resonance imaging (MRI) of the brain on the first or second day after surgery with T2*, FLAIR and DWI sequences to determine the presence of «fresh» embolic ischemic foci and to exclude hemorrhagic complications. After 6 months, a control clinical examination, computed tomography or MRI of the brain, ultrasound angioscanning of the main arteries of the head were performed.Results. In all patients the patency of the carotid arteries was completely restored, and in the early postoperative period, no clinical signs of recurrent ischemic brain damage were detected in any of the cases. No signs of plaque prolapse through the stent were detected in any case. A significant amount of atheromatous debris was in 11 cases when aspirated on an external filter. In 3 cases, emboli were also detected in the distal protection filter. This fact indicates that the joint use of distal and proximal antiembolic systems reliably protects against the risk of embolism in such cases. According to MRI on the 1st or 2nd day there were no signs of «fresh» subclinical embolic ischemic foci, as well as hemorrhage. In 20 patients who underwent a follow-up examination, no signs of restenosis in the stent were recorded in any case, as well as repeated ischemic strokes. In 7 cases where the plaque had an ulcer, the ulcer resolved under the stent. Three patients are expected for a follow-up examination. According to the remote survey, these patients do not have new ischemic brain lesions. The effectiveness of the technique of triple antiembolic protection for the treatment of patients with subtotal ultraembolic hazardous carotid stenosis is indicated by the absence of clinical and neuroradiological signs of recurrent ischemic lesions.Conclusions. The technique of triple antiembolic protection for the treatment of patients with subtotal ultraembolic hazardous carotid stenoses is safe and highly effective. It is the improvement of carotid stenting results in this most dangerous group that gives reason to think about revealing the advantages of carotid stenting over carotid endarterectomy in general.

LOW INCIDENCE OF SYMPTOMATIC STROKES AFTER CAROTID STENTING WITHOUT EMBOLIZATION PROTECTION DEVICES FOR EXTRACRANIAL CAROTID STENOSIS

Neurosurgery ◽  
2008 ◽  
Vol 63 (5) ◽  
pp. 867-873 ◽  
Author(s):  
Aditya S. Pandey ◽  
Christopher J. Koebbe ◽  
Kenneth Liebman ◽  
Robert H. Rosenwasser ◽  
Erol Veznedaroglu
Keyword(s):  
Carotid Stenosis ◽  
Controlled Trial ◽  
Carotid Stenting ◽  
Published Data ◽  
Cerebrovascular Accidents ◽  
Period 2 ◽  
In Series ◽  
Protection Devices ◽  
Low Incidence

Abstract OBJECTIVE Carotid angioplasty and stenting (CAS) remains the primary modality of treating individuals with carotid stenosis and significant comorbidities or anatomically difficult lesions. The use of embolization protection devices (EPD) has been mandated by the cerebrovascular community even though the ability of these devices to prevent symptomatic strokes is not supported by the current literature. Our goal was to assess the clinical and radiological outcomes of patients who underwent CAS without EPDs at our hospital from 1996 to 2006. METHODS We performed a retrospective chart analysis of all patients who underwent CAS without EPDs at the Jefferson Hospital for Neuroscience in Philadelphia, PA. The clinical and angiographic outcomes of these patients were studied retrospectively using chart reviews and operative, angiographic, and radiological reports. The mean clinical and radiological follow-up period was 18.6 months. RESULTS One hundred five patients (97.2%) had clinical follow-up at 1 month. During this period, the following complications were observed: cerebrovascular accidents in 2 patients (1.9%), myocardial infarctions in 2 patients (1.9%), femoral hematoma in 1 patient (0.9%), retroperitoneal hematomas in 3 patients (2.8%), and cervical carotid dissections in 4 patients (3.7%); 2 patients (1.9%) died. Seventy-six patients (80.9%) had a mean clinical follow-up period of 18.6 months. During this period, 2 patients (2.6%) had cerebrovascular accidents, 1 of which was fatal. The long-term morbidity and mortality rate was 2.6%. In the same follow-up period, the restenosis (>50% stenosis from baseline) rate was 9.2% (7 patients). Three (3.9%) of these patients went on to require repeat CAS. CONCLUSION Our experience reveals that CAS can be performed safely with risks similar to those reported in series in which EPDs were used. Any procedure or device that adds risk and cost to the patient should be evaluated with a randomized, controlled trial to evaluate its efficacy, especially in situations in which published data provide conflicting results. The use of EPDs should be no exception to this paradigm.

