scholarly journals Carotid Artery Stenting and Its Impact on Cognitive Function: A Prospective Observational Study

2020 ◽  
Vol 15 (2) ◽  
pp. 74-78
Author(s):  
Avinash N Gupta ◽  
Amit A Bhatti ◽  
Mudasir M Shah ◽  
Niranjan P Mahajan ◽  
Divya K Sadana ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Therapeutic Option ◽  
Carotid Revascularization ◽  
Single Center Study ◽  
Before And After ◽  
Delayed Complications ◽  
Lost To Follow Up

Purpose: Carotid artery stenting (CAS) has evolved as a first-line therapeutic option for carotid revascularization in indicated patients for stroke prevention, but there is still a lack of data on its effect on cognitive function (CF), especially among Indian patients. To determine the effect of CAS on CF and to study the immediate and delayed complications of CAS in Indian patients.Materials and Methods: This was a prospective, observational, single-center study. CF was assessed using Addenbrooke’s cognitive examination version III (ACE) before and 3 months after stenting. The demographic and clinical parameters were also assessed. A follow-up evaluation after 3 months was done to compare CF and to observe the occurrence of any complications.Results: Out of 31 patients, 3 were lost to follow up. There were no immediate or delayed procedure-related complications. There was a statistically significant improvement in overall ACE score and memory before and after stenting. On subgroup analysis of those with and without strokes, there was a significant improvement in visuospatial function and mean ACE score. Those with left CAS had significant improvement in memory, visuospatial, language, and ACE scores than right CAS.Conclusion: CAS was associated with significant improvement in CF in patients.

scholarly journals Carotid artery stenting has similar outcomes in men and women

2021 ◽  
Vol 20 ◽  
Author(s):  
Marina Ansuategui ◽  
Gabriela Ibarra ◽  
Carmen Romero ◽  
Alejandra Comanges ◽  
Jose A. Gonzalez-Fajardo
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Risk ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Therapeutic Option ◽  
Stent Patency ◽  
Cerebrovascular Events ◽  
Long Term Follow Up

Abstract Background The aim of carotid interventions is to prevent cerebrovascular events. Endovascular treatment (carotid-artery-stenting/CAS) has become established as an alternative to open surgery in some cases. Historically, female sex has been considered as a perioperative risk factor, however, there are few studies regarding this hypothesis when it comes to CAS. Objectives To analyze the CAS results in our center adjusted by sex. Methods A retrospective cohort study was designed, including patients with carotid atheromatosis operated at a single center from January 2016 to June 2019. Our objective was to compare cardiovascular risk, including myocardial infarction, stroke, and mortality, by sex. Follow-up rates of stent patency, restenosis, stroke, myocardial infarction, and death were reported. Results 71 interventions were performed in 50 men (70.42%) and 21 women (29.57%). Mean age was 70.50 ± 10.72 years for men and 73.62 ± 11.78 years for women. Cardiovascular risk factors did not differ significantly between sexes. Mean follow-up was 11.28 ± 11.28 months. There were no significant differences in neurological events during follow-up. No adverse cardiological events were detected at any time. Regarding the mortality rate, during medium-term follow up there were 2 neurological related deaths with no significant differences between sexes (p=0.8432). Neither sex had higher rated of restenosis during long term follow-up (5.63% vs. 1.41%, p = 0.9693) or reoperation (1.41% vs. 1.41%, p = 0.4971). All procedures remained patent (<50% restenosis). Conclusions Despite the limitations of our study, CAS is a therapeutic option that is as effective and safe in women as in men. No sex differences were observed.

