Bilateral Carotid Artery Stenting Research Articles

SIMULTANEOUS BILATERAL CAROTID STENTING VS STAGED BILATERAL CAROTID STENTING : A RETROSPECTIVE CLINICAL INVESTIGATION

Objective-: Simultaneous bilateral carotid artery stenting (SBCAS) is a complicated and challenging procedure. Final outcome depends upon selective criteria. The purpose of study was to determine the efcacy and safety of the SBCAS retrospectively patients with signicant bilateral carotid artery disease vs staged bilateral carotid stenting. Patients Method: with symptomatic stenosis of 50% or asymptomatic stenosis of 60% of bilateral carotid arteries are included for bilateral carotid artery stenting (BCAS). Procedure time, stent thrombosis,dissection,bradycardia ,hypotension,ischemia, presence of high-intensity spots on postoperative dwi image, duration of postprocedure stays and one month outcome of patients performed with simultaneous BCAS (group A, 11 patients with 22 stenotic lesions (11 procedures)) were compared with those of staged BCAS (group B, 14 patients with 28 stenotic lesions (28 procedures))out of total 205 patients during march 2017 to January 2021. In Results: groups A and B, median procedure time was 166.0 and 115 min; intraprocedure hypotension was observed in 52% and 40%; postprocedure hypotension occurred in 40% and 42%; dwi image showed high intensity spots in 25% and 12.5%; and median duration of postprocedural hospital stays was 5.1 and 6.3 days.One patient suffered ischemic complications and recoverd. Procedure time was longer in simultaneous BCAS, but there was no increase in symptomatic ischemic complications and duration of hospital stays compared to staged BCAS. Safety of Conclusions: simultaneous BCAS may be noninferior to staged BCAS. In terms of cost and duration of hospitalization,simultaneous BCAS are often superior to staged BCAS for patients with bilateral carotid artery stenosis

Building of a Clinical Prediction Model for Hemodynamic Depression after Carotid Artery Stenting

Objective To analyze the risk factors and build a clinical prediction model for hemodynamic depression (HD) after carotid artery stenting (CAS). Methods A total of 116 patients who received CAS in the Department of Vascular Surgery,Drum Tower Clinical College of Nanjing Medical University and the Department of Vascular Surgery,the Affiliated Suqian First People's Hospital of Nanjing Medical University from January 1,2016 to January 1,2022 were included in this study.The patients were assigned into a HD group and a non-HD group.The clinical baseline data and vascular disease characteristics of each group were collected,and multivariate Logistic regression was employed to identify the independent predictors of HD after CAS and build a clinical prediction model.The receiver operating characteristic (ROC) curve was drawn,and the area under the ROC curve (AUC) was calculated to evaluate the predictive performance of the model. Results The HD group had lower proportions of diabetes (P=0.014) and smoking (P=0.037) and higher proportions of hypertension (P=0.031),bilateral CAS (P=0.018),calcified plaque (P=0.001),eccentric plaque (P=0.003),and the distance<1 cm from the minimum lumen level to the carotid bifurcation (P=0.009) than the non-HD group.The age,sex,coronary heart disease,symptomatic carotid artery stenosis,degree of stenosis,and length of lesions had no statistically significant differences between the HD group and the non-HD group (all P>0.05).Based on the above predictive factors,a clinical prediction model was established,which showed the AUC of 0.807 and the 95% CI of 0.730-0.885 (P<0.001).The model demonstrated the sensitivity of 62.7% and the specificity of 87.7% when the best cut-off value of the model score reached 12.5 points. Conclusions Diabetes,smoking,calcified plaque,eccentric plaque,and the distance<1 cm from the minimum lumen level to the carotid bifurcation are independent predictors of HD after CAS.The clinical prediction model built based on the above factors has good performance in predicting the occurrence of HD after CAS.

