Embolic protection devices for carotid artery stenting: A network meta-analysis

Giannopoulos, Stefanos; Sagris, Μarios; Giannopoulos, Spyridon; Tzoumas, Andreas; Kokkinidis, Damianos G.; Texakalidis, Pavlos; Koutsias, George; Volteas, Panagiotis; Li, Jing; Malgor, Rafael D.

doi:10.1177/17085381221140616

Cited by 3 publications

(3 citation statements)

References 36 publications

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“…The metallic stents used for carotid artery stenting (CAS) are also thrombogenic, particularly until they are completely covered by native endothelium over weeks to months following placement. CAS can be associated with acute and subacute ischemic complications with an incidence of under 1% (stroke and TIA with modern embolic protection devices and minimal comorbidities) to over 40% (often asymptomatic post-procedure diffusion weighted imaging lesions seen on MRI), as recently reviewed in a study comparing embolic protection devices 81. Intimal injury of the artery releases procoagulant tissue factors and exposes collagen in the sub-endothelium, thereby triggering platelet activation, thrombus formation, and distal embolization.…”

Section: Disease-specific Considerationsmentioning

confidence: 99%

“…CAS can be associated with acute and subacute ischemic complications with an incidence of under 1% (stroke and TIA with modern embolic protection devices and minimal comorbidities) to over 40% (often asymptomatic post-procedure diffusion weighted imaging lesions seen on MRI), as recently reviewed in a study comparing embolic protection devices. 81 Intimal injury of the artery releases procoagulant tissue factors and exposes collagen in the subendothelium, thereby triggering platelet activation, thrombus formation, and distal embolization. Although pretreatment with DAPT is often recommended, data are limited regarding the optimal timing, dose, and duration of DAPT treatment for CAS.…”

Section: Intracranial Atherosclerotic Disease Treatmentmentioning

confidence: 99%

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Antiplatelets and antithrombotics in neurointerventional procedures: Guideline update

Schirmer

Bulsara

Al‐Mufti

et al. 2023

J NeuroIntervent Surg

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BackgroundAntiplatelet and antithrombotic medication management before, during, and after neurointerventional procedures has significant practice variation. This document updates and builds upon the 2014 Society of NeuroInterventional Surgery (SNIS) Guideline ‘Platelet function inhibitor and platelet function testing in neurointerventional procedures’, providing updates based on the treatment of specific pathologies and for patients with specific comorbidities.MethodsWe performed a structured literature review of studies that have become available since the 2014 SNIS Guideline. We graded the quality of the evidence. Recommendations were arrived at through a consensus conference of the authors, then with additional input from the full SNIS Standards and Guidelines Committee and the SNIS Board of Directors.ResultsThe management of antiplatelet and antithrombotic agents before, during, and after endovascular neurointerventional procedures continues to evolve. The following recommendations were agreed on. (1) It is reasonable to resume anticoagulation after a neurointerventional procedure or major bleeding episode as soon as the thrombotic risk exceeds the bleeding risk in an individual patient (Class I, Level C-EO). (2) Platelet testing can be useful to guide local practice, and specific approaches to using the numbers demonstrate marked local variability (Class IIa, Level B-NR). (3) For patients without comorbidities undergoing brain aneurysm treatment, there are no additional considerations for medication choice beyond the thrombotic risks of the catheterization procedure and aneurysm treatment devices (Class IIa, Level B-NR). (4) For patients undergoing neurointerventional brain aneurysm treatment who have had cardiac stents placed within the last 6–12 months, dual antiplatelet therapy (DAPT) is recommended (Class I, Level B-NR). (5) For patients being evaluated for neurointeventional brain aneurysm treatment who had venous thrombosis more than 3 months prior, discontinuation of oral anticoagulation (OAC) or vitamin K antagonists should be considered as weighed against the risk of delaying aneurysm treatment. For venous thrombosis less than 3 months in the past, delay of the neurointerventional procedure should be considered. If this is not possible, see atrial fibrillation recommendations (Class IIb, Level C-LD). (6) For patients with atrial fibrillation receiving OAC and in need of a neurointerventional procedure, the duration of TAT (triple antiplatelet/anticoagulation therapy=OAC plus DAPT) should be kept as short as possible or avoided in favor of OAC plus single antiplatelet therapy (SAPT) based on the individual’s ischemic and bleeding risk profile (Class IIa, Level B-NR). (7) For patients with unruptured brain arteriovenous malformations there is no indication to change antiplatelet or anticoagulant management instituted for management of another disease (Class IIb, Level C-LD). (8) Patients with symptomatic intracranial atherosclerotic disease (ICAD) should continue DAPT following neurointerventional treatment for secondary stroke prevention (Class IIa, Level B-NR). (9) Following neurointerventional treatment for ICAD, DAPT should be continued for at least 3 months. In the absence of new stroke or transient ischemic attack symptoms, reversion to SAPT can be considered based on an individual patient’s risk of hemorrhage versus ischemia (Class IIb, Level C-LD). (10) Patients undergoing carotid artery stenting (CAS) should receive DAPT before and for at least 3 months following their procedure (Class IIa, Level B-R). (11) In patients undergoing CAS during emergent large vessel occlusion ischemic stroke treatment, it may be reasonable to administer a loading dose of intravenous or oral glycoprotein IIb/IIIa or P2Y12 inhibitor followed by maintenance intravenous infusion or oral dosing to prevent stent thrombosis whether or not the patient has received thrombolytic therapy (Class IIb, C-LD). (12) For patients with cerebral venous sinus thrombosis, anticoagulation with heparin is front-line therapy; endovascular therapy may be considered particularly in cases of clinical deterioration despite medical therapy (Class IIa, Level B-R).ConclusionsAlthough the quality of evidence is lower than for coronary interventions due to a lower number of patients and procedures, neurointerventional antiplatelet and antithrombotic management shares several themes. Prospective and randomized studies are needed to strengthen the data supporting these recommendations.

