scholarly journals Symptomatic patients with intraluminal carotid artery thrombus: outcome with a strategy of initial anticoagulation

2013 ◽  
Vol 118 (1) ◽  
pp. 34-41 ◽  
Author(s):  
Ananth K. Vellimana ◽  
Yasha Kadkhodayan ◽  
Keith M. Rich ◽  
DeWitte T. Cross ◽  
Christopher J. Moran ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Medical Therapy ◽  
Anticoagulation Therapy ◽  
Retrospective Chart Review ◽  
Perioperative Period ◽  
Carotid Revascularization ◽  
Long Term Follow Up ◽  
Ischemic Attack ◽  
Angioplasty And Stenting

Object The aim of this study was to define the optimal treatment for patients with symptomatic intraluminal carotid artery thrombus (ICAT). Methods The authors performed a retrospective chart review of patients who had presented with symptomatic ICAT at their institution between 2001 and 2011. Results Twenty-four patients (16 males and 8 females) with ICAT presented with ischemic stroke (18 patients) or transient ischemic attack ([TIA], 6 patients). All were initially treated using anticoagulation with or without antiplatelet drugs. Eight of these patients had no or only mild carotid artery stenosis on initial angiography and were treated with medical management alone. The remaining 16 patients had moderate or severe carotid stenosis on initial angiography; of these, 10 underwent delayed revascularization (8 patients, carotid endarterectomy [CEA]; 2 patients, angioplasty and stenting), 2 refused revascularization, and 4 were treated with medical therapy alone. One patient had multiple TIAs despite medical therapy and eventually underwent CEA; the remaining 23 patients had no TIAs after treatment. No patient suffered ischemic or hemorrhagic stroke while on anticoagulation therapy, either during the perioperative period or in the long-term follow-up; 1 patient died of an unrelated condition. The mean follow-up was 16.4 months. Conclusions Results of this study suggest that initial anticoagulation for symptomatic ICAT leads to a low rate of recurrent ischemic events and that carotid revascularization, if indicated, can be safely performed in a delayed manner.

Treatment of Carotid Restenosis Using Transcarotid Revascularization

2020 ◽  
Vol 54 (5) ◽  
pp. 436-440
Author(s):  
S. Keisin Wang ◽  
Alexander H. King ◽  
Vikram S. Kashyap ◽  
Mazin I. Foteh ◽  
Ravi N. Ambani ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Perioperative Period ◽  
Carotid Revascularization ◽  
Stent Restenosis ◽  
Postoperative Hematoma ◽  
United States Food ◽  
Hospital Systems ◽  
States Food ◽  
Clinically Significant

Objective: Transcarotid artery revascularization (TCAR) using the ENROUTE Neuroprotection System (Silk Road Medical) is a United States Food and Drug Administration–approved treatment modality for stroke risk reduction in the setting of carotid artery stenosis. The goal of this investigation was to define the real-world outcomes associated with the application of this technique to patients presenting with restenosis after previous carotid endarterectomy (CEA) or transfemoral carotid artery stenting (TF-CAS). Methods: Retrospective review of prospectively maintained institutional databases capturing all nontrial TCARs performed between August 2013 and July 2018 using the ENROUTE Neuroprotection System was completed at 3 unaffiliated hospital systems and unified for descriptive outcomes analysis. Results: During the study period, 237 combined TCARs were performed at our respective institutions. Of these procedures, 55 stents were implanted for the indication of restenosis after previous carotid revascularization (47 CEA, 8 TF-CAS). Within the 30-day perioperative period, we observed no ipsilateral strokes or deaths; one patient experienced perioperative myocardial infarction (MI; 1.8%). We noted a 4.8% incidence of postoperative hematoma, but none of these events were clinically significant as no reinterventions were performed in any of the 55 patients. Additionally, we did not observe any cases of stent thrombosis or pulmonary embolus. Mean length of stay was 2.2 ± 2.8 days. Our mean follow-up duration was 15.0 ± 9.2 months. Throughout the follow-up period, we did not observe any additional stroke or MI events. Additionally, there were no cases of in-stent restenosis, thrombosis, or reinterventions. Conclusion: Transcarotid artery revascularization can be performed in patients with restenotic carotid arteries with acceptable rates of ipsilateral stroke, MI, and death as demonstrated in this small multi-institutional series.

Carotid Artery Stenting

2019 ◽  
Author(s):  
Craig Weinkauf ◽  
Wei Zhou
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
New Technology ◽  
Current Data ◽  
Carotid Revascularization ◽  
Long Term Follow Up ◽  
Stroke Death

In addition to medical therapy and carotid endarterectomy (CEA), carotid artery stenting (CAS) is a treatment option for carotid stenosis. Multi-centered clinical trials showed that CAS has a similar composite outcome of stroke, death, and MI to CEA.  However,  CAS has a higher stroke complication than CEA.  Although controversy remains regarding appropriate patient selection for CAS, consensus is that CAS is a good option in patients who need an intervention and are at high risk for endarterectomy. New technology, techniques, and treatments continue to develop with resultant controversy and slow changes in practice.  Although long-term follow-up is still needed. current data showed Transcarotid Carotid Revascularization (TCAR) has similar perioperative stroke risk compared to CEA, suggesting TCAR is a promising technique for CAS. This review 11 figures, 3 tables, and 36 references. Key Words: carotid artery angiogram, carotid artery stenting, carotid endarterectomy, Carotid Revascularization Endarterectomy versus Stenting Trial, cerebrovascular disease, transcarotid artery revascularization

