Clinical Predictors of Transient Ischemic Attack, Stroke, or Death within 30 Days of Carotid Artery Stent Placement with Distal Balloon Protection

Kawabata, Yasuhiro; Sakai, Nobuyuki; Nagata, Izumi; Horikawa, Fumihiko; Miyake, Hidenori; Ueno, Yasushi; Kikuchi, Hiroe

doi:10.1016/j.jvir.2008.10.008

Cited by 9 publications

(5 citation statements)

References 48 publications

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“…Most authors agree that age and the presence of symptoms are important determinants of periprocedural outcomes following CAS. 17,18 The largest prospective trials showed that older age was associated with increased risk of periprocedural stroke and death. 5,7,19 Unfavorable arterial anatomical characteristics such as aortic arch elongation, arch calcification and proximal arch vessel stenosis are also proposed causes.…”

Section: Discussionmentioning

confidence: 99%

Postoperative ischemic events in patients undergoing carotid artery stenting using algorithmic selection for embolic protection

et al. 2019

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Purpose Carotid artery stenting (CAS) is a valuable alternative to carotid endarterectomy, especially in high-risk patients. However, the reported incidences of perioperative stroke and death remain higher than for carotid endarterectomy, even when using embolic protection devices (EPDs) during CAS. Our purpose was to evaluate 30-day major adverse events after CAS when selecting the most appropriate EPD. Methods We reviewed the clinical outcomes of 61 patients with 64 lesions who underwent CAS with EPDs. Patients who underwent CAS associated with thrombectomy and who had a preoperative modified Rankin scale score >3 were excluded from the analysis. The EPD was selected based on symptoms, carotid wall magnetic resonance imaging and lesion length, and we analyzed combined 30-day complication rates (transient ischemic attack, minor stroke, major stroke or death). Results Forty-nine patients were men and 12 were women. The median age was 72 years (range: 59–89 years) and 44 lesions were asymptomatic. A filter-type EPD was selected in 23 procedures, distal-balloon protection in 14 procedures and proximal-occlusive protection in 27 procedures. Two patients (3.1%) experienced a transient ischemic attack and one patient (1.6%) had a minor stroke within 30 days of the procedure. No patients experienced procedure-related morbidities (modified Rankin score >2) or death. Conclusions The perioperative stoke rate was low when we selected a proximal-occlusive-type EPD in high-risk patients with vulnerable carotid artery disease. Our algorithm for EPD selection was an effective tool in the perioperative management of carotid artery stenosis.

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Section: Discussionmentioning

confidence: 99%

Postoperative ischemic events in patients undergoing carotid artery stenting using algorithmic selection for embolic protection

et al. 2019

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“…Since the introduction of Precise stents in Japan, they have been used exclusively. Before January 2003, the cerebrum was protected from distal embolism using a Tranvas protective balloon (Kaneka Medix, Kanagawa, Ja- pan), as described previously in two cases 10 . In the 36 cases treated between February 2003 and April 2009, all of the procedures, including predilatation, stent deployment and postdilatation, were performed under cerebral protection with GuardWire, intermittently in some cases.…”

Section: Therapeutic Proceduresmentioning

confidence: 99%

“…In 12 cases since April 2008, emboli protection was performed using Angioguard XP. In nine cases, proximal endovascular blockage of blood flow was also performed during predilatation, as previously described 10 . Postdilatation was performed after stent placement in 39 cases (66.1%), in whom residual stenosis was more than about 30% after stent deployment.…”

Section: Therapeutic Proceduresmentioning

confidence: 99%

“…The reported incidence of perioperative stroke and death is 0-9.6% for CASP 4,6-9 . We recently published data for the perioperative rates transient ischemic neurological attack and stroke with CASP using distal balloon occlusion emboli protection 10 , and these data show an acceptably low rate of immediate post-procedural complications. However, CASP is a relatively novel treatment that is still being developed, and concerns remain regarding its long-term durability.…”

