Predictors of Carotid Occlusion Intolerance During Proximal Protected Carotid Artery Stenting

Giugliano, Giuseppe; Stabile, Eugenio; Biamino, Giancarlo; Petroni, Giampaolo; Sannino, Anna; Brevetti, Linda; Pucciarelli, Armando; Popusoi, Grigore; Tesorio, Tullio; Cioppa, Angelo; Cota, Linda; Salemme, Luigi; Sorropago, Antonio; Ausania, Angelo; Pietra, Giovanni Della; Fontanelli, Arturo; Trimarco, Bruno; Esposito, Giovanni; Rubino, Paolo

doi:10.1016/j.jcin.2014.05.021

Cited by 20 publications

(21 citation statements)

References 13 publications

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“… 2) 3) 4) 5) However, NI occurs inevitably during the procedure. The incidence of NI was reported 6–30% in previous studies, 6) 7) 8) 9) which is known to be relatively common. In this study, the incidence of NI was 40%, and it seemed more frequently compared with previous studies.…”

Section: Discussionmentioning

confidence: 96%

Low Common Carotid Artery Systolic Occlusion Pressure and Symptomatic Carotid Artery Stenosis Are Associated with Development of Neurologic Intolerance during Proximal Protected Carotid Artery Stenting

et al. 2018

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Background and ObjectivesNeurologic intolerance (NI) is defined as the occurrence of neurological symptoms during carotid artery stenting (CAS). Because NI is inevitable problem, it may be helpful to anticipate its occurrence. So, we studied factors associated with NI during proximal protected CAS.MethodsWe retrospectively analyzed all consecutive patients underwent proximal protected CAS from August 2012 to January 2017.ResultsWe included total 123 patients (109 males, 72±8 years old). The total procedure time was 43±12 minutes, and mean occlusion time was 4.8±1.2 minutes. We divided CAS patients into 2 groups according to presence of NI; neurologic tolerance (NT; n=74, 60%) and NI (n=49, 40%) groups. After the univariate analysis, symptomatic carotid artery stenosis (p=0.003), absence of anterior communicating artery (p=0.015) and low common carotid artery occlusion pressure (CCAOP, p<0.001) were associated with NI. After the multivariate analysis, NI was significantly associated with symptomatic carotid artery stenosis (odds ratio [OR], 5.549; p=0.014) and systolic CCAOP≤42 mmHg (OR, 6.461; p<0.001). In NI group, 43 patients (88%) recovered right after the balloon deflation and 2 patients were normalized within 2 hours. However, 1 had major stroke and 3 had minor strokes in 4 patients with persistent NI ≥24 hours.ConclusionsAbout 40% showed NI during the CAS. Most of them (88%, 43 of 49 patients) recovered after the balloon deflation, but stroke incidence was significantly higher in NI group. Symptomatic carotid artery stenosis and systolic CCAOP ≤42 mmHg were significantly associated with the development of NI during proximal protected CAS.

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Section: Discussionmentioning

confidence: 96%

Low Common Carotid Artery Systolic Occlusion Pressure and Symptomatic Carotid Artery Stenosis Are Associated with Development of Neurologic Intolerance during Proximal Protected Carotid Artery Stenting

et al. 2018

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“…It is advised, however, that proximal CPDs should be avoided in patients with severe ECA/CCA disease. 317 Overall, 30% will not tolerate proximal occlusion 318 and will develop neurological symptoms. In a series of 600 patients, the only clinical predictive factor of not being able to tolerate proximal occlusion was contralateral ICA occlusion.…”

Section: Treatment Of High Internal Carotid Artery Lesionsmentioning

confidence: 99%

“…In a series of 600 patients, the only clinical predictive factor of not being able to tolerate proximal occlusion was contralateral ICA occlusion. 318 A systematic review has reported that the relative risk reduction in peri-procedural stroke was 0.62 (95% CI 0.54e0.72) in favour of protected CAS, with significant benefit being conferred in both asymptomatic and symptomatic patients. 319 These contradictory reports and the lack of high-quality data have led to conflicting opinions among CAS practitioners, with some claiming that CPDs are unnecessary, while others would never perform an unprotected CAS procedure.…”

