Carotid Artery Stenting

Kotsugi, Masashi; Takayama, Katsutoshi; Myouchin, Kaoru; Wada, Takeshi; Nakagawa, Ichiro; Nakagawa, Hiroyuki; Taoka, Toshiaki; Kurokawa, Syuhei; Nakase, Hiroyuki; Kichikawa, Kimihiko

doi:10.1016/j.jcin.2017.01.029

Cited by 93 publications

(48 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Atherosclerotic plaque protrusion through conventional carotid stent struts [ 8 , 56 – 59 ] has been identified as a leading mechanism of post-procedural cerebral embolisation [ 55 ] and post-procedural adverse neurological events seen with the prior generation of carotid stents [ 47 , 48 , 50 , 54 ]. Vascular surgery key opinion leaders have repeatedly indicated that the safety of CAS needs to be improved before CAS can be routinely applied by surgeons as an alternative to CEA [ 68 , 69 ], and that the CAS role in carotid revascularisation would be fully established only with an increased use of proximal neuroprotection systems and the development of novel “ultra-closed” cell stent systems [ 68 ].…”

Section: Discussionmentioning

confidence: 99%

“…Atherosclerotic carotid artery stenosis continues to be a major cause of acute ischaemic strokes [ 1 – 4 ]. Accordingly, patients with symptomatic carotid stenosis account for up to ~30–60% of subjects enrolled in contemporary clinical trials of carotid revascularisation [ 5 – 8 ]. Some of these patients develop symptoms of carotid stenosis-associated cerebral ischaemia despite optimised medical therapy (OMT) [5, 9 – 12 ], consistent with the concept that OMT may reduce or delay [ 10 , 13 ], but does not abolish, the stroke risk in relation to carotid atherosclerosis [ 9 , 10 , 12 ].…”

Section: Atherosclerotic Carotid Stenosis and Ischaemic Strokementioning

confidence: 99%

“…Atherosclerotic plaque prolapse occurs (depending on the visualisation technique such as angiography, intravascular ultrasound, or optical coherence tomography) in up to 30–60% of conventional carotid stents and it may be reduced but not eliminated with the conventional closed-cell stent designs [ 56 – 59 ]. Recent systematic evaluation of a large patient series (328 consecutive patients, 48% symptomatic) with CAS accompanied by routine intravascular ultrasound imaging confirmed a significant increase in plaque prolapse susceptibility with the unstable carotid plaque and open-cell stent use [ 8 ]. Plaque protrusion was strongly associated not only with new ischaemic lesions on DW-MRI but also with the clinical manifestation of perioperative ischaemic stroke ( p < 0.0001), indicating the necessity to prevent plaque prolapse [ 8 ].…”

Section: Evolution Of Carotid Revascularisation Strategies After Cresmentioning

confidence: 99%

“…Recent systematic evaluation of a large patient series (328 consecutive patients, 48% symptomatic) with CAS accompanied by routine intravascular ultrasound imaging confirmed a significant increase in plaque prolapse susceptibility with the unstable carotid plaque and open-cell stent use [ 8 ]. Plaque protrusion was strongly associated not only with new ischaemic lesions on DW-MRI but also with the clinical manifestation of perioperative ischaemic stroke ( p < 0.0001), indicating the necessity to prevent plaque prolapse [ 8 ]. Mesh-covered carotid stents, designed to prevent plaque prolapse, have been developed and implemented in the clinical practice of CAS, leading to an increasing body of clinical evidence in the public domain today [ 5 – 7 , 60 – 63 ].…”

Section: Evolution Of Carotid Revascularisation Strategies After Cresmentioning

confidence: 99%

See 3 more Smart Citations

One swallow does not a summer make but many swallows do: accumulating clinical evidence for nearly-eliminated peri-procedural and 30-day complications with mesh-covered stents transforms the carotid revascularisation field

