scholarly journals Carotid Stenting for Treatment of Symptomatic Carotid Webs: A Single-Center Case Series

2018 ◽  
Vol 7 (5) ◽  
pp. 233-240 ◽  
Author(s):  
Waleed Brinjikji ◽  
Ronit Agid ◽  
Vitor M. Pereira
Keyword(s):  
Stent Placement ◽  
Case Series ◽  
Carotid Bifurcation ◽  
Posterior Wall ◽  
Carotid Stenting ◽  
Filling Defect ◽  
Stroke Recurrence ◽  
Single Center ◽  
Recurrence Rates ◽  
Symptomatic Carotid

Background and Purpose: Carotid webs are an increasingly recognized cause of acute is­chemic stroke, particularly in younger adults. The optimal medical and surgical strategies for managing these lesions have not been well established. We report a single-center case series of carotid stenting for treatment of symptomatic carotid webs. Materials and Methods: Consecutive patients undergoing stent placement for treatment of symptomatic carotid webs were included. Carotid webs were defined as a thin intraluminal filling defect along the posterior wall of the carotid bulb just beyond the carotid bifurcation on CTA. Data were collected on demographic characteristics, antiplatelet management, clinical presentation, imaging findings, treatment characteristics, complications, and stroke recurrence rates. Descriptive statistics are reported. Results: A total of 4 patients were treated. Their mean age was 44 years (range 30–50). Three patients were female and 1 was male. All patients were symptomatic presenting with ipsilateral transient ischemic attacks or stroke. Patients were placed on dual antiplatelet therapy with ticagrelor and aspirin prior to the procedure. There were no ischemic or hemorrhagic complications. Three patients had postoperative bradycardia, 1 of whom required atropine immediately following stenting. No patients had recurrent ischemic events. Conclusions: Stent placement for treatment of carotid webs can be performed safely. Further studies are needed to confirm our findings.

A Case Series of 18 Patients Receiving Ticagrelor After Carotid Stenting

2017 ◽  
Vol 31 (5) ◽  
pp. 519-521 ◽  
Author(s):  
Elizabeth M. Olafson ◽  
Jodi R. DeGrote ◽  
Alexander Drofa ◽  
Evgueni Kouznetsov ◽  
Michael Manchak ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Stent Placement ◽  
Case Series ◽  
Carotid Stenting ◽  
Carotid Stent ◽  
Promising Alternative ◽  
End Point ◽  
P2y12 Receptor Antagonist ◽  
Thrombotic Complications ◽  
Endovascular Stent Placement

Purpose: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor antagonist is often used to prevent thrombotic complications after endovascular stent placement. Most of the published experience surrounding DAPT after carotid stenting is with clopidogrel. Ticagrelor may be a promising alternative, especially in patients who may be considered nonresponders to clopidogrel. However, clinical outcomes utilizing DAPT with ticagrelor in a cohort with carotid stenting is lacking. In this case series, we describe our experience with systematic prescribing of ticagrelor after carotid stent placement in 18 patients. Methods: A retrospective review of 18 patients prescribed ticagrelor who underwent carotid stenting between November 2015 and January 2017 was performed. All eligible patients were included in the review. The primary end point of interest was any ischemic stroke or death within 30 days following the procedure. Intracranial hemorrhage was a secondary end point. Results and Conclusions: No patients experienced the primary end point of ischemic stroke or death within 30 days. No intracranial hemorrhages were observed. The use of ticagrelor after carotid stenting may be a reasonable alternative to clopidogrel after carotid stent placement. Randomized trials to support our findings are needed.

scholarly journals Hemodynamic Impact of Stenting on Carotid Bifurcation: A Potential Role of the Stented Segment and External Carotid Artery

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Zhenmin Fan ◽  
Xiao Liu ◽  
Yingying Zhang ◽  
Nan Zhang ◽  
Xia Ye ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Adverse Events ◽  
Carotid Bifurcation ◽  
Posterior Wall ◽  
Carotid Stenting ◽  
External Carotid Artery ◽  
External Carotid ◽  
Flow Disturbance ◽  
Local Flow ◽  
Stent Length