scholarly journals EARLY COMPLICATIONS IN BARIATRIC SURGERY:

2013 ◽  
Vol 50 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Marco Aurelio SANTO ◽  
Denis PAJECKI ◽  
Daniel RICCIOPPO ◽  
Roberto CLEVA ◽  
Flavio KAWAMOTO ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Severe Obesity ◽  
Gastric Bypass Surgery ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Early Postoperative Period ◽  
Morbidly Obese ◽  
Early Complications ◽  
Appropriate Treatment

ContextBariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control.MethodThe medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery) were reviewed. Ninety-three (17.2%) patients were male and 445 (82.8%) were female. The ages of the patients ranged from 18 to 70 years (average = 46), and their body mass indices ranged from 34.6 to 77 kg/m2.ResultsEarly complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5%) patients experienced pulmonary thromboembolism. The mortality rate was 0,55%.ConclusionThe incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years.

scholarly journals Treatment of carotid stenosis: surgery and stent in comparison

2021 ◽  
Vol 23 (Supplement_E) ◽  
pp. E91-E94
Author(s):  
Rocco Giudice ◽  
Claudio Spataro
Keyword(s):  
Endovascular Treatment ◽  
Carotid Stenosis ◽  
Carotid Stenting ◽  
Perioperative Outcomes ◽  
Controlled Clinical Trials ◽  
Safe Alternative ◽  
Symptomatic Carotid ◽  
Asymptomatic Patients ◽  
Symptomatic Carotid Stenosis

Abstract Carotid stenosis in the extracranial tract determines 10–15% of all ischaemic strokes. The aim of treatment, therefore, is to prevent major neurological events. Carotid endarterectomy surgery has proved effective in this regard, with various randomized studies that have demonstrated its validity in both symptomatic and asymptomatic patients. As an alternative, since the late 1990s, the endovascular treatment of carotid stenosis by stenting has gradually established itself. Numerous controlled clinical trials have compared surgery and carotid stenting in terms of perioperative outcomes (death, stroke, and myocardial infarction within 30 days of the procedure) and stroke prevention ipsilateral to the lesion treated during follow-up, evaluating both symptomatic and asymptomatic patients. From the systematic review of the data, it is legitimate to state that stenting may represent a safe alternative to conventional surgery in patients with symptomatic carotid stenosis under the age of 70, while endarterectomy is clearly safer and more effective than endovascular treatment for symptomatic older patients. On the other hand, as regards asymptomatic patients, the available evidence is limited and further data are needed to compare the two methods and to compare them with the best current medical therapy in order to draw conclusions.

scholarly journals Carotid Stenting in Asymptomatic Carotid Stenosis: The Calgary Experience

2010 ◽  
Vol 37 (5) ◽  
pp. 568-573 ◽  
Author(s):  
N. Shobha ◽  
M. A. Almekhlafi ◽  
A. Pandya ◽  
P. L. Couillard ◽  
W. F. Morrish ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Medical Center ◽  
Carotid Stenting ◽  
Minor Stroke ◽  
Safe Procedure ◽  
Asymptomatic Group ◽  
Symptomatic Group ◽  
Asymptomatic Patients

Background:Although carotid endarterectomy is considered the ‘gold standard’ for standard risk symptomatic patients, the treatment of choice for asymptomatic patients remains controversial. Carotid stenting has demonstrated real-world outcomes consistent with established guidelines for carotid endarterectomy in asymptomatic high-surgical risk patients in recent prospective multicenter trials. We describe our experience with asymptomatic patients who underwent carotid stenting at our center in a routine clinical setting.Methods:This is a retrospective, longitudinal cohort study of patients who underwent carotid angioplasty and stenting at the Foothills Medical Center, Calgary, Canada between 1997 and 2007. The qualifying events were categorized as symptomatic and asymptomatic. The procedures were performed by four experienced neurointerventionists. The primary outcome was stroke or death at 30-day follow- up.Results:243 patients underwent 255 carotid stenting procedures. Their ages ranged from 50 to 83 years; the mean age was 72.0 ± 9.3 years; 67(26.3%) were women. Forty one patients (16.1%) were asymptomatic; 214 patients (83.9%) were symptomatic. The patients in the asymptomatic group were significantly younger - 66.0 ± 8.8 years compared to patients in the symptomatic group 73.2 ± 8.9 years (p<0.0001). Intraprocedurally one minor stroke (2.4%) occurred in the asymptomatic group. At 30-day follow-up, no deaths or further strokes were noted in the asymptomatic group; while eight deaths, six major and seven minor strokes occurred in the symptomatic group (p=0.22).Conclusion:Carotid stenting appears to be a safe procedure in asymptomatic patients with severe carotid stenosis in routine clinical settings as witnessed in this single center study.