Musiałek

Hopkins

Siddiqui

2017

pwki

View full text Add to dashboard Cite

Atherosclerotic carotid artery stenosis (CS) continues to be a common cause of acute ischaemic stroke. Optimised medical therapy (OMT), the first-line treatment modality in CS, may reduce or delay – but it does not abolish – CS-related strokes. As per current AHA/ASA and ESC/ESVS/ESO guidelines, carotid artery stenting (CAS) is a less-invasive alternative to carotid endarterectomy (CEA) for CS revascularisation in primary and secondary stroke prevention.Ten-year follow-up from the CREST trial in patients with symptomatic and asymptomatic CS confirmed equipoise of CAS and CEA in the primary endpoint. Nevertheless CAS – using a widely open-cell, first-generation stent and first-generation (distal/filter) neuroprotection – has been criticised for its relative excess of (mostly minor) strokes by 30 days, a significant proportion of which were post-procedural.Atherosclerotic plaque protrusion through conventional carotid stent struts, confirmed on intravascular imaging, has been implicated as a leading mechanism of the relative excess of strokes with CAS vs. CEA, including delayed strokes with CAS. Different designs of mesh-covered carotid stents have been developed to prevent plaque prolapse. Several multi-centre/multi-specialty clinical studies with CGurad MicroNet-Covered Embolic Prevention Stent System (EPS) and RoadSaver/Casper were recently published and included routine DW-MRI cerebral imaging peri-procedurally and at 30 days (CGuard EPS).Data from more than 550 patients in mesh-covered carotid stent clinical studies to-date show an overall 30-day complication rate of ~1% with near-elimination of post-procedural events. While more (and long-term) evidence is still anticipated, these results – taken together with optimised intra-procedural neuroprotection in CAS (increased use of proximal systems including trans-carotid dynamic flow reversal) and the positive 12-month mesh-covered stent data reports in 2017 – are transforming the carotid revascularisation field today.Establishing effective algorithms to identify the asymptomatic subjects at stroke risk despite OMT, and large-scale studies with mesh-covered stents including long-term clinical and duplex ultrasound outcomes, are the next major goals.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Atherosclerotic Carotid Stenosis and Ischaemic Strokementioning

confidence: 99%

Section: Evolution Of Carotid Revascularisation Strategies After Cresmentioning

confidence: 99%

Section: Evolution Of Carotid Revascularisation Strategies After Cresmentioning

confidence: 99%

See 2 more Smart Citations

One swallow does not a summer make but many swallows do: accumulating clinical evidence for nearly-eliminated peri-procedural and 30-day complications with mesh-covered stents transforms the carotid revascularisation field

Musiałek

Hopkins

Siddiqui

2017

pwki

View full text Add to dashboard Cite

show abstract

“…[ 22 23 24 ] Several factors related to post-CAS restenosis have been reported, including demography, comorbidity, and/or characters of original plaques, e.g., age,[ 4 22 ] female gender,[ 22 ] symptomatic cases,[ 13 ] diabetes,[ 5 22 ] hypertension,[ 22 40 ] hyperlipidemia,[ 22 ] inflammation markers,[ 37 ] high-degree stenosis,[ 32 ] and length of the plaques,[ 31 ] although some of these studies merely conducted univariate or combined analyses with restenoses after carotid endarterectomy (CEA). Several researchers reported CAS-procedure-related factors of post-CAS restenosis, such as immediate residual stenosis,[ 7 31 40 ] double stent deployment,[ 7 ] use of an open-cell stent,[ 20 ] and the predilation balloon diameter. [ 32 ]…”

Section: Introductionmentioning

confidence: 99%

Calcification in original plaque and restenosis following carotid artery stenting

