Favorable Early Outcome of Carotid Artery Stenting Without Protection Devices

Sztriha, L.; Vörös, Erika; Sas, Katalin; Szentgyörgyi, Réka; Anna, Pócsik; Barzó, Pál; Szikra, Péter; Makai, Attila; Szólics, Alex; Elek, Péter; Rudas, László; Vécsei, László

doi:10.1161/01.str.0000147714.19871.45

Cited by 35 publications

(22 citation statements)

References 22 publications

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“…Experimentally, covered stents have proved to be efficient in ex vivo flow models, 11,12 and an initial clinical experience in atherosclerotic carotid stenosis also seemed promising. 13 Consistently, in a previous randomized trial, 14 we demonstrated a significantly reduced rate of microembolic signals during CAS by transcranial Doppler with the covered Symbiot stentgraft compared with Wallstents. Unfortunately, the stentgraft revealed an excessively high restenosis rate of Ϸ40% at 6 months and the trial had to be stopped.…”

Section: Discussionsupporting

confidence: 85%

Does Carotid Stent Cell Design Matter?

Schillinger

Gschwendtner

Reimers

et al. 2008

Stroke

145

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Background and Purpose-Carotid stent cell design has recently been suggested to be a determinant of periprocedural and early postprocedural neurologic complications. We investigated the impact of closed-versus open-cell stent design on neurologic adverse events and mortality after carotid artery stenting. Methods-We studied 1684 consecutive patients (1010 asymptomatic, 674 symptomatic) from 10 European centers who underwent carotid artery stenting with either closed-cell (nϭ859, 51%) or open-cell (nϭ825, 49%) design stents. Rates of transient ischemic attack, stroke, and death on the day of the procedure (acute events) and from day 1 to day 30 after the procedure (subacute events) were analyzed (95% CIs). Results-Combined transient ischemic attack, stroke, or death rates, and stroke or death rates within 30 days of treatment were 6.1% (95% CI, 5.0 to 7.2) and 3.1% (95% CI, 2.3 to 3.9) for the closed-cell design versus 4.1% (95% CI, 3.2 to 5.0) and 2.4% (95% CI, 1.7 to 3.1) for the open-cell design stents (Pϭ0.077, Pϭ0.38), respectively, without significant differences in asymptomatic and symptomatic patients. By propensity-score-adjusted multivariable analysis, the open-cell carotid stent design was not associated with a differential risk for combined acute and subacute neurologic complications compared with closed-cell stents (adjusted odds ratioϭ0.84, Pϭ0.53). When analyzed separately, the risk for acute events on the day of the procedure (adjusted odds ratioϭ0.83, Pϭ0.57) and the risk for subacute events at days 1 to 30 (adjusted odds ratioϭ1.61, Pϭ0.51) also were not significantly different between the groups. Conclusions-Current data do not support the superiority of a specific carotid stent cell design with respect to neurologic complications, stroke, and mortality risk.

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Section: Discussionsupporting

confidence: 85%

Does Carotid Stent Cell Design Matter?

Schillinger

Gschwendtner

Reimers

et al. 2008

Stroke

145

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“…Although cerebral protection devices reduce this kind of embolism, they can cause some mechanical or iatrogenic complications such as vasospasm and dissection of the vessel. 2,[6][7][8] In cases of serious vasospasm, minor stroke can be seen. 9 However "mechanical" complications such as incomplete expansion of the stent caused by displacement of a marker ring with intraluminal locking of the stent are unusual.…”

Section: Discussionmentioning

confidence: 99%

“…Less common complications during CAS placement are hemodynamic conditions such as bradycardia and hypotension, which are easily treatable. [1][2][3] Mechanical complications such as spasm or dissection are seen less and less frequently with personal experience and innovations in equipment. Complications caused by unlucky mechanical accidents during stent implantation such as incomplete opening are unusual and therefore can be a reason for unpredictable outcomes of CAS placement.…”

mentioning

confidence: 99%

A Rare Complication of Carotid Artery Stenting: Displacement of Marker Ring Causing Locking of Stent and Incomplete Stent Expansion