SIMULTANEOUS BILATERAL CAROTID STENTING: A SINGLE CENTRE EXPERIENCE

Objective: To evaluate the efficiency, reliability and complications of simultaneous bilateral carotid artery stenting in patients with atherosclerotic bilateral carotid artery stenosis. Methodology: We analyzed 14 consecutive patients who underwent simultaneous bilateral carotid stenting from September 2010 to January 2016, retrospectively. Clinical outcomes at 30 days and one year after stenting, including hyperperfusion syndrome, haemodynamic depression, minor and major stroke, myocardial infarction and death, were assessed. Results: The patients were 43 to 73 (62.3 ± 8.8) years old, and 8 (57.1%) were male. Carotid stenting procedure success rate was 100%. Distal embolic protection devices were used in all patients. Up to 30 days after carotid artery stenting, the haemodynamic depression rate was 21.4% (3/14). There were no deaths, minor and major strokes, cases of hyperperfusion syndrome or myocardial infarctions within 30 days. One patient died of septic shock seven months after carotid artery stenting. There were no minor and major strokes or myocardial infarctions within one year. Conclusion: The data showed that simultaneous bilateral carotid stenting is a technically feasible and reliable alternative treatment method in a selected group of patients with bilateral carotid artery disease.

Carotid artery stenting in octogenarians: Clinical observation and follow-up

Objective To observe the safety and long-term efficacy of carotid artery stenting(CAS)in octogenarians with carotid stenosis. Methods Clinical data of patients aged 80 years or older undergoing CAS for carotid stenosis in our hospital between July 2008 and October 2017 were retrospectively analyzed.The perioperative treatment outcomes and mid- and long-term follow-up results were analyzed. Results A consecutive series of 61 patients(a median age of 81 years, 54 males)were enrolled.Of 61 patients, 23(37.7%)patients had symptomatic carotid artery stenosis.Sixty patients underwent unilateral CAS, one patient underwent bilateral CAS, and 26(42.6%)underwent other cerebrovascular interventional therapy during the same period.The technical success rate was 100.0%.During the perioperative period, the incidence of stroke was 6.6%(4/61), and no patient died.Eight(13.1%)patients had contrast-induced nephropathy, 4(6.6%)patients suffered from cardiac dysfunction, and 30(49.2%)patients had hypotension requiring vasopressor support postoperatively, and all of them recovered well when discharged from hospital.All patients were followed up for a median of 42 months(range 2-108 months, with an interquartile interval of 44 months). The incidence of stroke and death was 8.2%(5/61)within 30 days to 1 year after surgery.The median stroke-free survival was 72 months in patients with symptomatic carotid stenosis, and was 93 months in asymptomatic patients, with the statistically significant difference between the two groups(χ2=4.258, P=0.039). Conclusions Carotid artery stent implantation in octogenarians with carotid stenosis has a favorable safety and feasibility when performed in experienced centers, and the outcome of a mid- and long-term follow-up is good. Key words: Carotid stenosis; Stents; Stroke

Safety of simultaneous bilateral carotid artery stenting for bilateral carotid artery stenosis.

Bilateral carotid artery stenting (BCAS) is often performed in two stages (staged BCAS) but it is also an option to be performed in one stage (simultaneous BCAS). To confirm the safety of simultaneous BCAS, we retrospectively analyzed perioperative and postoperative course of simultaneous BCAS compared with staged BCAS. Patients with symptomatic stenosis of ≥50% or asymptomatic stenosis of ≥80% of bilateral carotid arteries underwent BCAS. Procedure time, symptomatic ischemic complications, presence/absence of high-intensity spots on postoperative diffusion-weighted image, duration of postoperative hospital stays and 30 days outcome of patients performed with simultaneous BCAS (group A, 8 patients with 16 stenotic lesions (8 procedures)) were compared with those of staged BCAS (group B, 4 patients with 8 stenotic lesions (8 procedures)). In groups A and B, procedure time was 146.0 ± 53.8 and 103.5 ± 39.4 min; intraoperative hypotension was observed in 62.5% and 50.0%; postoperative hypotension occurred in 37.5% and 50.0%; diffusion-weighted image showed high-intensity spots in 37.5% and 12.5%; and duration of postoperative hospital stays was 5.1 ± 1.8 and 5.3 ± 2.3 days. No patients suffered symptomatic ischemic complications. In simultaneous BCAS, there was a tendency that procedure time was longer and high-intensity spots on postoperative diffusion-weighted image was more frequent, but there was no increase in symptomatic ischemic complications and duration of hospital stays compared to staged BCAS. Safety of simultaneous BCAS may not be inferior to staged BCAS. In terms of duration of hospital stays, simultaneous BCAS can be superior to staged BCAS for patients with bilateral carotid artery stenosis.