Carotid stenting near the bifurcation carina is associated with adverse events, especially in-stent restenosis, thrombosis, and side branch occlusion in clinical data. This study is aimed at determining the potential biomechanical mechanisms for these adverse events after carotid stenting. The patient-specific carotid models were constructed with different stenting scenarios to study the flow distribution and hemodynamic parameters, such as wall shear stress (WSS), flow velocity, relative residence time (RRT), and oscillating shear index (OSI) in the carotid bifurcation. The results suggested that the existing stents surely reduced blood flow to the external carotid artery (ECA) but enhanced local flow disturbance both in ECA and stented internal carotid artery (ICA), and the inner posterior wall of the stented ICA and the outer posterior wall of ECA might endure a relatively low level of WSS and remarkably elevated OSI and RRT. In addition, the implanted stent leads to more ECA adverse flow than ICA after stenting. While disturbed flow near the strut increased as stent length increased, blood flow and areas of local flow disturbance in ECA slightly decreased as stent length increased. In conclusion, the results revealed that ECA might be in relatively high levels of abnormal local hemodynamics after stenting, followed by stented ICA, leading to potential adverse events after intervention.

scholarly journals Hemodynamic Impact of Stenting on Carotid Bifurcation: A Potential Role in the Stented Segment and External Carotid Artery

2021 ◽  
Author(s):  
Zhenmin Fan ◽  
Xiao Liu ◽  
Yingying Zhang ◽  
Nan Zhang ◽  
Xia Ye ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Adverse Events ◽  
Carotid Bifurcation ◽  
Posterior Wall ◽  
Carotid Stenting ◽  
External Carotid Artery ◽  
External Carotid ◽  
Flow Disturbance ◽  
Local Flow ◽  
Stent Length

Abstract Carotid stenting near the bifurcation carina is associated with adverse events, especially in-stent restenosis, in-stent thrombosis, and side branch occlusion in clinical data. This study aims to determine the potential biomechanical mechanisms for these adverse events after carotid stenting. The patient-specific carotid models were constructed with different stenting scenarios to study the flow distribution and hemodynamic parameters, such as wall shear stress (WSS), flow velocity, relative residence time (RRT), and oscillating shear index (OSI) in the carotid bifurcation. The results suggested that existing stent obviously reduced blood flow to external carotid artery (ECA) but enhanced local flow disturbance both in ECA and stented internal carotid artery (ICA), and the inner-posterior wall of stented ICA and the outer-posterior wall of ECA might endure a relatively low level of WSS and remarkably elevated OSI and RRT. In addition, the implanted stent leads to more ECA adverse flow than stented ICA. While disturbed flow in the vicinity of strut increased as stent length increased, blood flow and areas of local flow disturbance in ECA slightly decreased as stent length increased. In conclusion, the results revealed that ECA might be in relatively high levels of abnormal local hemodynamics after stenting, followed by stented ICA, leading to potential adverse events after interventions.

scholarly journals Carotid angioplasty and stenting for recurrent and radiation-induced stenosis: preliminary experience

1998 ◽  
Vol 5 (4) ◽  
pp. E16 ◽  
Author(s):  
Ronald P. Benitez ◽  
Rocco A. Armonda ◽  
James Harrop ◽  
Jeffrey E. Thomas ◽  
Robert H. Rosenwasser
Keyword(s):  
Carotid Endarterectomy ◽  
Stent Placement ◽  
Carotid Bifurcation ◽  
Occlusive Disease ◽  
Surgical Patient ◽  
Carotid Angioplasty ◽  
Asymptomatic Group ◽  
Symptomatic Carotid ◽  
Radiation Induced

Carotid endarterectomy for atherosclerotic occlusive disease has become the standard of care for the treatment of symptomatic and asymptomatic occlusive disease of the carotid bifurcation, based on the results of the North American Symptomatic Carotid Endarterectomy Trial, as well as the Asymptomatic Carotid Atherosclerosis Study. For surgical treatment to be of benefit, the perioperative complication rate for neurological events should be 6% or less in the symptomatic population and 3% or less in the asymptomatic group. The performance of carotid endarterectomy for recurrent stenosis and radiation-induced stenosis has reported neurological events ranging from 4 to 10%. It is in this particular population that carotid angioplasty and stent placement may play a role. The authors performed a retrospective analysis of 11 patients who underwent carotid angioplasty and stent placement for recurrent or radiation-induced stenosis. One patient in whom endarterectomy was performed by the vascular surgery service had a critical stenosis distal to the endarterectomy site and awoke with a neurological deficit. This patient underwent reexploration and placement of a stent in the artery distal to the arteriotomy site. The follow-up period ranged from 7 to 12 months. Patient age ranged from 65 to 77 years (mean 75 years). Five of eight patients underwent angioplasty and stent placement for recurrent atherosclerotic disease. Two patients had radiation-induced stenosis, and one patient had a stent placed intraoperatively. All patients, with the exception of the one who underwent intraoperative stent placement, had posttreatment stenoses of less than 15%. The surgical patient had a 30% residual stenosis distally. There were no intra- or postoperative transient ischemic attacks, major or minor strokes, or deaths. Patients who have recurrent or radiation-induced stenosis are potential candidates for angioplasty and stent placement. Before this can be recommended as an alternative to surgical correction, a longer follow-up period is required.