scholarly journals Tandem cervical carotid stenting for stenosis with flow diversion embolisation for the treatment of intracranial aneurysms

2018 ◽  
Vol 4 (1) ◽  
pp. 43-47 ◽  
Author(s):  
Jessica K Campos ◽  
Li-Mei Lin ◽  
Narlin B Beaty ◽  
Matthew T Bender ◽  
Bowen Jiang ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Intracranial Aneurysms ◽  
Single Case ◽  
Carotid Stenting ◽  
Thromboembolic Complications ◽  
Carotid Disease ◽  
Case Presentation ◽  
Access System ◽  
Unruptured Intracranial Aneurysms

BackgroundAn estimated 2%–3% of the population harbour an intracranial aneurysm. Concomitant atherosclerotic cervical carotid disease is not uncommon. The management of these two entities remains a challenge within the field.Case presentationWe report a single case of concomitant carotid stenosis and two ipsilateral unruptured intracranial aneurysms treated with a single-staged cervical carotid stenting and cerebral aneurysm embolisation with the Pipeline embolisation device.DiscussionNo consensus currently exists to guide endovascular treatment of intracranial aneurysms associated with asymptomatic ipsilateral stenosis. Here, we present a case of asymptomatic moderate carotid stenosis with two ipsilateral intracranial aneurysms and suggest carotid artery stenting takes procedural priority over aneurysm embolisation in single-stage treatment. The rationale for the sequence of neurointerventions is based on the tracking a robust distal access system beyond a stenotic proximal carotid lesion and stabilisation of the ulcerated plaque to avoid thromboembolic complications associated with plaque irritation during aneurysm embolisation. Additional cases and longer follow-up will be needed to further assess the efficacy of this technique.

scholarly journals The Asymptomatic Carotid Surgery Trial-2 (ACST-2): an ongoing randomised controlled trial comparing carotid endarterectomy with carotid artery stenting to prevent stroke

2017 ◽  
Vol 21 (57) ◽  
pp. 1-40 ◽  
Author(s):  
Richard Bulbulia ◽  
Alison Halliday
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Controlled Trial ◽  
Carotid Stenting ◽  
Carotid Surgery ◽  
Asymptomatic Carotid ◽  
Randomised Controlled ◽  
Surgery Trial

