scholarly journals Internal Carotid Artery Stent Placement: Our Standard Technique

2006 ◽  
Vol 34 (3) ◽  
pp. 190-193 ◽  
Author(s):  
Yasushi MATSUMOTO ◽  
Masayuki EZURA ◽  
Ryuji KONDOH ◽  
Naoto KIMURA ◽  
Akira TAKAHASHI
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Internal Carotid ◽  
Standard Technique ◽  
Carotid Artery Stent

scholarly journals Open-Label Phase I Clinical Study to Assess the Safety and Efficacy of Cilostazol in Patients Undergoing Internal Carotid Artery Stent Placement

2016 ◽  
Vol 6 (1-2) ◽  
pp. 42-48
Author(s):  
Ameer E. Hassan ◽  
Haralabos Zacharatos ◽  
Mikayel Grigoryan ◽  
Wondwossen G. Tekle ◽  
Amir Khan ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Phase I ◽  
Stent Thrombosis ◽  
Stent Placement ◽  
Internal Carotid ◽  
Antiplatelet Drug ◽  
Open Label ◽  
End Point ◽  
Carotid Artery Stent

Background: One-month dual antiplatelet treatment, with aspirin and clopidogrel, following internal carotid artery stent placement is the current standard of care to prevent in-stent thrombosis. Cilostazol, an antiplatelet drug, has been demonstrated to have a safety profile comparable to aspirin and clopidogrel. Objective: To evaluate the safety and clinical efficacy of cilostazol and aspirin therapy following internal carotid artery stent placement up to 1 month postprocedure. Methods: A phase I open-label, nonrandomized two-center prospective study was conducted. All subjects received aspirin (325 mg/day) and cilostazol (200 mg/day) 3 days before extracranial stent placement. Two antiplatelet agents were continued for 1 month postprocedure followed by aspirin daily monotherapy. The primary efficacy end point was the 30-day composite occurrence of death, cerebral infarction, transient ischemic attack, and in-stent thrombosis. The primary safety end point was bleeding. Results: Twelve subjects (mean age ± SD, 66 ± 12 years; 9 males) were enrolled and underwent internal carotid artery angioplasty and stent placement. None of the subjects who successfully followed the study protocol experienced any complications at the 1- and 3-month follow-ups. One patient had a protocol deviation due to concurrent use of enoxaparin (1 mg/kg twice daily) in addition to aspirin and cilostazol, resulting in a fatal symptomatic intracerebral hemorrhage following successful stent placement on postprocedure day 1. One patient discontinued cilostazol after the first dose secondary to dizziness. Conclusion: The use of cilostazol and aspirin for internal carotid artery stent placement appears to be safe, but protocol compliance needs to be emphasized.

The Casper carotid artery stent: a unique all metal micromesh stent designed to prevent embolic release

2017 ◽  
Vol 10 (2) ◽  
pp. 133-136 ◽  
Author(s):  
Orlando Diaz ◽  
Gloria Lopez ◽  
John O F Roehm ◽  
Ginna De la Rosa ◽  
Fernando Orozco ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Carotid Artery Stenosis ◽  
Internal Carotid ◽  
Cone Beam Ct ◽  
Large Cell ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Carotid Artery Stent

BackgroundStroke due to the release of embolic debris during the placement of a stent to correct carotid artery stenosis is a constant procedural and peri-procedural threat. The new all metal Casper stent has been created with two layers of nitinol, the inner layer of which has pores diminutive enough to prevent embolic release.ObjectiveTo evaluate the safety, effectiveness, and utility of the double layer nitinol Casper carotid artery stent in the treatment of patients with severe carotid artery stenosis.Methods19 patients with severe internal carotid artery stenosis, 14 symptomatic and 5 asymptomatic, were treated with the Casper stent. After stent placement, angiographic and cone beam CT images were recorded in all patients.ResultsThe unique low profile delivery system allowed for easy stent placement, re-sheathing, and repositioning of the stent. The large cell external layer produced excellent apposition to the artery wall. The inner layer prevented prolapse of atherosclerotic debris through the device. Plaque coverage was achieved; residual stenosis ranged from 0% to 20%. Long term angiographic follow-up in 5 patients showed wall apposition of the device covering the lesion and no restenosis. There were no procedure related complications. Two patients experienced a delayed ischemic stroke, likely related to inconsistent medical management.ConclusionsThe Casper has been an excellent stent for the treatment of internal carotid artery stenosis and its internal micromesh layer has been effective in preventing plaque prolapse. It provides the flexibility of large cell stents and the inner layer provides maximum protection against plaque prolapse.

