Neuro-rescue during Carotid Stenting

Abstract

This paper deals with the treatment of acute neurological complications that may occur during carotid angioplasty with stenting. Endovascular 'neurorescue' techniques include mechanical thrombus removal (using retrieval devices, aspiration catheters, and wire or balloon fragmentation) and local and intra-arterial thrombolysis. The treatment of acute thrombosis and dissection during carotid artery and stenting will also be discussed. Knowledge of these additional skills is essential to increasing the safety of carotid stenting procedures.

Neurological complications of carotid revascularisation

“…Other causes of delayed stroke include arterial spasm and a patient's thrombogenic tendency, but in some cases the cause is unknown 33. Acute or subacute carotid in-stent thrombosis rarely complicates CAS and is usually the result of inadequate preoperative anti-platelet therapy 32 34…”

“…Acute or subacute in-stent thrombosis is a rare (0.5%–2%) complication of CAS and is usually due to lack of pre-treatment with dual antiplatelet therapy 34. Different techniques are available to treat perioperative thromboembolism including mechanical thromboembolectomy, thrombus fragmentation and microaspiration, and intra-arterial thrombolysis.…”

“…Different techniques are available to treat perioperative thromboembolism including mechanical thromboembolectomy, thrombus fragmentation and microaspiration, and intra-arterial thrombolysis. The administration of glycoprotein platelet inhibitors (abciximab or tirofiban) or ‘facilitated thrombolysis’ (intra-arterial thrombolysis followed by half dose abciximab) can achieve recanalisation 34. If medical therapy is unsuccessful, surgical thrombectomy with or without stent removal can be considered.…”

Minimizing Complications of Carotid Stenting

“…These radiological findings disappeared on follow-up FLAIR images accompanied by clinical improvement over following several days after the procedures. 20…”

Catheter-based neurosalvage for acute embolic complication during carotid intervention

“…12 Emboli manipulation techniques, including retrieval devices, aspiration catheters, and wire/balloon fragmentation, have been applied in acute ischemic stroke but are seldom used in complications associated with CAS. 13 We present our experience of stepwise neurosalvage techniques, combining intra-arterial pharmacotherapy and mechanical emboli manipulation, in the management of macroembolic events complicating CAS.…”