Robotic‐assisted balloon angioplasty and stent placement with distal embolic protection device for severe carotid artery stenosis in a high‐risk surgical patient

2020 ◽  
Vol 96 (2) ◽  
pp. 410-412 ◽  
Author(s):  
Jon C. George ◽  
Luai Tabaza ◽  
Sean Janzer
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Balloon Angioplasty ◽  
Stent Placement ◽  
Carotid Artery Stenosis ◽  
Surgical Patient ◽  
Protection Device ◽  
Embolic Protection Device ◽  
Robotic Assisted ◽  
High Risk Surgical Patient

Cumulative incidence of restenosis in the endovascular treatment of extracranial carotid artery stenosis: a meta-analysis

2019 ◽  
Vol 11 (9) ◽  
pp. 916-923
Author(s):  
Pierre Clavel ◽  
Solène Hebert ◽  
Suzana Saleme ◽  
Charbel Mounayer ◽  
Aymeric Rouchaud ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Cumulative Incidence ◽  
Lower Risk ◽  
Meta Analysis ◽  
Artery Stenosis ◽  
Protection Device ◽  
Embolic Protection Device ◽  
Embolic Protection ◽  
Hostile Neck

ObjectiveTo assess the cumulative incidence of restenosis and stroke after stenting for cervical carotid artery stenosis.MethodsWe reviewed PubMed, ScienceDirect, and Scopus and included all studies reporting restenosis after stenting. The cumulative incidence of restenosis at 6 and 12 months was calculated. We also estimated the cumulative incidence of ipsilateral stroke within 30 days after stenting. Random effect meta-analysis and meta-regression were performed using relevant study level covariates. Sources of heterogeneity were investigated.ResultsAmong 7765 records, 40 studies were selected. 15 943 patients and 16 337 carotid arteries were considered. The overall pooled cumulative incidence of restenosis >50% at 12 months was 5.7% (95% CI 3.8% to 8.6%), >70% at 12 months was 5.2% (95% CI 3.3% to 8.2%), >50% at 6 months was 3.9% (95% CI 2.2% to 6.8%), and ipsilateral stroke within 30 days after stenting was 1.6% (95% CI 1.0% to 2.5%) without association with the use of an embolic protection device. We did not identify any relevant source of heterogeneity of the cumulative incidence of restenosis >50% at 12 months. Mean age explained 80.9% (R2=80.9%, p=0.01) of heterogeneities of restenosis >70% at 12 months. The presence of hostile neck explained 53.9% (R2=53.9%, p=0.03) of heterogeneities of restenosis >50% at 6 months.ConclusionThis meta-analysis showed a low cumulative rate of restenosis at 12 months and ipsilateral stroke within 30 days after stenting. Older patients and those with hostile neck present a lower risk of in-stent restenosis. The use of an embolic protection device was not associated with a lower risk of stroke.

Carotid artery stenosis: treatment with protected balloon angioplasty and stent placement.

Radiology ◽  
1996 ◽  
Vol 201 (3) ◽  
pp. 627-636 ◽  
Author(s):  
J G Theron ◽  
G G Payelle ◽  
O Coskun ◽  
H F Huet ◽  
L Guimaraens
Keyword(s):  
Carotid Artery ◽  
Balloon Angioplasty ◽  
Stent Placement ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis

Abstract P540: Safety of Carotid Artery Stenting Without Embolic Protection: A Single Centre Experience

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Christine Hawkes ◽  
Aviraj Deshmukh ◽  
Brian van Adel
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Atheromatous Plaque ◽  
Stroke Rate ◽  
Protection Device ◽  
Single Centre ◽  
Stent Occlusion ◽  
Embolic Protection Device ◽  
Embolic Protection