Treatment of Idiopathic Recurrent Internal Carotid Artery Vasospasms with Bilateral Carotid Artery Stenting: A Case Report

Treatment of Idiopathic Recurrent Internal Carotid Artery Vasospasms with Bilateral Carotid Artery Stenting: A Case Report

Simultaneous Bilateral Carotid Stenting in High-risk Patients: A Single-center Experience with Review of Literature

Background: The aim of the present study is to determine the role of simultaneous carotid artery stenting in high-risk patients with triple vessel coronary artery disease and to determine the safety and efficacy of the procedure in these cases. Materials and Methods: The present study is a retrospective analysis of 33 patients who underwent carotid artery stenting in the same setting in our institution from 2009 to 2016. There were 22 male and 11 females with a mean age of 65 years (53–76 years). Demographic factors clinical characteristics and atherosclerosis risk factors were documented. Results: Technical success was 100% in our series. Intraprocedural and postprocedural events in the form of hypotension and bradycardia due to hemodynamic depression were seen in 11 patients. We did not encounter hyperperfusion syndrome in any of our patients. Twenty-nine patients underwent cardiac bypass surgery after 3 weeks, and 4 patients were kept on medical management for coronary artery disease. No deaths or major strokes occurred in our series. Conclusion: Simultaneous bilateral carotid artery stenting is a safe treatment option even in patients with high-risk factors and can be considered as the therapeutic option in patients with significant bilateral carotid artery disease.

Assessing risk factors for major adverse cardiovascular and cerebrovascular events during the perioperative period of carotid angioplasty with stenting patients.

Carotid atherosclerotic stenosis is a risk factor for ischemic stroke. The rapid development of neuroimaging techniques had led to carotid angioplasty with stenting (CAS) becoming a useful, effective and minimally invasive method for the treatment of extracranial carotid artery stenosis. The aim of the present study was to identify independent risk factors to predict perioperative major adverse cerebral and cardiovascular events for CAS patients and establish a risk evaluation model. Consecutive patients treated with a standardized CAS procedure were enrolled in the present study. The patients included underwent independent neurological evaluation prior to and after the procedure and at 30 days. The rates of transient ischemic attack, stroke, myocardial infarction and mortality were recorded. A relative regression model was established to evaluate risk factors of perioperative major adverse cardiac and cerebrovascular events (MACCE). In total, 403 subjects treated with CAS were enrolled into the study at a baseline MACCE rate of 8.19%, whereas the overall stroke, myocardial infarction and mortality rate at 30 days was 3.97%. The multiple regression analysis revealed that certain factors significantly predicted the 30-day risk of treatment-related MACCE. These factors included age of ≥70 years, ulcerative plaque, severe carotid stenosis, bilateral carotid artery stenting and hemodynamic depression following CAS. The MACCE risk prediction model and risk score system were subsequently established. In conclusion, factors that significantly predicted the 30-day risk of MACCE of CAS included, age of ≥70 years, ulcerative plaque, severe carotid stenosis, bilateral carotid artery stenting and hemodynamic depression, with hemodynamic depression being a controllable factor. The established risk score system is therefore a potentially useful tool that can be employed in the prediction of MACCE after CAS.

