Choice of cerebral protection devices for carotid stenting

The article analyzes a retrospective analysis of long-term results of 316 carotid stentings performed in patients with atherosclerotic stenosis of the extracranial parts of the internal carotid arteries using various types of cerebral protection devices – filters and proximal protection devices and their combinations. As a result of the analysis, we obtained data on the influence of the choice of cerebral protection devices on the risks of ischemic complications. The topic under consideration will be of interest to specialists in X-ray endovascular diagnostics and treatment, cardiovascular surgeons, and neurologists.

The combined use of proximal and distal protection devices uring carotid stenting: A case report

<p>Despite the development of modern medical technologies, cerebrovascular disease remains a major health and social issue. Among all the cases of ischemic stroke, approximately 20% are attributable to stenotic lesions in the carotid artery. The main drawback of carotid stenting is the risk of embolic complications during the procedure. To resolve this problem, various devices that protect against embolism have been developed. In this clinical case, we describe the ability to minimize the risk of operative stroke through a combined application of the distal and proximal protection systems in carotid stenting.</p><p>In our patient, a 65-year-old woman, angiography of the carotid arteries revealed an ulcerated atherosclerotic plaque of the right internal carotid artery, with stenosis of the lumen of up to 95%. Considering the high risk of distal embolism, the Mo MaUltra (Italy) proximal protection system was used. When evaluating the installation of the Mo MaUltra system, the preserved blood flow through the superior thyroid artery and, therefore, the antegrade blood flow in the internal carotid artery was revealed. Considering the identified risk and the anatomy of the plaque surface, we decided on the additional use of the distal SpiderFX (USA) protection device.</p><p>The combined use of proximal protection system and distal protective device for carotid stenting is technically possible and may reduce the risk of embolic complications.</p><p>Received 23 January 2019. Revised 18 March 2019. Published 23 April 2019.</p><p><strong>Informed consent:</strong> The patient’s informed consent to use the records for medical purposes is obtained.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

Preliminary Experience With Proximal Flow Reversal During Intracranial Balloon Angioplasty and Stenting for Symptomatic, Severe Intracranial Stenosis

INTRODUCTION The frequency of balloon-angioplasty and stenting for symptomatic intracranial stenosis was drastically reduced after publication of the negative SAMMPRIS trial. In part, this was due to a higher than expected periprocedural complication rate (14.7% 30-d stroke or death) compared to maximal medical therapy (5.8%). Although the cause of periprocedural stroke was not defined, intraprocedural artery-to-artery embolism is a likely contributor. The Silk Road ENROUTE Transcarotid Neuroprotection System (TCNS) was designed as an alternative revascularization strategy for carotid bifurcation disease. It provides direct transcarotid access and proximal protection through flow reversal. We adapted this system as a proximal protection strategy for balloon angioplasty and stenting of severe, symptomatic intracranial stenosis. METHODS From May-2017 to May-2019, 7 patients underwent intracranial balloon angioplasty and stenting for symptomatic intracranial stenosis using the TCNS. Baseline demographics, comorbidities, procedure-related parameters, and outcomes were assessed. RESULTS A total of 7 patients (mean age 63, SEM 4.7 yr, 57% female) with severe (84% +/− 5%) supraclinoid internal carotid artery (ICA) and/or M1 stenosis presented with recurrent strokes (86% left sided) despite dual antiplatelet therapy (DAPT). Angiographically, cessation or reversal of flow was seen in the supraclinoid ICA in all patients, with confirmation by transcranial doppler in selected cases, after the institution of flow reversal by the TCNS. A noncompliant balloon was used to perform submaximal angioplasty, followed by stenting with intracranial stents. All procedures were technically successful with no evidence of periprocedural thromboembolic complications. Follow-up ranged from 6 to 12 mo. One patient suffered a fatal reperfusion hemorrhage on POD 3. One patient suffered from a minor recurrent stroke at 7 mo (after the cessation of DAPT) and was restarted on DAPT. CONCLUSION Traditional methods of intracranial balloon angioplasty and stenting suffer from high periprocedural ischemic stroke rates. TCNS can be adapted to provide a means of proximal protection during the treatment of these high-risk lesions. This procedural innovation warrants further investigation.