Katano¹,

Nishikawa²,

Yamada³

et al. 2017

Surg Neurol Int

View full text Add to dashboard Cite

Background:The relationship between calcification in primary plaque and recurrent stenosis after carotid artery stenting (CAS) is not established, but an inverse association with restenosis following carotid endarterectomy (CEA) has been suggested.Methods:We retrospectively analyzed 75 plaques of 109 consecutive CAS with regard to calcification, using the calcium score and shape, location, and other characteristics of original plaques together with stenting-related factors. CAS was performed in a standard fashion with an embolic protection device. Greater-than-moderate restenosis (≥50%) was assessed by peak systolic velocity (PSV) with duplex ultrasonography (≥130 cm/s, internal/common carotid or distal/proximal PSV ratio ≥2.0).Results:Univariate analysis revealed percentages of dyslipidemia treated with statins (P = 0.03), calcification in distal ICA (P = 0.02), and immediate residual stenosis (P = 0.02) were significantly higher in patients with greater-than-moderate restenosis, whereas calcification in carotid bulb and usage of open-cell stent were rather less frequent (P < 0.001 and P = 0.02, respectively). Multivariate logistic regression analysis showed that rarity of calcification in carotid bulb was a sole independent predictor for greater-than-moderate recurrent carotid stenosis 1 year after CAS (OR = 0.21, CI = 0.06–0.77, P = 0.02).Conclusions:Calcium score was not significantly related to restenosis at 1 year after CAS, as was previously found following CEA, though scarcity of calcification in carotid bulb was suggested as a predictor of in-stent restenosis. Compared to post-CEA restenosis, carotid plaque calcification may be inversely but tenuously associated with recurrent stenosis 1 year post-CAS. No other stenting factors (e.g., stent design, pre-/post-dilation, or protection devices) showed a significant association with recurrent stenosis post-CAS.

show abstract

Evaluation of a novel mesh‐covered stent for treatment of carotid stenosis in patients at high risk for endarterectomy: 1‐year results of the SCAFFOLD trial

Gray

Levy

Bacharach

et al. 2019

Cathet Cardio Intervent

View full text Add to dashboard Cite

ObjectiveThe SCAFFOLD trial evaluated the GORE® Carotid Stent (GCS), a novel, mesh‐covered device and evaluated outcomes at 1 year.BackgroundSCAFFOLD was a prospective, multicenter, single‐arm clinical trial in patients with severe carotid artery stenosis (angiographically defined as symptomatic ≥50% or asymptomatic ≥80%) at increased risk for adverse events from carotid endarterectomy. Interim 30‐day analysis demonstrated low rates of death/stroke/myocardial infarction (DSMI; 3.0%) and stroke (1.1%) in a high surgical risk population.MethodsThe rate of DSMI within 30 days plus ipsilateral stroke between 31 days and 1 year (primary endpoint) was compared to a predetermined performance goal. Secondary outcomes of freedom from clinically driven target lesion revascularization (CD‐TLR; diameter stenosis ≥80% by core lab angiography, or ≥50% with clinical symptoms) and restenosis (≥80% diameter stenosis by core lab angiography) are reported as Kaplan–Meier (KM) estimates.ResultsOf the 312 patients enrolled and treated, 264 were eligible per protocol and evaluable for major adverse events at 30 days, and 244 (92%) of these were evaluable at 1 year. The proportion of patients with DSMI at 1 year was 4.5% and was significantly lower than the prespecified performance goal of 16.9% (p < .00001). The proportion with ipsilateral stroke from 31 to 365 days was 1.2%. The KM estimates of 1‐year event probability were 1.6% for CD‐TLR and 1.2% for restenosis.ConclusionsUse of the mesh‐covered GCS in the SCAFFOLD trial demonstrated 100% technical success and low rates of both periprocedural and late stroke, with durable patency at 1 year.ClinicalTrials.gov Identifier: NCT01901874 (redacted).

show abstract

Carotid Artery Stenting

Abstract: The incidence of PP in CAS was 2.6%, with a high risk of ischemic complications if PP was observed. The present findings indicate the necessity of appropriate device selection to avoid PP.

Cited by 93 publications

References 21 publications

One swallow does not a summer make but many swallows do: accumulating clinical evidence for nearly-eliminated peri-procedural and 30-day complications with mesh-covered stents transforms the carotid revascularisation field

One swallow does not a summer make but many swallows do: accumulating clinical evidence for nearly-eliminated peri-procedural and 30-day complications with mesh-covered stents transforms the carotid revascularisation field

Calcification in original plaque and restenosis following carotid artery stenting

Evaluation of a novel mesh‐covered stent for treatment of carotid stenosis in patients at high risk for endarterectomy: 1‐year results of the SCAFFOLD trial

Contact Info

Product

Resources

About