One Session Bilateral Carotid Stenting – Experience from Slovakian Center

Abstract Objectives: Bilateral carotid artery stenting (BCAS) in one session is relatively rare procedure. However, clear recommendations still do not exist. The aim of our study was to analyze efficacy and safety of the BCAS performed by single operator in our center. Material and Methods: A retrospective analysis of 95 carotid angioplasty with stent implantation (CAS) patients performed in our center, totally 9 patients (8 males and 1 female, age 59-83, average 69) was identified where simultaneous BCAS was performed. All patients had bilateral hemodynamic significant stenosis (≥ 70 %), and all patients had symptomatic stenosis. Results: Only 1 patient was without any complication. The most frequent complications were arterial hypotension. However, duration of stay on the Intensive Care Unit, or hospitalisation was not prolonged. From serious complications we noticed one case of periprocedural filter occlusion and one patient died 30 days after procedure. No other serious complications were in the BCAS group noticed. Conclusion: Because of limited data it is not possible to make any clear conclusions or recommendations from the results of our study. Our data show that probably BCAS appears to be safe and effective way in the treatment of bilateral carotid artery stenosis in high-risk population.

Simultaneous Bilateral vs Unilateral Carotid Artery Stenting

Purpose: To evaluate clinical outcomes of simultaneous bilateral carotid artery stenting (sbCAS) compared with unilateral CAS (uCAS). Methods: The database in our institution was queried to identify all patients treated with CAS from January 2005 to December 2012. In this time frame, 120 (18.8%) patients (mean age 64.9±7.7 years; 96 men) underwent sbCAS and 517 (81.2%) patients (mean age 65.7±7.7 years; 421 men) received uCAS. The primary endpoint was the composite of stroke, myocardial infarction, or death within 30 days or any ipsilateral stroke within 1 year. Results: There was no significant difference in the rates of the primary endpoint between the sbCAS and uCAS groups (6.7% vs 4.6%, p=0.358). The rates of the primary endpoint among symptomatic patients was 8.0% in the sbCAS group and 5.0% in the uCAS group (p=0.299) and 3.1% and 4.0%, respectively (p=0.821) among asymptomatic patients. During the 30-day periprocedural period, the rates of the primary endpoint did not differ significantly between the sbCAS and uCAS groups among all patients (5.8% vs 4.4%, p=0.479), symptomatic patients (6.8% vs 5.0%, p=0.594), or asymptomatic patients (3.1% vs 3.5%, p>0.999). After this period, the incidences of any ipsilateral stroke were similarly low (0.8% and 0.2%, respectively; p=0.342). Conclusion: The study showed that simultaneous bilateral CAS had no more adverse events than unilateral CAS during the periprocedural period or within 1 year. This 1-stage strategy may become a valuable alternative in the treatment of patients with severe bilateral carotid stenosis.

Efficacy and safety of carotid artery stenting for stroke prevention

BackgroundExtracranial carotid artery stenosis is a leading cause of ischemic stroke. Carotid endarterectomy (CEA) is the gold-standard management for secondary stroke prevention yet carotid artery stenting (CAS) has emerged in the last decade as an alternative for high surgical risk patients. PurposeTo assess the effectiveness, safety and outcomes of CAS in extra-cranial carotid artery stenosis patients in terms of stroke prevention. MethodologyTwenty patients with symptomatic and asymptomatic carotid artery stenosis were enrolled between 2012 and 2014. Symptomatic patients were eligible for CAS if the internal carotid artery stenosis was ⩾50%, while 80% was the threshold in asymptomatic patients. ResultsSymptomatic patients enrolled were fifteen (75%) and asymptomatic patients were five (25%). Two patients (10%) were excluded owing to target vessel occlusion. One patient (5%) underwent bilateral CAS. The procedure was successful in eighteen patients (90%) one of them complicated by distal embolization (5%). One patient died secondary to associated chronic liver disease (5%), otherwise no stroke or death was recorded along the follow-up period. ConclusionCareful patient selection and technique optimization are crucial to improve clinical outcome which make it a safe alternative for surgical revascularization in stroke prevention.