Carotid Artery Stenting

2019 ◽  
Author(s):  
Craig Weinkauf ◽  
Wei Zhou
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
New Technology ◽  
Current Data ◽  
Carotid Revascularization ◽  
Long Term Follow Up ◽  
Stroke Death

In addition to medical therapy and carotid endarterectomy (CEA), carotid artery stenting (CAS) is a treatment option for carotid stenosis. Multi-centered clinical trials showed that CAS has a similar composite outcome of stroke, death, and MI to CEA.  However,  CAS has a higher stroke complication than CEA.  Although controversy remains regarding appropriate patient selection for CAS, consensus is that CAS is a good option in patients who need an intervention and are at high risk for endarterectomy. New technology, techniques, and treatments continue to develop with resultant controversy and slow changes in practice.  Although long-term follow-up is still needed. current data showed Transcarotid Carotid Revascularization (TCAR) has similar perioperative stroke risk compared to CEA, suggesting TCAR is a promising technique for CAS. This review 11 figures, 3 tables, and 36 references. Key Words: carotid artery angiogram, carotid artery stenting, carotid endarterectomy, Carotid Revascularization Endarterectomy versus Stenting Trial, cerebrovascular disease, transcarotid artery revascularization

Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

2020 ◽  
pp. 112067212097604
Author(s):  
Reem R Al Huthail ◽  
Yasser H Al-Faky
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Nasal Endoscope ◽  
Long Term Follow Up ◽  
Mean Size ◽  
External Dacryocystorhinostomy ◽  
The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

scholarly journals Percutaneous transluminal angioplasty and stenting for recurrent carotid artery stenosis

1998 ◽  
Vol 5 (6) ◽  
pp. E7
Author(s):  
Giuseppe Lanzino ◽  
Robert A. Mericle ◽  
Demetrius K. Lopes ◽  
Ajay K. Wakhloo ◽  
Lee R. Guterman ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Artery Stenosis ◽  
Cardiac Complications ◽  
Neurological Event ◽  
Angioplasty And Stenting ◽  
Percutaneous Transluminal

Percutaneous transluminal angioplasty (PTA) and stenting has recently been proposed as an alternative to surgical reexploration in patients with recurrent carotid artery stenosis following endarterectomy. The authors retrospectively reviewed their experience after performing 25 procedures in 21 patients to assess the safety and efficacy of PTA with or without stenting for carotid artery restenosis. The mean interval between endarterectomy and the endovascular procedure was 57 months (range 8-220 months). Seven arteries in five patients were treated by PTA alone (including bilateral procedures in one patient and repeated angioplasty in the same vessel in another). Early suboptimum results and recurrent stenosis in some of these initial cases prompted the authors to combine PTA with stenting in the treatment of 18 arteries over the past 3 years. No major periprocedural deficits (neurological or cardiac complications) or death occurred. There was one periprocedural transient neurological event. A pseudoaneurysm of the femoral artery (at the access site) required surgical repair. In the 16 patients who each underwent at least 6 months of follow-up review, no neurological events ipsilateral to the treated artery had occurred after a mean follow-up period of 27 months (range 6-57 months). Three of five patients who underwent PTA alone developed significant (> 50%) asymptomatic restenoses that required repeated angioplasty in one and PTA with stenting in two patients. Significant restenosis (55%) was observed in only one of the vessels treated by combined angioplasty with stenting. Endovascular PTA and stenting of recurrent carotid artery stenosis is both technically feasible and safe and has a satisfactory midterm patency. This procedure can be considered a viable alternative to surgical reexploration in patients with recurrent carotid artery stenosis.

Effect of Open- vs Closed-Cell Stent Design on Periprocedural Outcomes and Restenosis After Carotid Artery Stenting: A Systematic Review and Comprehensive Meta-analysis

2018 ◽  
Vol 25 (4) ◽  
pp. 523-533 ◽  
Author(s):  
Pavlos Texakalidis ◽  
Stefanos Giannopoulos ◽  
Damianos G. Kokkinidis ◽  
Giuseppe Lanzino
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Stent Design ◽  
Open Cell ◽  
Stent Restenosis ◽  
Closed Cell ◽  
Ischemic Attack ◽  
In Stent Restenosis

Purpose:To compare periprocedural complications and in-stent restenosis rates associated with open- vs closed-cell stent designs used in carotid artery stenting (CAS). Methods: A systematic search was conducted to identify all randomized and observational studies published in English up to October 31, 2017, that compared open- vs closed-cell stent designs in CAS. Identified studies were included if they reported the following outcomes: stroke, transient ischemic attack (TIA), myocardial infarction (MI), hemodynamic depression, new ischemic lesions detected on imaging, and death within 30 days, as well as the incidence of in-stent restenosis. A random-effects model meta-analysis was employed. Model results are reported as the odds ratio (OR) and 95% confidence interval (CI). The I2 statistic was used to assess heterogeneity. Results: Thirty-three studies (2 randomized trials) comprising 20, 291 patients (mean age 71.3±3.0 years; 74.6% men) were included. Patients in the open-cell stent group had a statistically significant lower risk of restenosis ⩾40% (OR 0.42, 95% CI 0.19 to 0.92; I2=0%) and ⩾70% (OR 0.23, 95% CI 0.10 to 0.52; I2=0%) at a mean follow-up of 24 months. No statistically significant differences were identified for periprocedural stroke, TIA, new ischemic lesions, MI, hemodynamic depression, or death within 30 days after CAS. Sensitivity analysis of the 2 randomized controlled trials only did not point to any significant differences either. Conclusion: Use of open-cell stent design in CAS is associated with a decreased risk for restenosis when compared to the closed-cell stent, without significant differences in periprocedural outcomes.

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