A Case of Intraprocedural Plaque Protrusion during Carotid Artery Stenting Using the Stent-in-Stent Technique for Carotid Artery Stenosis with Unstable Plaque

Carotid artery atherosclerotic disease impacts over 2 million Americans annually. Since the advent of the carotid endarterectomy by Debakey in 1953, the surgical management of carotid artery stenosis has prevented cerebrovascular accidents. The technology utilized to manage carotid artery stenosis continued to evolve with the utilization of carotid artery stenting in 1989 and more recently transcarotid artery revascularization (TCAR). This review discusses the modern management of carotid artery stenosis with an emphasis on transcarotid artery revascularization (TCAR) and reversal of flow for reversal of flow for embolic protection.

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Changes on Cognitive Function after Carotid Artery Stenting in Patients with Severe Carotid Artery Stenosis: A Prospective, 3 Months Follow-up Study

Journal of the Korean Geriatrics Society ◽

10.4235/jkgs.2012.16.1.12 ◽

2012 ◽

Vol 16 (1) ◽

pp. 12-20 ◽

Cited By ~ 1

Author(s):

Ji Yoon Kang ◽

Hye Suk Kim ◽

Myung-Jin Kang ◽

Dae-Hyun Kim ◽

Jae-Kwan Cha ◽

...

Keyword(s):

Cognitive Function ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Artery Stenosis ◽

Follow Up Study

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The role of transfemoral carotid artery stenting with proximal balloon occlusion embolic protection in the contemporary endovascular management of carotid artery stenosis

Journal of Vascular Surgery ◽

10.1016/j.jvs.2020.02.036 ◽

2020 ◽

Vol 72 (5) ◽

pp. 1701-1710 ◽

Cited By ~ 1

Author(s):

Patric Liang ◽

Peter Soden ◽

Mark C. Wyers ◽

Mahmoud B. Malas ◽

Brian W. Nolan ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Balloon Occlusion ◽

Artery Stenosis ◽

Endovascular Management ◽

Embolic Protection

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The Early Effect of Carotid Artery Stenting on Antioxidant Capacity and Oxidative Stress in Patients with Carotid Artery Stenosis

Oxidative Medicine and Cellular Longevity ◽

10.1155/2016/1789596 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Slawomir Michalak ◽

Wojciech Ambrosius ◽

Ewa Wysocka ◽

Mieczyslaw Dziarmaga ◽

Robert Juszkat ◽

...

Keyword(s):

Carotid Artery ◽

Antioxidant Capacity ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Antioxidant Defense ◽

Artery Stenosis ◽

Sulfhydryl Groups ◽

Early Effect ◽

Spectrophotometric Methods ◽

And Oxidative Stress

The treatment of carotid artery stenosis is associated with the risk of complications, which may include stroke after carotid artery stenting (CAS) and myocardial infarction after carotid endarterectomy (CEA). The imbalance between prooxidative mechanisms and antioxidant capacity creates a milieu of factors, which may increase the risk of complications after endovascular procedures. We have examined 43 consecutive patients with carotid artery stenosis. Sera were analyzed for the activity of paraoxonase (PON) and arylesterase (ARE), sulfhydryl groups (SG), malondialdehyde (MDA), and conjugated dienes (CD) concentrations by means of spectrophotometric methods before and next day after CAS. We have found lowered PON (P=0.0032), increase in ARE activity (P=0.0058), and decrease in sulfhydryl groups concentration (P=0.0267). No effect on absolute MDA and CD concentrations was observed. The degree of carotid artery stenosis correlated negatively with PON/ARE ratio after CAS (rS= −0.507,P=0.0268). To conclude, CAS influences both enzymatic (differently, PON and ARE activity) and nonenzymatic antioxidant defense. Females are more susceptible to lipid peroxidation after CAS. PON/ARE ratio after CAS correlated with the degree of carotid artery stenosis. The changes (deltas) in ARE activity, SG, and MDA concentrations correlated with the severity of neurological deficit and disability.

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Carotid Endarterectomy Versus Stenting: A Meta-Analysis of Randomized Trials

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100011380 ◽

2011 ◽

Vol 38 (2) ◽

pp. 230-235 ◽

Cited By ~ 29

Author(s):

Daniel Yavin ◽

Derek J. Roberts ◽

Michael Tso ◽

Garnette R. Sutherland ◽

Misha Eliasziw ◽

...

Keyword(s):

Myocardial Infarction ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Meta Analysis ◽

Artery Stenosis ◽

Cranial Neuropathy ◽

Cardiac Complications ◽

Lower Odds

Background:A meta-analysis of randomized controlled trials (RCTs) was conducted to update the available evidence on the safety and efficacy of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) in the treatment of carotid artery stenosis.Methods:A comprehensive search was performed of MEDLINE, EMBASE, CENTRAL, bibliographies of included articles and past systematic reviews, and abstract lists of recent scientific conferences. For each reported outcome, a Mantel-Haenszel random-effects model was used to calculate odds ratios (ORs) and 95% confidence intervals (CI). The I2 statistic was used as a measure of heterogeneity.Results:Twelve RCTs enrolling 6,973 patients were included in the meta-analysis. Carotid artery stenting was associated with a significantly greater odds of periprocedural stroke (OR 1.72, 95% CI 1.20 to 2.47) and a significantly lower odds of periprocedural myocardial infarction (OR 0.47, 95% CI 0.29 to 0.78) and cranial neuropathy (OR 0.08, 95% CI, 0.04 to 0.16). The odds of periprocedural death (OR 1.11, 95% CI 0.56 to 2.18), target vessel restenosis (OR 1.95, 95% CI 0.63 to 6.06), and access-related hematoma were similar following either intervention (OR 0.60, 95% CI 0.30 to 1.21).Conclusions:In comparison with CEA, CAS is associated with a greater odds of stroke and a lower odds of myocardial infarction. While the results our meta-analysis support the continued use of CEA as the standard of care in the treatment of carotid artery stenosis, CAS is a viable alternative in patients at elevated risk of cardiac complications.

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