Section: Introductionmentioning

confidence: 99%

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Follow-up Outcomes of Self-Expanding Stents for Carotid Artery Angioplasty at a Single Hospital

et al. 2010

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Carotid artery angioplasty and stent placement (CASP) is widely accepted as a valuable alternative to carotid endarterectomy, particularly among high-risk patient populations. We analyzed the follow-up data of patients who underwent CASP with self-expanding stents for carotid lesions. Since 2001, self-expanding stents have been deployed in 59 lesions in 56 patients. Forty-seven patients were male, and nine were female. The median age was 73 years, ranging 50 to 83 years. There were 31 asymptomatic lesions and 28 symptomatic lesions. The median follow-up period was 27 months, ranging six to 102 months. All lesions received stents and technical success was achieved in 58 (98.3%) out of 59 lesions. The 30-day transient ischemic attack rate was 8.6%, the stroke rate was 3.4%, and the death rate was 0%. No ischemic attack was observed on the ipsilateral side after 30 days. Recurrent stenosis (>50%) was observed in three patients (5.1%) and in two (3.4%) of these, revascularization was performed. Kaplan-Meier analysis showed that the rates for one year and two year freedom from any stroke or death were 93.1% and 90.9%, respectively. The incidence of recurrent carotid stenosis is acceptably low after CASP. CASP is effective to prevent ipsilateral ischemic stroke in symptomatic and asymptomatic patients.

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“…The selection of stents and cerebral protection devices is also important for favorable outcome. 2 Previous studies have examined the effect risk factors, [3][4][5][6][7][8][9][10] blood flow (measurements using hypotension 11 or hemodynamic instability 12 ), lesion characteristics, 13 and plaque composition (determined by amount of debris trapped by the CPD, 14 by histology, 15 and by intravascular ultrasound 16 ) have on CAS patient outcome. Few studies have incorporated device design characteristics in their analysis other than stent cell type.…”

Section: Introductionmentioning

confidence: 99%

The Association of Clinical Variables and Filter Design with Carotid Artery Stenting Thirty-day Outcome

Siewiorek¹,

Krafty²,

Wholey³

et al. 2011

Journal of Vascular Surgery

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Structure of Delay in Carotid Surgery -An Observational StudyVikatmaa P., Sairanen T., Lindholm J.-M., Capraro L., Lepäntalo M., Venermo M. Eur J Vasc Endovasc Surg 2011;42:273-9. Objectives and design: Undelayed investigation and surgical treatment of symptomatic carotid artery stenosis are recommended as per guidelines on stroke prevention. We evaluated patient referral pathways and delays from symptom to surgery in Helsinki University Central Hospital (HUCH) region.Materials and Methods: One hundred consecutive symptomatic patients scheduled for carotid endarterectomy (CEA) between August 2007 and September 2008 were identified and the delay between ischaemic index symptom and CEA was analysed.Results: The median time from the index symptom to surgery was 47 days (range: 3-688 days). The longest delay was surgery related with a median of 25 days (range: 2-202 days) from the consultation of the vascular surgeon to the operation. Only 11% of the patients were operated within the recommended 2 weeks' time. It was more likely that CEA was performed within 2 weeks if an emergent consultation to Meilahti Hospital neurologist on call did take place (odds ratio (OR) 12.6, 95% confidence interval (CI) 1.5-104, p ϭ 0.019).Conclusion: Delays from symptom to surgery were generally too long and the in-hospital door-to-knife time (DKT) was long mostly due to waiting for the operation theatre. The investigation of all stroke, amaurosis fugax and transient ischaemic attack patients should be performed on an emergency basis and most optimally centralised to hospitals were carotid surgery is performed.

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Clinical Predictors of Transient Ischemic Attack, Stroke, or Death within 30 Days of Carotid Artery Stent Placement with Distal Balloon Protection

Cited by 9 publications

References 48 publications

Postoperative ischemic events in patients undergoing carotid artery stenting using algorithmic selection for embolic protection

Postoperative ischemic events in patients undergoing carotid artery stenting using algorithmic selection for embolic protection

Follow-up Outcomes of Self-Expanding Stents for Carotid Artery Angioplasty at a Single Hospital

The Association of Clinical Variables and Filter Design with Carotid Artery Stenting Thirty-day Outcome

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