Internal carotid artery stent placement without emboli protection: Results and long-term outcome

Neurology ◽  
2005 ◽  
Vol 65 (1) ◽  
pp. 132-134 ◽  
Author(s):  
D. Bibl ◽  
C. Lampl ◽  
I. Biberhofer ◽  
K. Kerschner ◽  
A. Kypta ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Internal Carotid ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Carotid Artery Stent

scholarly journals Indications and Problems of Intracranial Stenting Report of Two Cases

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 149-154
Author(s):  
J. Deguchi ◽  
T. Kuroiwa ◽  
S. Nagasawa ◽  
G. Satoh ◽  
T. Ohta
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
External Force ◽  
Stent Placement ◽  
Internal Carotid ◽  
Total Occlusion ◽  
Intracranial Stenting ◽  
Linear Portion ◽  
Vertebrobasilar Artery ◽  
Intracranial Arteries

There have been few reports of stenting in the intracranial arteries. We used coronary stents in the chronically occluded intracranial vertebral artery and stenosis of internal carotid artery by the external force, and good blood flow were resumed. Stenosis in the intracranial arteries is also a good indication for stent placement when it is due to chronic total occlusion or artery compression by external force. But stent placement in the intracranial arteries has some problems. Stent placement in the intracranial artery is indicated only when the site of stent placement has a diameter of 3 mm or more, is a relatively linear portion of the vertebrobasilar artery or the internal carotid artery proximal to the C3 segment, and does not branch off perforating arteries or is already completely occluded.

Abstract TP467: Effects of the Tortuosity of the Cervical Internal Carotid Artery on Procedural Outcomes of Stent Placement

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Iqra N Akhtar ◽  
Raza S Hyder ◽  
Vamshi Balasetti ◽  
Nitish Kumar ◽  
Jacqueline J Kraus ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Internal Carotid ◽  
Consecutive Series ◽  
Complication Rates ◽  
Grade 5 ◽  
Vessel Tortuosity ◽  
Grade 3 ◽  
Cervical Internal Carotid Artery

Introduction: Severe tortuosity of the cervical internal carotid artery distal to the stenosis may prevent successful placement of distal protection device and increase the risk of dissection and/or ischemic stroke. Objective: To assess and categorize the effects of tortuosity of the cervical internal carotid artery distal on procedural times, and peri-procedural complications in patients treated with carotid artery stent placement. Material and Methods: We analyzed the angiographic images and clinical data for a consecutive series of patients treated with stent placement over an 18-month period and graded the tortuosity as follows: Grade 0 is no vessel turns; Grade 1 (MILD) is 1 vessel turn, >90 degrees; Grade 2 (MODERATE) is 1 vessel turn, ≤90 degrees; Grade 3 (SEVERE) is 2 vessel turns, any angle; Grade 4 (SEVERE) is two vessel segments which are parallel to due to interspersed loop; Grade 5 (SEVERE) is a complete vessel loop (360 degrees). Technical complications including unsuccessful attempts to cross the stenosis with interventional devices, unutilized distal embolic protection, iatrogenic dissection, and ischemic events were ascertained. Results: A total of 80 patients were identified who underwent stent placement; mean (SD) 67.4 (8), 60 (75%) were men. Forty-three patients (53.8%) had evidence of stroke on non-invasive imaging prior to stent placement. In sixty-five cases, stent placement was performed electively (81.3%), emergently in fifteen cases (18.8%). The tortuosity was graded as 1 (46.2%), 2 (11.3%), 3 (15%), 4 (6.3%), and 5 (2.5%). Of the 80 patients, eighteen (22.5%) had severe tortuosity of grade 3 or higher. Mean procedural time (SD) was significantly greater with severe vessel tortuosity compared to mild to moderate vessel tortuosity (51.6 (6.2) versus 42.3 (5.2) minutes, p=.042). Technical complication rates were not significantly different with severe vessel tortuosity compared with mild to moderate vessel tortuosity (7% vs 9% p=.53). One intra-procedural dissection occurred in a case of severe tortuosity (grade 5). Conclusions: Severely tortuous internal carotid arteries distal to the stenosis can be seen in one fifth of patients undergoing carotid stent placement and is associated with increased procedural times.

