Carotid Stenting in Patients With High Risk Versus Standard Risk for Open Carotid Endarterectomy (REAL-1 Trial)

Haro, Joaquín De; Michel, Ignacio; Bleda, Silvia; Cañibano, Cristina; Aciń, Francisco

doi:10.1016/j.amjcard.2017.04.023

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…First, we assessed the clinical endpoints reported in CAS studies. A study statistician randomly identified (PubMed) 50 CAS studies reporting 30-day clinical outcomes [ 20 , 23 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ] and 50 studies reporting 12-month clinical outcomes ([ 11 , 30 , 35 , 38 , 39 , 42 , ...…”

Section: Methodsmentioning

confidence: 99%

“…Severe bias presence led to study exclusion from further analysis. Finally, CAS data from103 observational and 9 randomized studies were included [ 4 , 21 , 22 , 23 , 26 , 27 , 30 , 35 , 39 , 41 , 44 , 45 , 56 , 58 , 65 , 66 , 84 , 89 , 91 , 92 , 97 , 104 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 ,…”

Section: Methodsmentioning

confidence: 99%

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Clinical Outcomes of Second- versus First-Generation Carotid Stents: A Systematic Review and Meta-Analysis

Mazurek

Malinowski

Rosenfield

et al. 2022

JCM

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Background: Single-cohort studies suggest that second-generation stents (SGS; “mesh stents”) may improve carotid artery stenting (CAS) outcomes by limiting peri- and postprocedural cerebral embolism. SGS differ in the stent frame construction, mesh material, and design, as well as in mesh-to-frame position (inside/outside). Objectives: To compare clinical outcomes of SGS in relation to first-generation stents (FGSs; single-layer) in CAS. Methods: We performed a systematic review and meta-analysis of clinical studies with FGSs and SGS (PRISMA methodology, 3302 records). Endpoints were 30-day death, stroke, myocardial infarction (DSM), and 12-month ipsilateral stroke (IS) and restenosis (ISR). A random-effect model was applied. Results: Data of 68,422 patients from 112 eligible studies (68.2% men, 44.9% symptomatic) were meta-analyzed. Thirty-day DSM was 1.30% vs. 4.11% (p < 0.01, data for SGS vs. FGS). Among SGS, both Casper/Roadsaver and CGuard reduced 30-day DSM (by 2.78 and 3.03 absolute percent, p = 0.02 and p < 0.001), whereas the Gore stent was neutral. SGSs significantly improved outcomes compared with closed-cell FGS (30-day stroke 0.6% vs. 2.32%, p = 0.014; DSM 1.3% vs. 3.15%, p < 0.01). At 12 months, in relation to FGS, Casper/Roadsaver reduced IS (−3.25%, p < 0.05) but increased ISR (+3.19%, p = 0.04), CGuard showed a reduction in both IS and ISR (−3.13%, −3.63%; p = 0.01, p < 0.01), whereas the Gore stent was neutral. Conclusions: Pooled SGS use was associated with improved short- and long-term clinical results of CAS. Individual SGS types, however, differed significantly in their outcomes, indicating a lack of a “mesh stent” class effect. Findings from this meta-analysis may provide clinically relevant information in anticipation of large-scale randomized trials.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Clinical Outcomes of Second- versus First-Generation Carotid Stents: A Systematic Review and Meta-Analysis

Mazurek

Malinowski

Rosenfield

et al. 2022

JCM

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“…Patients at high risk and standard risk for CEA were included 19,20 . Inclusion criteria considered the degree of stenosis and related symptoms.…”

Section: Methodsmentioning

confidence: 99%

“…Patients at high risk and standard risk for CEA were included. 19,20 Inclusion criteria considered the degree of stenosis and related symptoms. The degree of stenosis was measured according to the North American Symptomatic Carotid Endarterectomy (NASCET) criteria.…”

Section: Introductionmentioning

confidence: 99%

Early and mid‐term outcomes of carotid angioplasty and stent placement in 579 patients