Single-stage endovascular treatment in patients with severe extracranial large vessel stenosis and concomitant ipsilateral unruptured intracranial aneurysm.

We aimed to evaluate the safety and effectiveness of single-stage endovascular treatment in patients with severe extracranial large vessel stenosis and concomitant ipsilateral unruptured intracranial aneurysm. Hospital database was screened for patients who underwent single-stage endovascular treatment between February 2008 and June 2013 and seven patients were identified. The procedures included unilateral carotid artery stenting (CAS) (n=4), bilateral CAS (n=2), and proximal left subclavian artery stenting (n=1) along with ipsilateral intracranial aneurysm treatment (n=7). The mean internal carotid artery stenosis was 81.6% (range, 70%-95%), and the subclavian artery stenosis was 90%. All aneurysms were unruptured. The mean aneurysm diameter was 7.7 mm (range, 5-13 mm). The aneurysms were ipsilateral to the internal carotid artery stenosis (internal carotid artery aneurysm) in five patients, and in the anterior communicating artery in one patient. The patient with subclavian artery stenosis had a fenestration aneurysm in the proximal basilar artery. Stenting of the extracranial large vessel stenosis was performed before aneurysm treatment in all patients. In two patients who underwent bilateral CAS, the contralateral carotid artery stenosis, which had no aneurysm distally, was treated initially. There were no procedure-related complications or technical failure. The mean clinical follow-up period was 18 months (range, 9-34 months). One patient who underwent unilateral CAS experienced contralateral transient ischemic attack during the clinical follow-up. There was no restenosis on six-month follow-up angiograms, and all aneurysms were adequately occluded. A single-stage procedure appears to be feasible for treatment of patients with severe extracranial large vessel stenosis and concomitant ipsilateral intracranial aneurysm.

Treatment Strategy for Bilateral Severe Carotid Artery Stenosis: One Center's Experience

To describe 1 center's experience using carotid artery stenting (CAS) or carotid endarterectomy (CEA) as a treatment strategy in patients with bilateral carotid artery stenosis. Patients with severe carotid artery stenosis, including bilateral carotid artery stenosis, treated by CEA or CAS during the period 2008-2013 were reviewed retrospectively. The selection of treatment depended on the individual patient's medical comorbidities, neurologic condition, and clinical and anatomic arterial factors. The main adverse events included death from any cause, major stroke within 30 days, and death between 30 days and 1 year later from the treated carotid artery or ipsilateral major stroke. There were 27 patients with bilateral carotid artery stenosis treated, including 11 patients with bilateral CEA, 9 patients with CEA on one side and CAS on the other side, and 7 patients with bilateral CAS. Of patients with unilateral carotid artery stenosis, 69 were treated with CEA, and 75 were treated with CAS. The incidence of main adverse events for the bilateral patients was 7.4%, similar to the unilateral patients undergoing CEA and CAS (8.7% and 6.7%, respectively). Restenosis occurred in 4 treated carotid arteries in bilateral patients within 1 year (4 of 54 [7.4%]); this was not significantly different from unilateral patients undergoing CEA and CAS (4 of 69 [5.8%] and 6 of 75 [8.0%], respectively). Local complications were not more frequent in bilateral patients. Good outcomes can be achieved in patients with bilateral carotid artery stenosis when treatment selection is based on each individual patient's clinical characteristics and with a proper combination of staged CEA and CAS.

