Benefits of Cerebral Protection during Carotid Stenting with the PercuSurge GuardWire System: Midterm Results

Henry, Michel; Henry, Isabelle; Klonaris, Chris; Masson, Isabelle; Hugel, Michèle; Tzvetanov, Kiril; Éthevenot, Gérard; Borgne, Edmond Le; Kownator, Serge; Luizi, François; Folliguet, Bernard

doi:10.1177/152660280200900102

Cited by 124 publications

(96 citation statements)

References 51 publications

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“…Our literature search resulted in 40 studies of CAS without cerebral protection and 14 studies of CAS with cerebral protection 17,30,[53][54][55][56][57][58][59][60][61][62][63][64] that met the inclusion criteria. Of these, several articles were excluded because they reported on patients already used in other publications from the same institutions: Theron et al 65 was excluded in favor of Guimaraens et al 58 ; several studies of the group of Roubin et al 36 -42 were excluded in favor of Roubin et al 32 ; Jordan et al 43 and Jordan et al 44 were excluded in favor of Jordan et al 22 ; Chakhtoura et al 45 62 One recent study 49 evaluating the efficacy of abciximab in patients undergoing CAS was also excluded.…”

Section: Resultsmentioning

confidence: 99%

Early Outcome of Carotid Angioplasty and Stenting With and Without Cerebral Protection Devices

Kastrup

Gröschel

Krapf

et al. 2003

Stroke

535

315

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Background— Carotid angioplasty and stenting (CAS) is increasingly being used for treatment of symptomatic and asymptomatic carotid artery disease (CAD). To evaluate the efficacy of cerebral protection devices in preventing thromboembolic complications during CAS, we conducted a systematic review of studies reporting on the incidence of minor stroke, major stroke, or death within 30 days after CAS. Summary of Review— We searched for studies published between January 1990 and June 2002 by means of a PubMed search and a cumulative review of reference lists of all relevant publications. In 2357 patients a total of 2537 CAS procedures had been performed without protection devices, and in 839 patients 896 CAS procedures had been performed with protection devices. Both groups were similar with respect to age, sex distribution, cerebrovascular risk factors, and indications for CAS. In many studies the periprocedural complication rates had not been presented separately for patients with symptomatic and asymptomatic CAD. The combined stroke and death rate within 30 days in both symptomatic and asymptomatic patients was 1.8% in patients treated with cerebral protection devices compared with 5.5% in patients treated without cerebral protection devices (χ 2 =19.7, P <0.001). This effect was mainly due to a decrease in the occurrence of minor strokes (3.7% without cerebral protection versus 0.5% with cerebral protection; χ 2 =22.4, P <0.001) and major strokes (1.1% without cerebral protection versus 0.3% with cerebral protection; χ 2 =4.3, P <0.05), whereas death rates were almost identical (≈0.8%; χ 2 =0.3, P =0.6). Conclusions— On the basis of this early analysis of single-center studies, the use of cerebral protection devices appears to reduce thromboembolic complications during CAS. These technical aspects should be taken into account before the initiation of further randomized trials comparing CAS with carotid endarterectomy.

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Section: Resultsmentioning

confidence: 99%

Early Outcome of Carotid Angioplasty and Stenting With and Without Cerebral Protection Devices

Kastrup

Gröschel

Krapf

et al. 2003

Stroke

535

315

View full text Add to dashboard Cite

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“…In 14 studies, the exact definition of a DU restenosis Ն50% was not given. 10,16,17,[23][24][25][26][27]29,31,35,37,39,42 Twenty-five studies used a lower restenosis threshold Ն50% to 70%, 10 -34 whereas 16 studies used a lower threshold Ͼ70% to 80% to define a restenosis. 10,11,14,15,17,19,21,[35][36][37][38][39][40][41][42][43] In Figure 1, the proportion of patients/arteries in whom/ which restenosis developed is plotted against the average follow-up time.…”

