Concern About Safety of Carotid Angioplasty

Beebe, Hugh G.; Archie, Joseph P.; Baker, William H.; Rw, Barnes; Becker, Gary J.; Bernstein, Eugene F.; Brener, Bruce J.; Clagett, G. Patrick; Clowes, A. W.; Cooke, John P.; Creager, Mark A.; Cronenwelt, J. L.; Dake, Michael D.; DeWeese, James A.; Fogarty, T J; Freischlag, Julie A.; Goldstone, Jerry; Greenfield, Lazar J.; Hertzer, Norman

doi:10.1161/01.str.27.2.197

Cited by 80 publications

(29 citation statements)

References 11 publications

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“…As any new therapy it has to be evaluated critically by means of prospective randomized clinical trials as a combined effort of neurologists, interventional neuroradiologists, vascular surgeons and cardiologists. Beebe et al [14] emphasized that the procedure had been reported only in small published series characterized by lack of complete descriptive [8] .…”

Section: Discussionmentioning

confidence: 99%

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Elective stenting of carotid artery stenosis in patients with severe coronary artery disease

Waigand¹

1998

European Heart Journal

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Aims To evaluate the feasibility and safety of elective carotid stent implantation in patients with carotid stenoses and concomitant coronary artery disease, as an alternative to combined carotid and coronary surgery. MethodsWe treated 50 patients with >70% stenoses in 53 carotid arteries with balloon angioplasty followed by elective stent implantation. All patients had severe coronary artery disease, and/or mitral insufficiency, aortic stenosis, rhythm disorders or generalized arteriosclerosis. In three patients the opposite carotid artery was occluded; nine patients had bilateral stenoses of which two received stents bilaterally.Results Fifty-six successful stent implantations (42 Wallstents, eight BeStents, two AVE-Microstents, one Palmaz Schatz stent, three Sito stents) were performed, reducing the baseline percent stenosis from 78 18% to 13 11%. Complications included three transient ischaemic attacks, one minor and one major stroke. Follow-up was available for 46 patients over a mean of 10 months. Three asymptomatic restenoses and one deformation of a BeStent occurred. ConclusionOur preliminary results indicate that carotid artery stenting in patients with concomitant severe coronary artery disease is feasible, safe, and may be an alternative to combined carotid and coronary surgery.

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Section: Discussionmentioning

confidence: 99%

“…Since the editorial of Beebe et al [14] observational studies have been reported, in which excellent follow-up data and documentation were available. Yadav et al [15] treated 107 patients with elective stenting of extracranial carotid arteries.…”

Section: Carotid Artery Stenting 1369mentioning

confidence: 99%

Elective stenting of carotid artery stenosis in patients with severe coronary artery disease

Waigand¹

1998

European Heart Journal

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“…[11][12][13][14][15][16] However, fear of distal embolization of plaque fragments to the brain has generated concern regarding the safety and wisdom of this approach, especially considering the established low risk and durability of endarterectomy. 17,18 The incidence of stroke generally reported with carotid stenting is 5% to 10%, [11][12][13][14][15][16] although 1 center reported stroke in 71% of an early series. 19 Transcranial Doppler studies suggest the universal occurrence of emboli associated with this procedure.…”