Safety and efficacy of simultaneous bilateral carotid angioplasty and stenting

In this study, we aimed to evaluate the safety and feasibility of simultaneous bilateral carotid artery stenting (BCAS) compared with staged BCAS in patients with bilateral atherosclerotic carotid stenosis (BCS). From January 2004 to March 2012, 68 patients who underwent BCAS were identified from the Nanjing Stroke Registry Program. Of these patients, 42 (61.8%) underwent simultaneous BCAS (simultaneous group), and 26 (38.2%) underwent staged BCAS (staged group). We compared demographic data, major vascular risk factors, procedural parameters, and 30day outcomes between the simultaneous and staged groups. No significant differences were detected in baseline data between the groups. Patients in the simultaneous group had a lower post-operative systolic pressure compared with the staged group (119.1±16.1 vs. 130.2±17.5mmHg, P=0.009). Technical success was 100% of patients in the simultaneous group and 98.1% in the staged group. Hemodynamic depression was observed in 57.4% of procedures, with no significant difference between groups in the rate of HD. Four (5.9%) patients had neurological complications within 30days, including two cases of hyperperfusion syndrome in the simultaneous group, and two ischemic events in the staged group. There was no significant difference in the 30day complication rate between the simultaneous and staged groups (4.8 vs. 7.7%, P=0.633). Simultaneous BCAS may be safe and feasible for most patients with BCS, with a similar 30day complication rate to staged BCAS. Multicenter randomized control studies with larger sample sizes are warranted to further explore the safety and efficacy of simultaneous BCAS.

Simultaneous Bilateral Carotid Stenting in a Series of 9 Patients: A Single-Center Experience with Review of Literature

Objectives:Simultaneous bilateral carotid artery stenting (SBCAS) is a challenging procedure, and selection criteria play an important role in determining the final outcome. The aim of the present study was to determine the efficacy and safety of the SBCAS in a series of 9 patients with significant bilateral carotid artery disease (>50% on the symptomatic side and >60% on the asymptomatic side).Materials and Methods:The present study is a retrospective study of 9 patients from January 2005 to December 2012 in a tertiary care center. There were 8 males and 1 female in the age range 50 to 75 years and an average mean age of 63 years. Inclusion criteria of the present study were patients with bilateral internal carotid artery stenosis >50% (50 - 99%) in the symptomatic side and >60% in the asymptomatic side as seen on digital subtraction angiography (DSA). SBCAS with use of distal protection device (Spider device, ev3), to prevent intra-procedural embolic migration, was done in all the patients.Results:Technical success was achieved in all patients (100%). Post-procedural events in the form of hypotension and bradycardia occurred in 3 patients after the placement of stent on both the sides, in 2 patients after the placement of the first stent, and in 1 patient after the placement of the second stent. We did not encounter any cases of hyperperfusion, which was a concern in these patients. There were no deaths, major or minor strokes, or myocardial infarction either in the post-procedural period (up to 1 month) or on clinical follow-up 3 and 6 months post-treatment.Conclusion:SBCAS was an effective and safe alternative treatment method in a select group of patients with bilateral carotid artery disease. It can be considered as a feasible treatment option with acceptable risks.

Carotid Artery Stenting: Analysis of a 12-Year Single-Center Experience

To analyze a 12-year experience performing carotid artery stenting (CAS) with cerebral protection. In accord with NASCET criteria, 672 patients underwent CAS at our hospital between November 1999 and September 2011 for de novo or postsurgical restenosis; among these, 636 patients (474 men; mean age 68 ± 6.8 years, range 63-85) had a minimum 6-month follow-up, which qualified them for this analysis. The majority of patients (381, 59.9%) were symptomatic; 47 patients had staged bilateral CAS procedures (total of 683 procedures). A cerebral protection device was used in 94.7%. Patients underwent duplex ultrasound and clinical evaluation during follow-up. Neurological adverse events were correlated with plaque morphology, patient age >80 years, learning curve, and spasm. Technical success was achieved in all cases. Neurological events [3 (0.4%) major strokes, 8 (1.2%) minor strokes, and 11 (1.6%) transient ischemia attacks] occurred in 22 (3.2%) of the 683 cases within 30 days of the procedure (no events in follow-up). These involved 5 (2.0%) of the 255 asymptomatic patients and 17 (4.5%) of the 381 symptomatic patients (p=0.001). Neurological events proved to be higher in patients >80 years (6.4% vs. 2.7% of patients <80 years, p<0.05) and in those with complex plaque morphology (6.1% vs. 1.0% in stable plaques, p<0.001). After a mean follow-up of 76 ± 32.4 months, 478 (70%) patients were alive, with a 30-day mortality of 1.9% (none due to stroke). In-stent stenosis occurred in 9 (1.3%) stents and was resolved with angioplasty or re-stenting. The primary patency rate was 98.7%. CAS is a valid technique for the treatment of carotid occlusive disease, with a very low rate of in-stent stenosis. Neurological complications were correlated with complex plaque morphology, which makes accurate pretreatment evaluation of the lesion mandatory if good CAS outcomes are to be achieved.