Background A successful open surgical operation to remove atheromatous carotid artery narrowing that has not yet caused a stroke (asymptomatic carotid stenosis) carries some procedural risk but, if completed successfully, halves patients’ future annual stroke risk for at least 10 years. A newer, less invasive alternative is carotid stenting, which also carries some procedural risk, especially if the carotid lesion has recently given rise to a stroke (symptomatic carotid stenosis). For both surgery and stenting, improvements in technique (and in medication) have reduced risk. Early studies showed that treating carotid narrowing by stenting, particularly for symptomatic lesions, caused more procedural minor strokes than surgery, but more recent trials in symptomatic and in asymptomatic patients found that both procedures might now be equally safe and effective. However, low patient numbers, short follow-up of the long-term effects on stroke rates and wide confidence intervals mean that worldwide uncertainty persists between carotid surgery and carotid stenting, and national and international guidelines remain unclear as to which is generally better. Objectives The second Asymptomatic Carotid Surgery Trial (ACST-2) compares carotid endarterectomy (CEA) with carotid artery stenting (CAS) directly, randomising patients with asymptomatic carotid stenosis for whom a carotid procedure is considered definitely necessary; both procedures seem anatomically feasible, and there is substantial uncertainty as to which of the two would be better for such individuals. Although it will compare procedural risks, the trial’s primary aim is to compare the long-term durability of protection against strokes occurring in the years post procedure due to any remaining or recurrent carotid disease. Design Randomised controlled trial comparing CEA with CAS. Setting Hospitals in the UK and worldwide, in which carotid procedures are common. Participants Men and women with severely stenotic atherosclerotic carotid artery disease, with or without previous stroke but with no recent symptoms from the randomised artery. Interventions CEA and CAS. Outcomes (1) Periprocedural risk defined as myocardial infarction, stroke or death within 30 days after the randomised procedure and (2) long-term rates of disabling or fatal stroke during follow-up of patients. Measurement of costs and outcomes Measurement of intervention costs and stroke costs (periprocedural and during follow-up) and of quality of life [EuroQol-5 Dimensions (EQ-5D®)] for patients in the top six recruiting countries (UK, Italy, Belgium, Germany, Serbia and Sweden), who currently constitute 85% of those randomised. Progress so far By the end of March 2016, ACST-2 had included 2125 patients, nearly two-thirds of the planned recruitment of 3600; 1061 were randomly allocated to CEA and 1064 to CAS. Conclusions Further funding has been secured and recruitment continues, with completion anticipated by the end of 2019. ACST-2 will report initial results in 2021. Trial registration Current Controlled Trials ISRCTN21144362. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 57. See the NIHR Journals Library website for further project information. Funding was also received from BUPA Foundation [BUPAF/33(a)/05].

Monitoring Criteria of Intracranial Lesions in Children Post Mild or Moderate Head Trauma

2018 ◽  
Vol 49 (06) ◽  
pp. 385-391
Author(s):  
Sergio Boetto ◽  
Annick Sevely ◽  
Jean-Christophe Sol ◽  
Yves Chaix ◽  
Emmanuel Cheuret ◽  
...  
Keyword(s):  
Head Trauma ◽  
Treatment Guidelines ◽  
Clinical Symptoms ◽  
Late Onset ◽  
Brain Lesion ◽  
Clinical Signs ◽  
Duration Of Hospitalization ◽  
Intracranial Lesions ◽  
The Brain

AbstractHead injury is the most common cause of child traumatology. However, there exist no treatment guidelines in children having intracranial lesions due to minor or moderate head trauma. There is little knowledge about monitoring, clinical exacerbation risk factors, or optimal duration of hospitalization. The aim of this retrospective study is to find predictive factors in the clinical course of non-severe head trauma in children, and thus to determine an optimal management strategy. Poor clinical progress was observed in only 4 out of 113 children. When there are no clinical signs and no eating disorders, an earlier discharge is entirely appropriate. Nevertheless, persistent clinical symptoms including headache, vomiting, and late onset seizure, especially in conjunction with hemodynamic disorders such as bradycardia, present a risk of emergency neurosurgery or neurological deterioration. Special attention should be paid to extradural hematoma (EDH) of more than 10 mm, which can have the most severe consequences. Clinical aggravation does not necessarily correlate with a change in follow-up imaging. Conversely, an apparent increase in the brain lesion on the scan is not consistently linked to a pejorative outcome.

Longitudinal Changes in Individual BrainAGE in Healthy Aging, Mild Cognitive Impairment, and Alzheimer’s Disease

GeroPsych ◽  
2012 ◽  
Vol 25 (4) ◽  
pp. 235-245 ◽  
Author(s):  
Katja Franke ◽  
Christian Gaser
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Healthy Aging ◽  
Brain Aging ◽  
Elderly Subjects ◽  
Additional Increase ◽  
Longitudinal Changes ◽  
Novel Method ◽  
The Brain

We recently proposed a novel method that aggregates the multidimensional aging pattern across the brain to a single value. This method proved to provide stable and reliable estimates of brain aging – even across different scanners. While investigating longitudinal changes in BrainAGE in about 400 elderly subjects, we discovered that patients with Alzheimer’s disease and subjects who had converted to AD within 3 years showed accelerated brain atrophy by +6 years at baseline. An additional increase in BrainAGE accumulated to a score of about +9 years during follow-up. Accelerated brain aging was related to prospective cognitive decline and disease severity. In conclusion, the BrainAGE framework indicates discrepancies in brain aging and could thus serve as an indicator for cognitive functioning in the future.

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