Early results of endovascular treatment of patients with bilateral stenoses of the internal carotid arteries using proximal protection systems at 30-day follow-up

Latacz, Paweł; Simka, Marian; Popiela, T; Kazibudzki, Marek; Mrowiecki, Tomasz

doi:10.1016/j.pjnns.2017.06.010

Cited by 1 publication

(3 citation statements)

References 21 publications

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“…Importantly, all of the aforementioned neurological symptoms occurred during procedures, which were longer than 6-7 min. This further confirms the validity of the 5-minute threshold as the safe time of endovascular carotid revascularisation [21].…”

Section: Discussionsupporting

confidence: 73%

“…Of note, there were no periprocedural neurological adverse events in our patients, while mid-term follow-up has revealed a complication rate of 0.8%, which is much less in comparison with the other studies. In our opinion, such a low complication rate has resulted from the fact that in our centre the proximal protection was the preferred method for the management of symptomatic patients, even those presenting with critical stenosis or contralateral occlusion [20][21][22]. In contrast to the results of the meta-analysis performed by Bersin et al [22], in our study adverse events were not more prevalent in patients older than 80 years, except for more frequent intolerance of the protection system.…”

Section: Discussioncontrasting

confidence: 60%

“…However, a contralateral occlusion or significant stenosis represents an important limitation of the proximal protection technique. The maximal tolerated time of the occlusion of the ICA by a proximal protection device, according to different authors, should not exceed 2.5-15 min [21]. Of note, in our patient series 5 (4.2%) individuals presented with an occlusion of contralateral internal carotid artery, while 25 (20.8%) patients had severe bilateral stenosis of the ICAs.…”

Section: Discussionmentioning

confidence: 60%

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Mid-term and late results of endovascular treatment for symptomatic carotid artery stenosis under proximal protection.

Latacz¹,

Simka²,

Krzanowski³

et al. 2020

Videosurgery and Other Miniinvasive Techniques

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Introduction: Although filters are still preferred during carotid stenting, proximal protection systems (PPS) are increasingly used during these procedures. PPS seem to be safer than distal systems, especially in symptomatic patients, but evidence supporting their use is limited. Aim: This was a post hoc survey with 30-day mid-term and long-term follow up, which was aimed at assessment of the safety and efficacy of stenting of the internal carotid artery under PPS in symptomatic patients. Material and methods: We analysed the results of stenting in 120 symptomatic patients presenting with at least 60% stenosis. Patients were aged 67.9 ±9.8 years, and 12 patients were older than 80 years. An occlusion of contralateral artery was found in 5 patients and bilateral stenosis in 26 patients. The primary endpoint of this study was the proportion of patients who had new neurological events, including transient ischemic attack and minor or major stroke in 30-day follow-up. The secondary endpoint was a composite of technical and clinical success. During longterm follow-up we assessed new neurological events and stenoses of implanted stents. Results: The incidence of new neurological events during 30-day follow-up was 0.8%. The rate of technical success defined by secondary endpoint was 100%. Mean internal carotid artery stenosis before and after stent implantation was 93.8 ±9% and 8.4 ±6.3%, respectively (p < 0.001). Procedural success was achieved in all cases. During longterm follow-up there were two (1.7%) asymptomatic in-stent stenoses and no (0%) new neurological events. Conclusions: Endovascular management of symptomatic carotid stenosis under PPS is safe, feasible, and appears to be a good alternative to surgical endarterectomy.

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Section: Discussionsupporting

confidence: 73%