Safety and efficacy of elective carotid artery stenting in high-risk patients

Shawl, Fayaz A.; Kadro, Waleed; Domanski, Michael J.; Lapetina, Fernando; Iqbal, Aleem A; Dougherty, Kathryn G.; Weisher, David D; Marquez, Jaime F; Shahab, S.Tariq

doi:10.1016/s0735-1097(00)00618-5

Cited by 165 publications

(86 citation statements)

References 21 publications

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“…[1][2][3] Initial reports suggest favorable efficacy in preventing stroke, and randomized trials are being commenced to compare its outcome to carotid endarterectomy. 4 Despite advanced stenting techniques, neurological events linked to the embolization of particulate material in the cerebral circulation occur in Ϸ5% of the cases.…”

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confidence: 99%

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Effect of the Distal-Balloon Protection System on Microembolization During Carotid Stenting

et al. 2001

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Background-The distal-balloon protection system is being evaluated for its efficacy in preventing embolic neurological events during carotid stenting (CAS). We sought to determine the effect of this system on the frequency of Doppler-detected microembolic signals (MES) during CAS. Methods and Results-Using transcranial Doppler, we compared the frequency of MES during CAS in 2 groups: 39 patients without distal protection and 37 who used the distal-balloon protection system (GuardWire). There were no significant differences in the clinical or angiographic characteristics between the 2 groups. Three phases with increased MES counts were identified during unprotected CAS; these were stent deployment, predilation, and postdilation (75Ϯ57, 32Ϯ36, and 27Ϯ25 METS, respectively). The distal-balloon protection significantly reduced the frequency of MES during CAS (MES counts: 164Ϯ108 in the control versus 68Ϯ83 in the protection group; Pϭ0.002), particularly during these 3 phases. MES in the protection group were detected predominantly during sheath placement, guidewire manipulation, and distal-balloon deflation. Conclusion-Three phases with increased MES counts were identified during unprotected CAS (eg, stent deployment, predilation, and postdilation). The distal-balloon protection system significantly reduced the frequency of MES during CAS, particularly during these 3 phases.

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“…4 Despite advanced stenting techniques, neurological events linked to the embolization of particulate material in the cerebral circulation occur in Ϸ5% of the cases. [1][2][3]5 Efforts are ongoing to optimize the outcome of this treatment by developing strategies that eliminate the risk of embolic events. 5 One such strategy is distal-balloon protection.…”

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confidence: 99%

Effect of the Distal-Balloon Protection System on Microembolization During Carotid Stenting

et al. 2001

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“…Various types of protection devices have been developed including distal balloon protection system, filter wires, and proximal flow control technique (Parodi's system) 1,5,6,8,10 . The results of carotid stenting improved after introduction of protection system as shown in our series (ischemic complication reduced from 21% to 1.5%) as well as recent reports.…”

Section: Discussionmentioning

confidence: 99%

Technique and Clinical Results of Carotid Stenting under Distal Protection

et al. 2004

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“…11 Other studies and reviews 12 have also concluded that surgery remains the better treatment option for most patients presenting with a symptomatic severe carotid artery stenosis but a subset of patients may qualify as candidates for angioplasty and stenting. [13][14][15] These are patients considered to have the greatest perioperative cardiac or cerebrovascular risk factors.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary edema in the neuroradiology suite: a diagnostic dilemma

Quader

Manninen

Lai

2001

Can J Anesth/J Can Anesth

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CARDIOTHORACIC ANESTHESIA, RESPIRATION AND AIRWAYPurpose: To present the case of an initially unexplained complication of sudden pulmonary edema in a patient during stenting of the carotid artery in the interventional neurology suite.Clinical Features: A 46-yr-old woman (ASA III) having an intracavernous carotid artery angioplasty and stenting procedure under neurolept anesthesia developed sudden pulmonary edema on completion of an otherwise uneventful stenting procedure. The patient responded well to initial management of pulmonary edema although the cause of the edema remained unclear. On retrospective examination of data and with the evolution of clinical signs it became apparent that the patient had suffered a subarachnoid hemorrhage which eventually resulted in her death.Conclusions: Clinical signs of intracerebral events may be slow to evolve. The cause of sudden pulmonary edema in patients undergoing an interventional neuroendovascular procedure is likely to be neurogenic in origin despite the initial lack of neurological signs. Éléments cliniques : Une femme de 46 ans (ASA III) admise pour une angioplastie du siphon carotidien et la pose d'un tuteur sous neuroleptanesthésie, a développé un oedème pulmonaire soudain à la fin de la pose du tuteur, par ailleurs sans incident. La patiente a bien réagi au traitement initial de l'oedème pulmonaire même si la cause en est restée obscure. À la suite d'un examen rétrospectif des données et de l'évolution des signes cliniques, il est devenu évident que la patiente a subi une hémorragie sous-arachnoïdienne qui a finalement causé sa mort. Conclusion :Les signes cliniques d'événements intracérébraux peuvent présenter une lente évolution. La cause d'un oedème pulmonaire soudain chez des patients qui subissent une intervention neuroendovasculaire peut être d'origine neurogène malgré l'absence initiale de signes neurologiques.

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Safety and efficacy of elective carotid artery stenting in high-risk patients

Abstract: Carotid artery stenting is feasible, can be performed even in high-risk patients and is associated with a low restenosis rate.

Cited by 165 publications

References 21 publications

Effect of the Distal-Balloon Protection System on Microembolization During Carotid Stenting

Effect of the Distal-Balloon Protection System on Microembolization During Carotid Stenting

Technique and Clinical Results of Carotid Stenting under Distal Protection

Pulmonary edema in the neuroradiology suite: a diagnostic dilemma

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