Introduction Endovascular treatment with a covered heparin-bonded stent graft has been shown to be feasible and safe for treatment of peripheral artery disease, but its role in carotid disease remains unclear. The purpose of this study was to determine the feasibility and safety of a covered stent graft in treating cervical carotid artery disease in a consecutive series of patients with acute ischemic stroke (AIS) due to tandem lesion in a single high-volume Comprehensive Stroke Center. Methods A retrospective review of all patients that underwent carotid endovascular interventions during mechanical thrombectomy for AIS using a self-expanding covered stent graft at Vall d'Hebron University Hospital between 2016 and 2018 was conducted. Patient clinical and angiographical characteristics as well as postoperative outcome and follow-up were recorded. Results A total of eight patients were treated with the covered stents, and we observed significant improvement in stroke severity at 24 h in 5/8 patients (mean NIHSS 18 ± 5 vs 12 ± 8, p = 0.02). Successful recanalization (TICI 2b-3) after thrombectomy was achieved in 5/8 (62.5%) patients. One stent occluded during the procedure. At 3-month follow-up, stents were patent in three (37.5%) patients (two with mRS 3 and one with mRS 1). The stents of the remaining four patients (62.5%) were occluded (one with mRS 2 and three with mRS 4), although the patients did not show signs of stroke recurrence. ConclusionThe preliminary results of our study show that the self-expanding covered stent graft did not achieve satisfactory patency at 90-days among patients with AIS and tandem lesions, suggesting that its use in the carotid circulation may not be recommended in the context of AIS.
Conclusions CEA and CAS have both been used to treat carotid webs although CAS is more commonly reported in the published literature. Both procedures appear highly effective at preventing recurrent stroke. The safety profile of both procedures is good with no deaths recorded.
Introduction: Safe and complete recanalization is important to reduce clot burden and determines functional prognosis of patients with cerebral infarction from large vessel occlusions (LVO). The aim of PROMISE is to evaluate the safe and effective use of the aspiration-based Penumbra System with the latest generation of ACE Reperfusion Catheters in a real world population with acute ischemic stroke from anterior circulation LVO, treated with the ADAPT technique in routine practice. Methods: The prospective, single-arm, multicenter PROMISE registry evaluated the Penumbra System with ACE64 and ACE68 catheters across 20 European centers. Criteria for inclusion include presentation of anterior circulation LVO within 6 hours of ictus, NIHSS ≥ 2, ASPECTS ≥ 6 and wherein intervention was proceeded with ADAPT as frontline. Primary endpoints include angiographic revascularization to TICI 2b-3, and clinical independence (mRS 0-2) at 90 days. Secondary endpoints include safety events, functional improvement at 7-10 days, procedural metrics and quality of life. Results: A total of 202 patients were enrolled for evaluation of this interim analysis. Table I details patient history and baseline characteristics. Prior to endovascular procedure, IV rtPA was administered in 61.9% of patients. A final revascularization mTICI 2b-3 was achieved in 96.5% (194/201), per investigator assessment. Of these, mTICI 3 was achieved in 68.2% (137/201). Mortality was observed in 15 of the 141 (10.6%) patients at this interim analysis. Patient follow-up data collection, including clinical outcome, will be completed by the end of 2017. Core lab adjudicated results will be available at time of presentation. Conclusion: Interim analysis of the PROMISE registry demonstrated safe and effective utility of the Penumbra System with the novel ACE64 and ACE68 Reperfusion Catheters using ADAPT as frontline treatment. All follow up visits and final results will be presented at the ISC conference.
Right internal iliac artery was then catheterized. Angiography and CBCT showed a less anastomotic right middle rectal artery involvement in hemorrhoid vascularization but confirmed the origin of the bleeding with contrast within the rectum. Hence, only one microcoil was used and some gelfoam pledget. Result(s): Angiographies and CBCT confirmed the origin of the bleeding and showed satisfying final result with complete exclusion of internal hemorrhoids. Stabilization of vital signs was perceived during the procedure. A three weeks clinical and endoscopic follow-up showed no recurrence of the bleeding. Conclusion(s):Emborrhoid technique can be used in urgent treatment of massive hemorrhoid bleeding even when the access to the inferior mesenteric artery is not possible by embolizing middle rectal artery as it is the main blood supply of hemorrhoid in this case. CBCT helps identifying the main feeder arteries and guides the embolization.
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