scholarly journals Multicenter Experience with Stenting for Symptomatic Carotid Web

2018 ◽  
Vol 7 (6) ◽  
pp. 413-418 ◽  
Author(s):  
Diogo C. Haussen ◽  
Jonathan A. Grossberg ◽  
Sebastian Koch ◽  
Amer Malik ◽  
Dileep Yavagal ◽  
...  
Keyword(s):  
Surgical Excision ◽  
Carotid Stenting ◽  
Functional Independence ◽  
Filling Defect ◽  
Conventional Angiography ◽  
Posterior Aspect ◽  
Symptomatic Carotid ◽  
Carotid Bulb ◽  
Ischemic Attack

Background: A carotid web (CaW) is a shelf-like lesion in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. CaW has been associated with recurrent strokes and conventionally treated with surgical excision. We report a multicenter experience of stenting in patients with symptomatic CaWs. Methods: Retrospective review of consecutive patients admitted to 5 comprehensive stroke centers who were identified to have a symptomatic CaW and treated with carotid stenting. A symptomatic CaW was defined by the presence of a shelf-like/linear, smooth filling defect in the posterior aspect of the carotid bulb diagnosed by neck CT angiography (CTA) and confirmed with conventional angiography in patients with negative stroke workup. Results: Twenty-four patients with stented symptomatic CaW were identified (stroke in 83% and transient ischemic attack in 17%). Their median age was 47 years (IQR 41–61), 14 (58%) were female, and were 17 (71%) black. The degree of stenosis by NASCET was 0% (range 0–11). All patients were placed on dual antiplatelets and stented at a median of 9 days (IQR 4–35) after the last event. Closed-cell stents were used in 18 (75%) of the cases. No periprocedural events occurred with the exception of 2 cases of asymptomatic hypotension/bradycardia. Clinical follow-up after stent placement occurred for a median of 12 months (IQR 3–19) with no new cerebrovascular events noted. Functional independence at 90 days was achieved in 22 (91%) patients. Follow-up vascular imaging (ultrasound n = 18/CTA n = 5) was performed at a median of 10 months (IQR 3–18) and revealed no stenosis. Conclusions: Stenting for symptomatic CaW appears to be a safe and effective alternative to surgical resection. Further studies are warranted.

Carotid Artery Pseudoaneurysm after Endovascular Stent Placement: Diagnosis and Follow-up Duplex Ultrasonography

2005 ◽  
Vol 29 (1) ◽  
pp. 28-32 ◽  
Author(s):  
Wei Zhou ◽  
Ruth L. Bush ◽  
Peter H. Lin ◽  
Megan D. Hodge ◽  
Deborah D. Felkai ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stent Graft ◽  
Stent Placement ◽  
Duplex Ultrasound ◽  
Carotid Bifurcation ◽  
Carotid Stenting ◽  
Duplex Scan ◽  
Artery Pseudoaneurysm ◽  
Endovascular Stent Placement

Purpose Carotid artery pseudoaneurysm development after endarterectomy, albeit rare, has been attributed to patch deterioration. We present an unusual case of pseudoaneurysm development 1 year after stent placement for recurrent carotid artery stenosis. Case Report A 64-year-old man had transient hemiparesis develop 1 week after carotid artery endarterectomy (CEA) with patch angioplasty for monocular transient ischemic attack. Carotid angiography reviewed an intimal flap at the distal endarterectomy site, which was successfully treated with carotid stent placement. During a duplex scan 1 year later, he was found to have a symptomatic 2.5-cm pseudoaneurysm at the level of stented carotid bifurcation. This was successfully treated with a combined open and endovascular approach, which consisted of stent-graft placement by means of an open carotid exposure. Completion angiogram showed successful stent-graft exclusion of the pseudoaneurysm. A follow-up duplex scan 6 months later demonstrated diminution of pseudoaneurysm size without endoleak. Conclusion This report highlights the importance of duplex ultrasound surveillance in patients with CEA or carotid stenting, because it can accurately detect recurrent stenosis or carotid pseudoaneurysm. Moreover, a combined open and endovascular therapy using stent graft successfully treated the carotid pseudoaneurysm in our patient.

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