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

Carotid Artery Stenting for Stenosis following Revascularization or Cervical Irradiation

2002 ◽  
Vol 9 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Pierre Alric ◽  
Pascal Branchereau ◽  
Jean-Philippe Berthet ◽  
Henri Mary ◽  
Charles Marty-Ané
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Balloon Dilation ◽  
Safe Alternative ◽  
Carotid Revascularization ◽  
Elapsed Time ◽  
Carotid Stenoses ◽  
Radiation Induced ◽  
The Mean

Purpose: To assess the safety and efficacy of carotid artery stenting (CAS) for stenosis following revascularization or cervical irradiation. Methods: Twenty-two CAS procedures performed on 21 patients (20 men; mean age 69.3 years, range 58–87) from June 1997 to June 2000 were retrospectively reviewed. There were 5 radiation-induced carotid stenoses in 4 patients and 17 postsurgical restenoses. The mean interval between carotid revascularization and CAS was 48.1 months (range 6–264), while the elapsed time from irradiation to CAS was always >8 years (range 8–28). Seven patients screened during this period were excluded from CAS because of a duplex-defined >50% hypoechoic lesion and/or angiographic documentation of an irregular ulcerated stenosis. Results: Four Palmaz and 16 Wallstents were successfully deployed in 20 arteries; 1 access failure prompted conversion to surgery and a stent delivery failure resulted in 1 patient receiving balloon dilation only (technical success 91%). No complications were encountered in the periprocedural period, and no neurological events were observed during a mean follow-up of 16.6 months (range 3–36). One patient died at 20 months from an unrelated cause. One (4.8%) restenosis was detected after 1 year in the patient who did not receive a stent. Conclusions: CAS is a safe alternative to conventional surgery in patients with carotid artery stenosis following surgical revascularization or cervical irradiation provided preoperative testing excludes stenoses at risk for embolism.

scholarly journals Intermediate Clinical Follow Up Results of Carotid Artery Stenting: Single Center Study

2013 ◽  
Vol 3 (2) ◽  
pp. 65-71
Author(s):  
Ahmet Goktug ERTEM ◽  
Ramazan Akdemir ◽  
Harun Kilic ◽  
Ekrem Yeter
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Single Center ◽  
Single Center Study ◽  
Center Study

Abstract TP126: Ocular Circulation in Carotid Artery Stenosis Treated by CEA or CAS

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Shoichiro Kawaguchi ◽  
Hisanobu Kurioka
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Color Doppler ◽  
Artery Stenosis ◽  
Color Doppler Flow Imaging ◽  
Carotid Revascularization ◽  
Ocular Circulation ◽  
Before And After ◽  
Revascularization Surgery

Background: The authors evaluated the effect of carotid artery revascularization surgery for ocular circulation and chronic ocular ischemic syndrome (OIS). Methods: The authors examined ninety-3 patients with carotid artery stenosis (more than 50% stenosis) at its origin treated by carotid endarterectomy (N=58) or carotid artery stenting (N=34). Twenty-six patients (28%) complained of chronic OIS evaluated by the ophthalmic examination. Ocular circulation was examined before and after revascularization surgery using ophthalmic artery (OphAr) and central retinal artery (CRA) color Doppler flow imaging. Results: 1) Ocular circulation: Preoperatively, the average OphAr peak systolic flow velocity (Vs) was 0.05 m/sec, and the average CRA Vs was 0.07 m/sec. At 1 week after surgery, the average OphAr Vs significantly increased to 0.32 ( p < 0.05), and the average CRA Vs significantly increased to 0.11 m/sec ( p < 0.05). These significant improvements were sustained throughout the three months of the follow up.2) OIS: During the follow-up period (mean: 3.6 years), 16 patients (62%) showed visual acuity improvement, and no patients complained of amaurosis fugax or worsening of the chronic OIS. Conclusion: Carotid revascularization surgery was effective in improving the ocular circulation, and it was also useful for the chronic OIS due to the carotid artery stenosis.

scholarly journals Is diabetes a marker of higher risk after carotid revascularization? Experience from a single centre

2018 ◽  
Vol 15 (4) ◽  
pp. 314-321 ◽  
Author(s):  
Renato Casana ◽  
Chiara Malloggi ◽  
Andrea Odero ◽  
Valerio Tolva ◽  
Richard Bulbulia ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Transient Ischaemic Attack ◽  
Carotid Artery Stenting ◽  
Single Centre ◽  
Carotid Revascularization ◽  
Patients With Diabetes ◽  
Single Centre Study ◽  
Ischaemic Attack