Introduction: One of the most feared complications of carotid revascularization, including carotid artery stenting (CAS), is peri-procedural ischemic stroke. Several studies suggest that the use of a distal embolic protection device (EPD), as well as over-sized pre- and post-stenting balloon angioplasty, may increase the risk of dislodgement of atheromatous plaque in patients undergoing CAS. The CREST trial, that mandated the use of an EPD, had a peri-procedural ischemic stroke rate of 4.1%. We hypothesize that our technique of stenting without the use of an EPD and sub-maximal angioplasty will have a low risk of peri-procedural complications. Methods: A retrospective review was conducted of consecutive cases of ICA stenting without use of an embolic protection device between January 2012 and June 2020 at a Canadian stroke centre. Data was extracted from the patient electronic medical record and Picture Archives and Communications Systems (PACS). Both symptomatic and asymptomatic CAS cases were included. Results: A total of 220 patients were included in the study, with a median age of 70 years (range 39-93 years), and 83 patients (38%) were female. The vast majority of patients were symptomatic (216 patients [98%]). A large portion of patients had a contralateral ICA occlusion or near occlusion (56 patients [25%]). In the majority of cases, a Precise Cordis RX carotid stent (Cordis) was placed. There were four patients with peri-procedural ischemic strokes (1.8%), with two occurring 8-30 days after stenting. There was one case of acute stent occlusion associated with an ischemic stroke. Two patients (less than 1%) had hyperperfusion syndrome after CAS. Median length of stay following the procedure was one day. Conclusions: In this single centre series, the peri-procedural risks of CAS without using an EPD are low. The ischemic stroke rate is less than 2%, lower than what has been reported in large randomized controlled trials using embolic protection.

Who is a high-risk surgical patient?

2018 ◽  
Vol 24 (6) ◽  
pp. 547-553 ◽  
Author(s):  
Somnath Bose ◽  
Daniel Talmor
Keyword(s):  
High Risk ◽  
Surgical Patient ◽  
High Risk Surgical Patient

scholarly journals An Ultrasound Model to Predict the Short-Term Effects of Endovascular Stent Placement in the Treatment of Carotid Artery Stenosis

2021 ◽  
Vol 7 ◽  
Author(s):  
Sheng-Jiang Chen ◽  
Rui-Rui Liu ◽  
Yi-Ran Shang ◽  
Yu-Juan Xie ◽  
Xiao-Han Guo ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stent Placement ◽  
Carotid Artery Stenosis ◽  
Resistance Index ◽  
Peak Systolic Velocity ◽  
Artery Stenosis ◽  
Endovascular Stent ◽  
Improvement Rate ◽  
Preoperative Ultrasound ◽  
Endovascular Stent Placement

Purpose: The present study aimed to explore the predictive ability of an ultrasound linear regression equation in patients undergoing endovascular stent placement (ESP) to treat carotid artery stenosis-induced ischemic stroke.Methods: Pearson's correlation coefficient of actual improvement rate (IR) and 10 preoperative ultrasound indices in the carotid arteries of 64 patients who underwent ESP were retrospectively analyzed. A predictive ultrasound model for the fitted IR after ESP was established.Results: Of the 10 preoperative ultrasound indices, peak systolic velocity (PSV) at stenosis was strongly correlated with postoperative actual IR (r = 0.622; P < 0.01). The unstable plaque index (UPI; r = 0.447), peak eccentricity ratio (r = 0.431), and plaque stiffness index (β; r = 0.512) moderately correlated with actual IR (P < 0.01). Furthermore, the resistance index (r = 0.325) and the dilation coefficient (r = 0.311) weakly correlated with actual IR (P < 0.05). There was no significant correlation between actual IR and the number of unstable plaques, area narrowing, pulsatility index, and compliance coefficient. In combination, morphological, hemodynamic, and physiological ultrasound indices can predict 62.39% of neurological deficits after ESP: fitted IR = 0.9816 – 0.1293β + 0.0504UPI – 0.1137PSV.Conclusion: Certain carotid ultrasound indices correlate with ESP outcomes. The multi-index predictive model can be used to evaluate the effects of ESP before surgery.

Contralateral High-Grade Carotid Artery Stenosis or Occlusion Is Not Associated with Increased Risk for Poor Neurologic Outcome after Elective Carotid Stent Placement

Radiology ◽  
2004 ◽  
Vol 230 (1) ◽  
pp. 70-76 ◽  
Author(s):  
Schila Sabeti ◽  
Martin Schillinger ◽  
Wolfgang Mlekusch ◽  
Tassilo Nachtmann ◽  
Wilfried Lang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stent Placement ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Neurologic Outcome ◽  
High Grade ◽  
Carotid Stent ◽  
Increased Risk
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