mentioning

confidence: 99%

Carotid Artery Stenting Protected With an Emboli Containment System

Whitlow

Lylyk

Londero

et al. 2002

Stroke

152

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Background and Purpose-Fear of distal embolization and stroke has aroused concern regarding carotid stenting. Devices to protect the cerebral circulation may make carotid stenting safer. Methods-A multidisciplinary study group tested a balloon occlusion-aspiration emboli entrapment device in conjunction with carotid stenting. The device consists of an elastomeric balloon on a steerable wire with a detachable adapter that inflates and deflates the distal temporary occlusion balloon. An aspiration catheter is used to remove trapped emboli after stenting and before occlusion balloon deflation. Results-Seventy-five patients with severe internal carotid artery stenosis were treated with stents deployed with this cerebrovasculature protection system. All 75 patients (100%) had grossly visible particulate material aspirated, and all were treated successfully without major or minor stroke or death at 30 days. Preintervention stenosis was 81Ϯ10%, and residual stenosis was 5Ϯ7%. Nine patients (12%) had angiographic evidence of thrombus before intervention, but no patient had thrombus or vessel cutoff after the procedure. Four patients (5%) developed transient neurological symptoms during protection balloon occlusion, but symptoms resolved with balloon deflation. The 22 to 667 particles aspirated per patient ranged from 3.6 to 5262 m in maximum diameter (mean, 203Ϯ256 m). These particles included fibrous plaque debris, lipid or cholesterol vacuoles, and calcific plaque fragments. Conclusions-Protected carotid stenting was performed successfully and safely in this study early in the experience with cerebrovascular protection devices. Particulate emboli are frequent with stenting, and cerebral protection will likely be necessary to minimize stroke. Randomized trials comparing protected carotid stenting with endarterectomy are warranted.

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“…Given this reality, it is somewhat intriguing to witness the rapidly growing enthusiasm for endovascular intervention to treat carotid artery disease. [3][4][5] The drive to perform catheter-based carotid procedures (instead of endarterectomy) has been fueled in large part by the aggressive attitude of cardiologists and a few interventional radiologists and vascular surgeons who are now proposing to treat carotid artery lesions nonsurgically with balloon angioplasty and endovascular stent placement. [5][6][7] …”

Section: Abstract Carotid Artery Stent Placement Endovascularmentioning

confidence: 99%

“…3 Illustration of selective catheterization technique using 5F JB-1 catheter (or similar) and 0.035 inch guidewire. (5) This step consists of the administration of a small amount of contrast through the catheter (which is now in the lumen of the target brachiocephalic vessel) to define the anatomy of the carotid bifurcation, and to identify the external carotid artery (ECA).…”

Section: Perspectives In Vascular Surgerymentioning

confidence: 99%

Access Strategies for Endovascular Intervention in the Carotid Artery: Does the Direct Cervical Approach Have A Role?

Criado¹,

Wilson²,

Zaman³

et al. 2000

Perspectives in Vascular Surgery

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Endovascular stent placement is rapidly evolving as a potential alternative to surgical endarterectomy in the treatment of carotid artery disease. Currently available information is preliminary and somewhat incomplete, but it does suggest that carotid catheter intervention is likely to become a frequent and successful procedure in the future. Access considerations are of key importance, with the transfemoral technique emerging as the best strategy in most instances. Direct puncture and cannulation of the cervical carotid artery is technically feasible but seldom required. When necessary, a cutdown open approach through a short incision at the base of the neck may offer advantages over the percutaneous technique. Vascular surgeons should be urged to become proficient with all forms of catheter-based procedures, and pay particular attention to carotid artery intervention. Keywords Carotid artery, stent placement, endovascularProspective randomized clinical trials have shown conclusively that carotid endarterectomy (CEA) is an effective, safe, and durable treatment for highgrade stenotic lesions of the carotid bifurcation and internal carotid artery (ICA) in both symptomatic and asymptomatic patients. 1,2 In fact, CEA may well be the most validated operation in contemporary vascular surgery. Given this reality, it is somewhat intriguing to witness the rapidly growing enthusiasm for endovascular intervention to treat carotid artery disease. [3][4][5] The drive to perform catheter-based carotid procedures (instead of endarterectomy) has been fueled in large part by the aggressive attitude of cardiologists and a few interventional radiologists and vascular surgeons who are now proposing to treat carotid artery lesions nonsurgically with balloon angioplasty and endovascular stent placement. [5][6][7]

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Concern About Safety of Carotid Angioplasty

Cited by 80 publications

References 11 publications

Elective stenting of carotid artery stenosis in patients with severe coronary artery disease

Elective stenting of carotid artery stenosis in patients with severe coronary artery disease

Carotid Artery Stenting Protected With an Emboli Containment System

Access Strategies for Endovascular Intervention in the Carotid Artery: Does the Direct Cervical Approach Have A Role?

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