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.

scholarly journals Retrograde three-dimensional rotational angiography: A novel method for the detection of plaque protrusion during carotid artery stenting under continuous distal balloon protection

2020 ◽  
Vol 26 (3) ◽  
pp. 316-320
Author(s):  
Hisayuki Hosoo ◽  
Wataro Tsuruta ◽  
Yusuke Hamada ◽  
Masahiro Katsumata ◽  
Daiichiro Ishigami ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Balloon Dilatation ◽  
Three Dimensional ◽  
Additional Treatment ◽  
Stent Deployment ◽  
Ischemic Complications ◽  
Novel Method ◽  
Stent Lumen ◽  
Balloon Protection

Background To prevent ischemic complications during carotid artery stenting, accurate detection of plaque protrusion and appropriate additional treatment are essential. Here, we introduce a novel method for the detection of plaque protrusion under distal balloon protection using three-dimensional rotation angiography—“retrograde 3DRA.” We evaluated the safety and efficacy of this method. Materials and methods We retrospectively analyzed 28 consecutive carotid artery stenting procedures under distal balloon protection at our hospital between July 2017 and August 2019. The first line of protection was dual balloon protection (proximal and distal balloon). After stent deployment, balloon dilatation, and subsequent blood aspiration, 3DRA was performed with the injection of diluted contrast medium from the aspiration catheter positioned just proximal to the distal protection balloon. The stent lumen was analyzed by obtaining the reconstruction maximum intensity projection image. Results Among the 28 cases, all cases could be assessed for in-stent plaque protrusion using “retrograde 3DRA.” We were able to evaluate the stent lumen clearly. There were three cases (10.7%) in which plaque protrusion could be confirmed. Since additional balloon dilatation was performed for all protrusion cases under continuing balloon protection, no ischemic complications occurred. Conclusion Retrograde 3DRA could be safe and useful for the detection of plaque protrusions and to avoid ischemic complication for tolerable cases of internal carotid artery transient balloon protection.

scholarly journals Postoperative Cerebellar Infarction after Carotid Artery Stenting for Symptomatic Stenosis: A Case Report

2017 ◽  
Vol 45 (6) ◽  
pp. 483-487
Author(s):  
Takashi NAGATA ◽  
Yutaka MITSUHASHI ◽  
Taichiro KAWAKAMI ◽  
Toshiyuki SUGINO ◽  
Tsuyoshi INOUE ◽  
...  
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Cerebellar Infarction ◽  
Symptomatic Stenosis

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 Trends in Postoperative Carotid Duplex Surveillance Ultrasound After Carotid Artery Stenting

2020 ◽  
Vol 72 (1) ◽  
pp. e106
Author(s):  
Nathan Belkin ◽  
Alex Fairman ◽  
Scott Damrauer ◽  
Benjamin M. Jackson ◽  
Paul J. Foley ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Carotid Duplex
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