Borhani‐Haghighi

Hooshmandi

Zahediasl

et al. 2022

Journal of Neuroimaging

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Background and Purpose Carotid angioplasty and stenting (CAS) could be considered for preventing stroke in patients with carotid artery stenosis. This study aimed to determine the incidence and the risk factors of the early and mid‐term complications associated with CAS. Methods This is a retrospective cohort study conducted at Shiraz University of Medical Sciences from March 2011 to March 2019. Patients at high risk and standard risk for carotid endarterectomy were included. The primary composite outcome was defined as stroke, myocardial infarction (MI), and death in the first 30 days after CAS. All‐cause mortality, vascular mortality, and stroke were investigated during mid‐term follow‐up. Results A total of 579 patients (618 CAS) were recruited (mean age: 71.52 years). Overall, 394 (68.40%), 211 (36.63%), 179 (31.07%), and 96 (16.72%) patients had hypertension, dyslipidemia, diabetes mellitus, or were cigarette smokers, respectively. Primary composite outcomes were observed in 2.59% of patients (1.55% stroke, 0.69% MI, and 1.72% death). Atrial fibrillation was a predictor of primary composite outcome in multivariate logistic regression (p = .048). The presence of total occlusion in the contralateral carotid artery was significantly associated with the risk of stroke in univariate logistic regression (p = .041). The patients were followed for a period ranging from 1 to 83 months. The overall survival rate for all‐cause mortality was 93.48% at 1 year, 77.24% at 5 years, and 52.92% at 8 years. All‐cause mortality was significantly higher among patients with symptomatic carotid stenosis (p = .014). Conclusion CAS provides acceptable short‐term and mid‐term outcomes in a unique population of high‐ and standard‐surgical‐risk, symptomatic and asymptomatic, octogenarian, and nonoctogenarian patients.

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“…4) In particular, a proximal protection device, MOMA, has facilitated safe treatment for patients in whom CAS was previously considered to be difficult. 5) In the two patients presented above, CAS was expected to be difficult based on the properties of the lesions, but we considered that complete protection under flow reversal was possible based on the preoperative assessment of an access route and collateral flow. Considering the patients' wishes, we selected CAS.…”

Section: Discussionmentioning

confidence: 99%

Importance of Predilatation for CAS: Two Patients for Whom Balloons Were Mis-selected

Matsushita

Sogabe

Suzue

et al. 2018

JNET

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Objective:We report two patients for whom balloons for carotid artery stenting (CAS) were mis-selected, and review balloon selection for CAS and the purpose of predilatation.Case Presentations: Case 1: A 73-year-old man developed amaurosis fugax on his right eye. An unstable, plaqueabundant stenotic lesion of the right internal carotid artery with calcification was detected. Under flow reversal, a Carotid WALLSTENT 8 mm × 29 mm was inserted, and postdilatation was performed using a Jackal 4.5 mm × 30 mm until a nominal pressure was achieved. In-stent plaque protrusion was noted. A Carotid WALLSTENT 8 mm × 21 mm was overlapped, and the procedure was completed. Subacute thrombosis (SAT) with North American Symptomatic Carotid Endarterectomy Trial (NASCET) 40% restenosis was observed 5 days after CAS. Anticoagulant therapy gradually reduced SAT.Case 2: An 83-year-old woman presented an asymptomatic acute phase ischemic lesion in left cerebral hemisphere by scheduled MRI as a follow-up study of medical checkup. An irregular, plaque-abundant, markedly stenotic lesion of the left internal carotid artery with calcification was detected. Under flow reversal, predilatation was performed using a Sterling 3 mm × 40 mm (Boston Scientific, Marlborough, MA, USA) until a nominal pressure was achieved, and a PRECISE 9 mm × 40 mm (Cardinal Health, Inc., Dublin, OH, USA) was inserted. It was impossible to pass an Aviator 4 mm x 30 mm (Cardinal Health, Inc.) for postdilatation through the site of stenosis, and a Gateway 2.5 mm × 12 mm (Stryker, Kalamazoo, MI, USA) and Jackal 4.5 mm × 30 mm (Kaneka Medix Corp., Osaka, Japan) were used. Dilatation was achieved. Conclusion:To improve the results of CAS, it is important to establish the purpose of balloon dilatation and select a balloon in accordance with its purpose, as indicated for the selection of embolic protection devices (EPDs) and stents.

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Carotid Stenting in Patients With High Risk Versus Standard Risk for Open Carotid Endarterectomy (REAL-1 Trial)

Cited by 7 publications

References 20 publications

Clinical Outcomes of Second- versus First-Generation Carotid Stents: A Systematic Review and Meta-Analysis

Clinical Outcomes of Second- versus First-Generation Carotid Stents: A Systematic Review and Meta-Analysis

Early and mid‐term outcomes of carotid angioplasty and stent placement in 579 patients

Importance of Predilatation for CAS: Two Patients for Whom Balloons Were Mis-selected

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