Section: Treatment Of High Internal Carotid Artery Lesionsmentioning

confidence: 99%

Editor's Choice – Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

Naylor¹,

Ricco²,

Borst³

et al. 2018

European Journal of Vascular and Endovascular Surgery

978

934

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“…We crossed the lesion with the EPD by synchronizing the movement of EPD with the blood flow, but the blood flow is interrupted by proximal protection or CGW, and it is difficult to check whether or not the EPD or guidewire is guided through the true lumen in lesion crossing. In addition, according to the literature, 19) about 10%-30% of the patients showed intolerance to proximal protection involving interruption of the blood flow, and there is some risk of induction of ischemic neurological symptoms by proximal protection as well as by the CGW. Therefore, FWEZ, with which the blood flow can be maintained during CAS, is considered to be more advantageous.…”

mentioning

confidence: 99%

Outcomes between 30 Days and 1 Year after Carotid Artery Stenting Using FilterWire EZ: Clinical Results and Diffusion-weighted MRI Findings in 262 Consecutive Patients

Mizobe

Nakamura

Motooka

et al. 2016

JNET

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Objective: To report the clinical outcomes of carotid artery stenting (CAS) using the FilterWire EZ (FWEZ) Embolic Protection System. Methods:In 262 consecutive patients who underwent CAS using FWEZ from May 2010 to December 31, 2015, major adverse events (MAEs) including stroke, myocardial infarction, and death that occurred between 30 days and 1 year after the procedure and findings on diffusion-weighted imaging (DWI) were evaluated. Results:Ischemic stroke was observed after CAS using FWEZ in four patients (1.53%), but the neurological symptoms disappeared within 30 days in all those patients. No cerebral hemorrhage, myocardial infarction, or death occurred within 30 days after CAS. New DWI lesions were observed in 53 patients (20.2%): ipsilateral hemisphere alone in 38 patients (14.5%), contralateral hemisphere alone in 5 patients (1.9%), and both hemispheres in 10 patients (3.82%). They were significantly related to age, smoking within 1 year, and prolonged post-procedural hypotension. In 235 patients who could be followed up, no ipsilateral stroke was noted between 31 days and 1 year after CAS. Non-ipsilateral strokes were observed in three patients (1.28%): contralateral cerebral infarction in one patient (0.43%), contralateral cerebral hemorrhage in one patient (0.43%), and death due to subarachnoid hemorrhage in one patient (0.43%). Other events included non-traumatic acute subdural hematoma in one patient (0.43%), myocardial infarction in six patients (2.55%), and death in seven patients (2.98%). No 50% or severer stenosis was observed within 1 year. Conclusion:The clinical outcomes and DWI-positive rates between 30 days and 1 year after CAS using FWEZ were favorable. CAS using FWEZ is a simple procedure and is considered effective for the treatment of carotid stenosis considered.

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Predictors of Carotid Occlusion Intolerance During Proximal Protected Carotid Artery Stenting

Abstract: OI may occur in as many as one-third of the patients undergoing proximal protected CAS. This event is more common in those patients with an OP ≤40 mm Hg. Patients presenting with concomitant occlusion of the contralateral internal carotid artery more frequently have an OP ≤40 mm Hg.

Cited by 20 publications

References 13 publications

Low Common Carotid Artery Systolic Occlusion Pressure and Symptomatic Carotid Artery Stenosis Are Associated with Development of Neurologic Intolerance during Proximal Protected Carotid Artery Stenting

Low Common Carotid Artery Systolic Occlusion Pressure and Symptomatic Carotid Artery Stenosis Are Associated with Development of Neurologic Intolerance during Proximal Protected Carotid Artery Stenting

Editor's Choice – Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

Outcomes between 30 Days and 1 Year after Carotid Artery Stenting Using FilterWire EZ: Clinical Results and Diffusion-weighted MRI Findings in 262 Consecutive Patients

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