Section: Resultsmentioning

confidence: 99%

Systematic Review of Early Recurrent Stenosis After Carotid Angioplasty and Stenting

Gröschel

Riecker

Schulz

et al. 2005

Stroke

133

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Background and Purpose-Carotid angioplasty and stenting (CAS) has emerged as a potential alternative to endarterectomy (CEA) for the treatment of carotid artery disease. Aside from the periprocedural complication rates, the benefits of CAS will be affected by the incidence of recurrent carotid stenosis. Methods-We conducted a systematic analysis of all peer-reviewed studies reporting on the rate of restenosis (Ն50%) after CAS based on duplex ultrasound or angiography that were published between January 1990 and July 2004. We identified 34 studies that reported on a total of 4185 patients with a follow-up of 3814 arteries over a median of 13 months (range, 6 to 31 months).The ultrasound criteria and the lower thresholds for defining a recurrent stenosis were very heterogeneous. Results-The cumulative restenosis rates after 1 and 2 years were Ϸ6% and 7.5% in those studies, which used a lower restenosis threshold Ն50% to 70% and Ϸ4% in the first 2 years after CAS in those studies, which used a lower restenosis threshold Ͼ70% to 80%. Conclusions-In reviewing the current literature, the early restenosis rates after CAS compare well with those reported for CEA. However, this analysis of the peer-reviewed literature also indicates that the early restenosis rates after CAS might be higher than previously suggested in observational surveys. Therefore, an active follow-up of all stented arteries seems to be warranted. Moreover, the bulk of endovascular data are derived from small studies with short follow-up periods so that the long-term durability of CAS still needs to be established in large trials.

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“…20,25 Nevertheless, in the GSM Յ25 subset, BPDs did not seem to maintain their efficacy. It should be noted that the BPDs used in the different centers were almost exclusively distal BPDs (96% of the total), requiring the passage of the device across the lesion with the inherent risk of embolization.…”

Section: Discussionmentioning

confidence: 99%

Carotid Plaque Echolucency Increases the Risk of Stroke in Carotid Stenting

et al. 2004

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Background-Carotid artery stenting (CAS) has recently emerged as a potential alternative to carotid endarterectomy.Cerebral embolization is the most devastating complication of CAS, and the echogenicity of carotid plaque has been indicated as one of the risk factors involved. This is the first study to analyze the role of a computer-assisted highly reproducible index of echogenicity, namely the gray-scale median (GSM), on the risk of stroke during CAS. Methods and Results-The Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) registry included 418 cases of CAS collected from 11 international centers. An echographic evaluation of carotid plaque with GSM measurement was made preprocedurally. The onset of neurological deficits during the procedure and the postprocedural period was recorded. The overall rate of neurological complications was 3.6%: minor strokes, 2.2%, and major stroke, 1.4%. There were 11 of 155 strokes (7.1%) in patients with GSM Յ25 and 4 of 263 (1.5%) in patients with GSM Ͼ25 (Pϭ0.005).Patients with severe stenosis (Ն85%) had a higher rate of stroke (Pϭ0.03). The effectiveness of brain protection devices was confirmed in those with GSM Ͼ25 (Pϭ0.01) but not in those with GSM Յ25. Multivariate analysis revealed that GSM (OR, 7.11; Pϭ0.002) and rate of stenosis (OR, 5.76; Pϭ0.010) are independent predictors of stroke. Conclusions-Carotid

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Benefits of Cerebral Protection during Carotid Stenting with the PercuSurge GuardWire System: Midterm Results

Cited by 124 publications

References 51 publications

Early Outcome of Carotid Angioplasty and Stenting With and Without Cerebral Protection Devices

Early Outcome of Carotid Angioplasty and Stenting With and Without Cerebral Protection Devices

Systematic Review of Early Recurrent Stenosis After Carotid Angioplasty and Stenting

Carotid Plaque Echolucency Increases the Risk of Stroke in Carotid Stenting

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