<b>Endovascular Treatment of Soft Carotid Plaques:</b>A Single-Center Carotid Stent Experience

Cremonesi, Alberto; Manetti, R; Liso, Armando; Ricci, E.; Bianchi, Paolo; Castriota, Fausto

doi:10.1583/05-1702mr.1

Cited by 23 publications

(13 citation statements)

References 23 publications

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“…Reported rates of intolerance in earlier studies of flow reversal range from 0 to 8.9% [23][24][25][26][27][28][29]; the rate in the EMPiRE study was 2.4%. Trials of a flow arrest EPD had intolerance rates of 5.8-13.8% [17][18][19][20][21]. Intolerance during flow reversal may be controlled by blood pressure management or by temporarily deflating the CCA balloon to restore antegrade flow and reinflating the balloon once baseline neurologic status is reestablished.…”

Section: Discussionmentioning

confidence: 99%

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Neuroprotection during carotid artery stenting using the GORE flow reversal system: 30‐day outcomes in the EMPiRE Clinical Study

Clair

Hopkins

Mehta

et al. 2010

Cathet Cardio Intervent

112

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Section: Discussionmentioning

confidence: 99%

“…The proximally placed flow arrest system avoids the need to cross the lesion to establish protection. Proximal flow arrest, however, like distal vessel occlusion, may not be tolerated in some patients [17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Neuroprotection during carotid artery stenting using the GORE flow reversal system: 30‐day outcomes in the EMPiRE Clinical Study

Clair

Hopkins

Mehta

et al. 2010

Cathet Cardio Intervent

112

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“…In previous studies, the reported rate of intolerance to proximal flow arrest or flow reversal devices ranged from 1.8 to 19.9% [6, 7, 14, 17–19]; thus, the 1.6% intolerance rate reported at this study can be considered to be one of the lowest observed thus far. Intermittent clamping has been proposed as a method for decreasing the severity of symptoms of intolerance [14, 17], and it may allow completion of CAS using proximal neuroprotection.…”

Section: Discussionmentioning

confidence: 48%

Prospective, multicenter European study of the GORE flow reversal system for providing neuroprotection during carotid artery stenting

Nikas

Reith

Schmidt

et al. 2012

Cathet Cardio Intervent

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“…They treated patients with a GSM Ͻ25 with a proximal brain protection device not requiring the crossing of the soft lesion. 3 Interestingly, they found visible debris during the procedure in 66.7% of patients, confirming the embolic potential of carotid plaques with a GSM Ͻ25. Using this brain protection device, the rate of stroke was not increased by GSM.…”

Section: Carotid Plaque Echolucency Predicts the Risk Of Stroke In Camentioning

confidence: 76%

Carotid Plaque Echolucency Predicts the Risk of Stroke in Carotid Stenting According to the Type of Brain Protection Device and the Learning Curve

Froio

Biasi

2007

Stroke

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In the ICAROS Study, we demonstrated that GSM is a predictor of stroke during CAS. 2 Dr Cremonesi, with one of the biggest CAS experiences, has already demonstrated Dr Reiter's findings. They treated patients with a GSM Ͻ25 with a proximal brain protection device not requiring the crossing of the soft lesion. 3 Interestingly, they found visible debris during the procedure in 66.7% of patients, confirming the embolic potential of carotid plaques with a GSM Ͻ25. Using this brain protection device, the rate of stroke was not increased by GSM. The message is that a tailored technique in skilled interventionalists can overcome the risk of stroke caused by echolucent carotid plaques. For few centers with excellent results, carotid plaque morphology could not be a predictor of stroke, but for most centers not performing hundreds of cases per year (or starting a CAS program!), GSM is a strong predictor of stroke.The same conclusion could be reached analyzing the outcome of CAS in octogenarians. The CREST Trial showed that the rate of stroke and death increases at older ages, being 12.1% in octogenarians. 4 However, Dr Cremonesi showed that CAS is safe in elderly patients, with an overall death and stroke rate of 2.12%. 5 Why are Cremonesi's and Reiter's conclusions not consistent with those in previous articles (CREST or ICAROS)? Those authors performing hundreds of procedures are unrepresentative of interventionalists with smaller number of cases. The learning curve in CAS is fundamental. The same author (Cremonesi participated in the ICAROS) may have both an increased and a nonincreased risk of stroke during CAS treating echolucent plaques, according to an improving learning curve over time because of a higher number of cases. How many interventionalists have treated 698 consecutive patients with such an excellent result (2.9%) to be allowed to discharge the GSM analysis before CAS? The issue is that the results published in the medical journals by few excellent centers are far better than those of the majority of the other hospitals. The EVA3S confirmed this finding, because the rate of stroke after CAS was far higher than showed by previous articles, probably because of a nonacceptable level of physician training. 6 Should we perform the GSM analysis or not? The message should be the following:In case of echolucent plaques, the embolic load to the brain will be higher. The rate of stroke will be increased.The stroke rate could not be influenced by carotid plaque morphology if there is huge experience in carotid stenting (several hundreds of cases) or if proximal brain protection device is used that does not require the crossing of the lesion; however, the correct selection of a brain protection device may depend on GSM.Carotid plaque morphology could influence the risk of late neurological dysfunction. The incidence of silent brain ischemia following CAS is high (Ϸ20% to 30%), both in protected and unprotected procedures. The higher the incidence of silent ischemia, the higher the risk of dementia. The use of the GS...

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Endovascular Treatment of Soft Carotid Plaques:A Single-Center Carotid Stent Experience

Abstract: Protected CAS with proximal flow blockage can successfully be applied in selected patients for soft carotid plaques at high risk for intraprocedural embolic events.

Cited by 23 publications

References 23 publications

Neuroprotection during carotid artery stenting using the GORE flow reversal system: 30‐day outcomes in the EMPiRE Clinical Study

Neuroprotection during carotid artery stenting using the GORE flow reversal system: 30‐day outcomes in the EMPiRE Clinical Study

Prospective, multicenter European study of the GORE flow reversal system for providing neuroprotection during carotid artery stenting

Carotid Plaque Echolucency Predicts the Risk of Stroke in Carotid Stenting According to the Type of Brain Protection Device and the Learning Curve

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