Purpose: This single centre study investigates the influence of diabetes mellitus on outcomes following carotid artery endarterectomy or stenting. Methods: In total, 752 carotid revascularizations (58.2% carotid artery stenting and 41.8% carotid endarterectomy) were performed in 221 (29.4%) patients with diabetes and 532 (70.6%) patients without diabetes. The study outcomes were death, disabling and non-disabling stroke, transient ischaemic attack and restenosis within 36 months after the procedure. Results: Patients with diabetes had higher periprocedural risk of any stroke or death (3.6% diabetes vs 0.6% no diabetes; p < 0.05), transient ischaemic attack (1.8% diabetes vs 0.2% no diabetes; p > 0.05) and restenosis (2.7% diabetes vs 0.6% no diabetes; p < 0.05). During long-term follow-up, there were no significant differences in Kaplan–Meier estimates of freedom from death, any stroke and transient ischaemic attack, between people with and without diabetes for each carotid artery stenting and carotid endarterectomy subgroup. Patients with diabetes showed higher rates of restenosis during follow-up than patients without diabetes (36-months estimate risk of restenosis: 21.2% diabetes vs 12.5% no diabetes; p < 0.05). Conclusion: The presence of diabetes was associated with increased periprocedural risk, but no further additional risk emerged during longer term follow-up. Restenosis rates were higher among patients with diabetes.

Abstract 3: Restenosis following Carotid Artery Stenting and Endarterectomy in the Carotid Revascularization Endarterectomy versus Stenting Trial

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Brajesh K Lal ◽  
Kirk W Beach ◽  
Gary S Roubin ◽  
Helmi L Lutsep ◽  
Wesley S Moore ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Proportional Hazards ◽  
Peak Systolic Velocity ◽  
Composite Endpoint ◽  
Carotid Revascularization ◽  
Repeat Revascularization ◽  
Kaplan Meier ◽  
Additional Procedure

Objectives The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) showed no difference in the composite endpoint of stroke, myocardial infarction, or death between carotid artery stenting (CAS) and carotid endarterectomy (CEA) in patients with symptomatic or asymptomatic carotid stenosis (CS). We compared restenosis or occlusion, and repeat revascularization, between CAS and CEA over 2 years of follow-up. Methods Restenosis, occlusion, and repeat revascularization were assessed at 1, 6, 12 and 24 months post-randomization. Hemodynamically significant restenosis (≥70% diameter reduction) was defined by a peak systolic velocity (PSV) ≥300 cm/second on standardized duplex ultrasonography (DUS), occlusion by an absence of flow within the target artery on DUS, and repeat revascularization by any additional procedure (CEA, angioplasty or CAS) performed on the index artery. Studies were performed in CREST-certified laboratories and interpreted in the CREST Ultrasound Core Lab. Patients included in this report were those who received their assigned treatment within 30 days of randomization and had an ultrasound reviewed at the Core Lab (n=2191). Treatment differences were assessed using proportional hazards models adjusting for age, sex, and symptomatic status. Results In the analytic cohort, 1086 patients received CAS and 1105 received CEA. Over 2 years 113 patients developed restenosis, 56 (rate 5.8%) in the CAS group and 57 (rate 5.8%) in the CEA group; and 8 developed an occlusion, 3 (rate 0.3 %) in the CAS group and 5 (rate 0.5%) in the CEA group. The combined restenosis-occlusion rate was 6.0% (n=58) for CAS and 6.3% (n=62) for CEA (HR=0.90, 95% CI=0.63-1.29, p=0.58). Forty-three patients of the 2191 underwent repeat revascularization (20 CAS, 23 CEA, p=0.69) of which 28 had restenosis by our criteria and so were included ( Figure ). Stroke occurred in 13 (4 CAS; 9 CEA) of the 120 patients with restenosis or occlusion; 1 of the 4 CAS strokes occurred after restenosis was detected, and 5 of 9 CEA strokes occurred after restenosis was detected. Conclusions This analysis of carotid restenosis is the largest reported to date from any randomized clinical trial. Restenosis and occlusion were infrequent and similar up to 2 years following CAS or CEA among 2191 patients. The rates of revascularization likewise did not differ between CAS and CEA. Follow-up out to 10 years is ongoing. Figure. Kaplan-Meier curves of restenosis and occlusion over 2 years.

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