Mid‐term outcomes of carotid artery stenting in patients with angiographic string sign

Špaček, Miroslav; Martinkovičová, Lucie; Zimolová, Petra; Veselka, Josef

doi:10.1002/ccd.23144

Cited by 18 publications

(12 citation statements)

References 16 publications

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“…Apart from operator training, it is equally essential to carefully select patients in order to reach favourable outcomes [18]. …”

Section: Patient Selectionmentioning

confidence: 99%

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State of the art paper Carotid artery stenting – current status of the procedure

Špaček

Veselka

2013

aoms

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Surgical carotid endarterectomy (CEA) was long considered the standard approach for the treatment of atherosclerotic carotid artery disease. This was based on results of several randomized trials demonstrating its effectiveness over the best medical therapy. In the past two decades, patients identified high-risk for surgery were offered carotid artery stenting (CAS) as a less invasive option. Despite its initial limitations, CAS has evolved into an elaborate method currently considered to be equivalent and in selected patients even preferable to CEA. However, outcomes of both procedures are highly operator dependent and a simple stratifying method to prioritize CAS, CEA or medical therapy only has not yet been proposed. In addition, recently published randomized trials highlighted the importance of proper patient selection and rigorous training contributing to low absolute rates of (procedural) adverse events. This review discusses the history and evidence for carotid revascularization and briefly presents technical aspects and innovations in CAS.

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“…Apart from operator training, it is equally essential to carefully select patients in order to reach favourable outcomes [18]. …”

Section: Patient Selectionmentioning

confidence: 99%

“…One must also be very reserved in indicating patients with multiple clinical high risk factors, which might influence the patient's long-term prognosis per se despite favourable procedural outcomes [18, 30]. In such case, the benefit of CAS over medical treatment must be critically evaluated, especially in asymptomatic patients.…”

Section: Patient Selectionmentioning

confidence: 99%

State of the art paper Carotid artery stenting – current status of the procedure

Špaček

Veselka

2013

aoms

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“…Reported outcomes were highly heterogeneous and ranged from a 30-day stroke/death risk of 0–11.1% for CEA [11–13, 20] to 0–9.2% for CAS [5–7, 16–18] and 0–43% for best medical treatment (BMT) [8, 12, 19]. Furthermore, analyses of published studies are hampered by both a variety in inclusion criteria and the reporting of different clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Carotid endarterectomy in patients with recurrent symptoms associated with an ipsilateral carotid artery near occlusion with full collapse

et al. 2018

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ObjectiveNear occlusion (NO) of the internal carotid artery (ICA) with full collapse (NOFC) is a rare condition, with a prevalence of around 1%. Guidelines on carotid stenosis recommend a conservative treatment in patients with a single-event ipsilateral to a NOFC, but the optimal treatment for patients with recurrent symptoms associated with NOFC remains uncertain. We describe a consecutive series of patients with recurrent symptoms associated with NOFC (RSNOFC) who underwent carotid endarterectomy (CEA).MethodsFrom 2008 to 2017, 17 consecutive patients with RSNOFC were treated according to our standardized multidisciplinary work-up and protocol and included for this single-center cohort study. NO was defined according to the angiographic North American Symptomatic Carotid Endarterectomy Trial criteria. Only patients with NOFC were included in this study.ResultsStandard longitudinal CEA was performed in 15 patients, whereas in 2 patients the ICA was ligated with concomitant endarterectomy of the ECA. Within 30 postoperative days, one patient died from a hemorrhagic infarction. During follow-up (median 23 months) one patient died of unknown cause 90 days after CEA. No TIA, stroke, myocardial infarction or re-stenosis occurred in the remaining patients.ConclusionIn patients with RSNOFC, CEA may be considered a potential treatment option. Although procedural risks in this small subgroup may be higher as compared to patients with low-to-moderate risk anatomy, this risk may outbalance the natural course.

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“…In a consecutive series of 25 patients with angiographic string sign, Nikas et al [16] reported a 100% technical success rate and no periprocedural adverse clinical events. Spacek et al [15] reported equally impressive results in a series of 19 patients, including 95% technical success and 0% incidence of periprocedural stroke or death. Post hoc analysis revealed that approximately 7% of patients in our series had a string sign; however, the presence of a string sign was not a predictor of periprocedural complications.…”

Section: Discussionmentioning

confidence: 87%

Results of carotid angioplasty and stenting are equivalent for critical versus high-grade lesions in patients deemed high risk for carotid endarterectomy

Ullery

Orlova

Shang

et al. 2013

Journal of Surgical Research

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Mid‐term outcomes of carotid artery stenting in patients with angiographic string sign

Cited by 18 publications

References 16 publications

State of the art paper Carotid artery stenting – current status of the procedure

State of the art paper Carotid artery stenting – current status of the procedure

Carotid endarterectomy in patients with recurrent symptoms associated with an ipsilateral carotid artery near occlusion with full collapse

Results of carotid angioplasty and stenting are equivalent for critical versus high-grade lesions in patients deemed high risk for carotid endarterectomy

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