Patient presentation, angiographic features, and treatment of strangulation-induced dissection of the internal carotid artery

2000 ◽  
Vol 92 (3) ◽  
pp. 481-487 ◽  
Author(s):  
Adel M. Malek ◽  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Constantine C. Phatouros ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Internal Carotid ◽  
Artery Dissection ◽  
Percutaneous Angioplasty ◽  
Consistent Finding ◽  
Content Type ◽  
Fine Print

✓ Domestic violence leading to strangulation by an abusive spouse can cause carotid artery dissection. This phenomenon is rare and has been described in only three previous instances. The authors present their management strategies in three additional cases.Three young women aged 24 to 43 years were victims of manual strangulation committed by their spouses 3 months to 1 year before presentation. Two of the patients suffered delayed cerebral infarctions before presentation and angiography demonstrated focal, mirror-image severe residual stenoses in the high-cervical internal carotid artery (ICA), which were characteristic of a healed chronic dissection; there was no evidence of fibromuscular dysplasia. One of these patients underwent unilateral percutaneous angioplasty with stent placement, and the other underwent bilateral percutaneous angioplasty. Both patients have recovered from their strokes and remain clinically stable at 8 and 20 months posttreatment, respectively. The third patient presented with bilateral ischemic frontal watershed infarctions resulting from an occluded left ICA and a severely narrowed right ICA. Given the extent of the established infarctions, this case was managed with a long-term regimen of anticoagulation medications, and the patient remains neurologically impaired.These cases illustrate the susceptibility of the manually compressed ICA to traumatic injury as a result of domestic violence. They identify bilateral symmetrical ICA dissection as a consistent finding and the real danger of delayed stroke as a consequence of strangulation. Endovascular therapy in which percutaneous angioplasty and/or stent placement are used can be useful in treating residual focal stenoses to improve cerebral perfusion and to lower the risk of embolic or ischemic stroke.

scholarly journals Snare-Assisted Trans-Brachial Stenting for the Cervical Internal Carotid Artery Stenosis of Patient with Aorto-Iliac Occlusion

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 221-228
Author(s):  
H. Oowaki ◽  
N Matsuura ◽  
M. Ishikawa
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Carotid Artery Stenosis ◽  
Internal Carotid ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Femoral Access ◽  
Cervical Internal Carotid Artery ◽  
Iliac Occlusion

We describe a case of endo-luminal stent placement with Snare-assist for a cervical internal carotid artery stenosis in which percutaneous access was obtained via the brachial artery. A 68-year-old man with known disease of the carotid, peripheral, and coronary arteries, with Human T-cell Lymphotrophic Virus type-1 (HTLV-1) Associated Myelopathy (HAM) presented for endoluminal revascularization of a severe, progressive right internal carotid artery stenosis, but with aorto-iliac occlusion. Transfemoral access was complicated by an aorto-iliac occlusion. A trans-brachial approach was successfully attempted, and a SMARTer stent (Cordis Endovascular, Miami Lakes, FL) was successfully placed through a 7-French Shuttle-SL guide sheath (Cook, Bloomington) under Snare-assist. The trans-brachial approach is becoming an increasingly viable alternative route for stent placement in patients with contra-indicated or complicated femoral access routes. As devices become increasingly more pliable and smaller, the trans-brachial route will be used with increasing frequency in the select patient population for stenting of both the cervical and intracranial circulation.

Fractured Internal Carotid Artery Stent

Vascular ◽  
2008 ◽  
Vol 16 (3) ◽  
pp. 179-182 ◽  
Author(s):  
M. Nazzal ◽  
J. Abbas ◽  
M. Nazzal ◽  
S. Afridi ◽  
M. Ritter
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Carotid Artery Stent
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