Akgül

Aksungur²,

Korur³

et al. 2007

American Journal of Neuroradiology

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SUMMARY: We present a rare case of a complication of placement of a carotid artery stent represented by partial opening of a carotid Wallstent caused by displacement of its metal ring marker, which thus hindered complete expansion of the stent. An intraluminally locked carotid stent necessitated referral of the patient for urgent carotid endarterectomy. A possible reason of this unusual complication can be a manufacturing defect, which, to our knowledge, was not documented previously in open public data bases or on the Internet. Carotid artery stent (CAS) placement is a well-established method for revascularization of the obstructed lumen in patients with carotid artery disease. Complications may occur during the procedure and generally are presented by neurologic symptoms as a result of microembolism or thrombosis, which can be prevented by the use of a protective filter. Less common complications during CAS placement are hemodynamic conditions such as bradycardia and hypotension, which are easily treatable.1-3 Mechanical complications such as spasm or dissection are seen less and less frequently with personal experience and innovations in equipment. Complications caused by unlucky mechanical accidents during stent implantation such as incomplete opening are unusual and therefore can be a reason for unpredictable outcomes of CAS placement. We present a rare case of a CAS complication with incomplete opening of a carotid Wallstent (Boston Scientific, Natick, Mass) caused by displacement of its metal ring marker, which hindered the complete expansion of the stent and required urgent surgical intervention. Case ReportA 71-year-old woman with a history of transient ischemic attack and right internal carotid artery stenosis of more than 70% in the proximal portion previously diagnosed on CT and MR angiography was referred to our hospital for implantation of a carotid stent. CAS with a carotid Wallstent Monorail 4 with a cerebral protection filter (EPI Filter Wire; Boston Scientific) was planned. The patient had received therapy with antiaggregant medications: aspirin 100 mg/day and clopidogrel 75 mg/day for 1 week before stent implantation. A 6F shuttle introducer was placed into the right common carotid artery by the femoral approach, and preprocedure control angiograms were obtained. A cerebral protection filter was placed distally to the obstructed internal carotid artery, and then self-expandable Wallstent (7 ϫ 50 mm) deployment was performed. During deployment, unexpected slipping of the distal ring of the metal marker over the shaft of the stent was observed. The slipped ring at one fourth of the proximal end of the stent hindered the complete expansion of the stent. The shaft of the stent and the protection filter could not be pulled back because the metal ring locked over the stent (Fig 1). Attempts to rescue the fixed stent and slipped metal ring were unsuccessful, and the patient was rushed to the operating room. During endarterectomy, the stent, stent shaft, and protection filter were removed without any ...

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“…9,20) Cerebral ischemia can be significantly reduced by using protected CAS compared to unprotected procedures, 8,35) whereas favorable outcomes have been reported with unprotected CAS and most of the neurological complications could not have been prevented with protection devices. 25) Cerebral protection can be achieved by different devices including filter embolic protection devices, distal balloon occlusion devices, and proximal flow reverse protection devices. Their efficacy has been evaluated in various in vitro [19][20][21][22] and clinical studies.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Ischemic Lesions Detected With Diffusion-Weighted Magnetic Resonance Imaging After Carotid Artery Stenting: Comparison of Several Anti-embolic Protection Devices

Taha

Maeda

Sakaida

et al. 2009

Neurol. Med. Chir.(Tokyo)

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Distal embolism is an important periprocedural technical complication with carotid angioplasty and carotid artery stenting (CAS). We evaluated the safety and efficacy of protection devices used during CAS by detecting new cerebral ischemic lesions using diffusion-weighted magnetic resonance imaging in 95 patients who underwent 98 CAS procedures: 34 using single PercuSurge GuardWire, 31 using double balloon protection, 15 using proximal flow reverse protection devices, 14 using Naviballoon, and 4 using filter anti-embolic devices. Diffusion-weighted imaging was performed preoperatively and postoperatively to evaluate the presence of any new embolic cerebral lesions. Postoperative diffusionweighted imaging revealed 117 new ischemic lesions. Three patients had new ischemic stroke, two minor and one major, all ipsilateral to the treated carotid artery. The remaining patients had clinically silent ischemia. The incidence of new embolic lesions was lower using the proximal flow reverse protection device than with the double balloon protection (33% vs. 48.4%), but the volume of ipsilateral new ischemic lesions per patient was 136.6 mm 3 vs. 86.9 mm 3 , respectively. Neuroprotection with Naviballoon yielded ipsilateral lesions of large volume (86.6 mm 3 ) and higher number (5.7 lesions per patient) than using the filter anti-embolic device (34.8 mm 3 and 1 lesion per patient). New cerebral ischemic lesions after neuroprotected CAS are usually silent. The lower incidence of distal ischemia using proximal flow reverse and double balloon protection devices is limited by the larger volume and higher number of ischemic lesions.

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Favorable Early Outcome of Carotid Artery Stenting Without Protection Devices

Cited by 35 publications

References 22 publications

Does Carotid Stent Cell Design Matter?

Does Carotid Stent Cell Design Matter?

A Rare Complication of Carotid Artery Stenting: Displacement of Marker Ring Causing Locking of Stent and Incomplete Stent Expansion

Cerebral Ischemic Lesions Detected With Diffusion-Weighted Magnetic Resonance Imaging After Carotid Artery Stenting: Comparison of Several Anti-embolic Protection Devices

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