scholarly journals Minimizing Distal Embolization During Carotid Artery Stenting

2019 ◽  
Vol 12 (4) ◽  
pp. 404-405 ◽  
Author(s):  
Debabrata Mukherjee ◽  
Marco Roffi
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Distal Embolization

Reduction of cerebral DWI lesion burden after carotid artery stenting using the CASPER stent system

2018 ◽  
Vol 11 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Erasmia Broussalis ◽  
Christoph Griessenauer ◽  
Sebastian Mutzenbach ◽  
Slaven Pikija ◽  
Hendrik Jansen ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Antiplatelet Agents ◽  
Protection Device ◽  
Median Length ◽  
Distal Embolization ◽  
Stent System ◽  
Single Operator ◽  
Excellent Functional Outcome

IntroductionDespite various measures to protect against distal embolization during carotid artery stenting (CAS), periprocedural ischemic lesions are still encountered.ObjectiveTo evaluate the periprocedural cerebral diffusion weighted imaging (DWI) lesion burden after CASPER stent placement.MethodsPatients who underwent CAS using the CASPER stent system were reviewed. Degrees of carotid stenosis and plaque configuration were determined. All patients were pretreated with dual antiplatelet agents and cerebral pre- and postprocedural MRI was obtained. All CAS procedures were performed by a single operator.ResultsA total of 110 patients with severe carotid artery stenosis (median degree of stenosis 80%, median length of stenosis 10 mm) were treated with CAS. Hypoechogenic or heterogeneous, mostly hypoechogenic, plaques were documented in 48.6% (52/107) of patients. Carotid ulceration was present in 15.9% (17/107). Postprocedurally, 7.3% (8/110) of patients were found to have ischemic DWI lesions. They were asymptomatic in all patients. Follow-up at 90 days was available in 88.2% (97/110) of patients with excellent functional outcome (modified Rankin Scale score 0–1) in 95.9% (93/97).ConclusionCarotid artery stenting using the new CASPER stent in combination with a distal embolic protection device is safe and results in a lower rate of periprocedural DWI lesion burden compared with reported results for historic controls.

scholarly journals Mobility of an in-stent plaque protrusion detected with carotid duplex during the carotid artery stenting procedure: a case report

2019 ◽  
Vol 21 (1) ◽  
pp. 89 ◽  
Author(s):  
Kanta Tanaka ◽  
Takamichi Kitagawa ◽  
Norikazu Yamana ◽  
Yoshinori Akiyama
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Risk Estimation ◽  
Distal Embolization ◽  
Stent Deployment ◽  
Potential Value ◽  
Carotid Duplex ◽  
Ischemic Complications ◽  
Stenting Procedure

In-stent plaque protrusion (ISP) is a predictor for ischemic complications in carotid artery stenting (CAS). Because its mobility would further increase the distal embolization risk, the intraprocedural detection of mobility is important but has not yet been reported. We present an 87-year-old male with symptomatic right carotid artery stenosis who underwent CAS. Intravascular ultrasound (IVUS) after stent deployment revealed a small ISP, and simultaneous extravascular carotid duplex disclosed its mobility. After coverage of the ISP with stent-in-stent implantation, no remaining protrusion was observed with either IVUS or carotid duplex. The patient experienced no periprocedural strokes. Carotid duplex is suited to evaluate targets’ movement because of its excellent temporal resolution. Carotid duplex has potential value for intraprocedural risk estimation of ISP.

The Effect of Embolic Protection Filters on Distal Embolization and Slow Flow Condition in Carotid Artery Stenting

2007 ◽  
Author(s):  
Gail M. Siewiorek ◽  
Ender A. Finol
Keyword(s):  
Carotid Artery ◽  
Flow Rate ◽  
Carotid Artery Stenting ◽  
Carotid Artery Disease ◽  
The United States ◽  
Distal Embolization ◽  
Embolic Protection ◽  
Distal Perfusion ◽  
Protection Filter

Strokes are the third leading cause of death in the United States today. Carotid artery stenting (CAS) used in conjunction with a cerebral protection device (CPD) is a current alternative treatment for severe carotid artery disease. A type of CPD, an embolic protection filter (EPF), has received attention recently due to its allowance of distal perfusion during use. This investigation studied the effects of four EPFs (Spider RX, FilterWire EZ, RX Accunet, Emboshield) on both pressure gradient and flow rate in the internal carotid artery (ICA) in vitro. Dyed polymer microspheres larger than the pore size of the devices tested were injected into the ICA of a 70% stenosed carotid artery model. The percentage of particles missed was calculated. None of the devices tested were able to completely prevent embolization. Emboshield had the least desirable performance (missing 35.4% of particles) while Spider RX had the best (missing 0.06%). A decrease in flow rate and an increase in pressure drop were seen after the device was filled with particles. From these results, it is inferred that improper wall apposition is the primary cause for inadequate capture efficiency rates, which may lead to an increase in distal embolization and stroke.

Distal embolization during intracranial carotid artery stenting

2008 ◽  
Vol 71 (6) ◽  
pp. 740-743 ◽  
Author(s):  
Osami Kawarada ◽  
Yoshiaki Yokoi ◽  
Makoto Izuta
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Distal Embolization

Aortic calcification on plain chest radiography predicts embolic complications during carotid artery stenting

2008 ◽  
Vol 35 (S 01) ◽  
Author(s):  
K Wasser ◽  
K Gröschel ◽  
S.M Pilgram ◽  
U Ernemann ◽  
S Schnaudigel ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Chest Radiography ◽  
Carotid Artery Stenting ◽  
Aortic Calcification ◽  
Plain Chest
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