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Section: Disease-specific Considerationsmentioning

confidence: 99%

Section: Intracranial Atherosclerotic Disease Treatmentmentioning

confidence: 99%

Antiplatelets and antithrombotics in neurointerventional procedures: Guideline update

Schirmer

Bulsara

Al‐Mufti

et al. 2023

J NeuroIntervent Surg

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“…Another important aspect of this potentially new treatment will probably be the necessity to employ, concomitantly to shockwaves delivery, embolic protection devices able to filter out from the blood the debris deriving from the calcium deposits fragmentation. In this respect, several types of these devices have been designed to capture debris that embolizes distally during vascular surgeries in specific vascular districts particularly critical such as, for example, carotid stenting ( 55 ).…”

Section: Use Of Shockwaves In Treatment Of Cardiovascular Diseasesmentioning

confidence: 99%

Shockwaves delivery for aortic valve therapy—Realistic perspective for clinical translation?

Curini

Pesce

2023

Front. Cardiovasc. Med.

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Calcific aortic valve disease (CAVD) is the most frequent valvular heart disorder, and the one with the highest impact and burden in the elderly population. While the quality and standardization of the current aortic valve replacements has reached unprecedented levels with the commercialization of minimally-invasive implants and the design of procedures for valve repair, the need of supplementary therapies able to block or retard the course of the pathology before patients need the intervention is still awaited. In this contribution, we will discuss the emerging opportunity to set up devices to mechanically rupture the calcium deposits accumulating in the aortic valve and restore, at least in part, the pliability and the mechanical function of the calcified leaflets. Starting from the evidences gained by mechanical decalcification of coronary arteries in interventional cardiology procedures, a practice already in the clinical setting, we will discuss the advantages and the potential drawbacks of valve lithotripsy devices and their potential applicability in the clinical scenario.

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Dual-layered micromesh stent technology for embolic prevention in carotid revascularization: technical experience and clinical outcomes from a high-volume interventional radiology center

STEFANINI,

CACIOPPA,

BELLINI

et al. 2024

J Cardiovasc Surg

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Embolic protection devices for carotid artery stenting: A network meta-analysis

Cited by 3 publications

References 36 publications

Antiplatelets and antithrombotics in neurointerventional procedures: Guideline update

Antiplatelets and antithrombotics in neurointerventional procedures: Guideline update

Shockwaves delivery for aortic valve therapy—Realistic perspective for clinical translation?

Dual-layered micromesh stent technology for embolic prevention in carotid revascularization: technical experience and clinical outcomes from a high-volume interventional radiology center

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