Immediate and 30-Day Clinical Outcome of Patients Treated with the TwinOne Cerebral Protection System: Multicenter Experience in 217 Cases

There are several cerebral protection devices used for carotid artery stenting (CAS). All of them require manipulation and exchange of two separate materials (cerebral protection device ? dilatation balloon), making the procedure longer and posing possible complications such as vasospasm and embolism. The new system described here is an evolution of the cerebral protection concept and allows temporary occlusion of the distal internal carotid during CAS procedures with both materials in one device. We present our experience using this new device. Between January 2007 and March 2008, consecutive patients sent for CAS (symptomatic, with stenosis C50%, or asymptomatic, with stenosis C70%) were treated using TwinOne as a cerebral protection system. All patients were treated using the "simplified" CAS technique, limiting cerebral protection to the poststenting angioplasty phase. Two hundred nine patients have been treated at our institutions; eight underwent bilateral CAS, for a total of 217 CAS procedures performed using the TwinOne for cerebral protection. There have been four periprocedural (within 3 h of procedure) cases of complications (1.8%): three disabling strokes (one in-stent thrombosis, one presumed clotting, one ipsilateral stroke with uncertain root cause) and one transient ischemic attack attributable to heart failure. There have been two in-hospital complications (0.92%): one disabling stroke of unclear origin and one contralateral transient ischemic attack. No additional adverse event has been reported at 30 days after the CAS procedure. In conclusion, this cerebral protection system is simple to use, allows a quick intervention and short occlusion time, and has a low rate of complications.

Carotid Artery Stenting for Stenosis Following Cervical Radiotherapy: Report of Early Failure With Associated Stent Fracture

Experience with carotid artery stenting (CAS) as an alternative to carotid endarterectomy (CE) for management of carotid stenosis continues to evolve. We report the case of a 64-year-old man who was treated with bilateral CAS for stenoses, which developed 7 years following thyroidectomy, neck dissection, and radiotherapy. Although long considered an ideal alternative to CE in this clinical setting, CAS in this case was complicated by multiple episodes of recurrent stenosis in his left carotid, managed by balloon angioplasty. Severe, early recurrence in his right carotid associated with a type III stent fracture was managed by CE. Close surveillance and intervention prevented neurologic morbidity. This case, combined with emerging published experience, argues for reappraisal of the general consensus that CAS is an ideal alternative to CE for radiotherapy-associated carotid stenoses.

White-centered Retinal Hemorrhage in Ocular Ischemic Syndrome Resolved After Carotid Artery Stenting

Ocular ischemic syndrome (OIS) is characterized by ocular symptoms and signs that are secondary to severe carotid artery obstruction. We report a 69-year-old man who suffered from progressively blurred vision in both eyes. Fundus examination showed scattered areas of retinal hemorrhage, some with a white center, in both eyes. Fluorescence angiography revealed multiple microaneurysm-like hyperfluorescent spots over the retina mimicking diabetic retinopathy. Carotid Doppler ultrasonography revealed 90-95% stenosis of bilateral internal carotid arteries, and OIS was diagnosed. Thus, bilateral internal carotid artery stenting was performed. After treatment, the patients visual acuity recovered within 1 month and the areas of white-centered retinal hemorrhage completely resolved within 6 months.

Staged bilateral carotid stenting, an effective strategy in high-risk patients – insights from a prospective multicenter trial

To prospectively evaluate outcomes of high-risk patients undergoing bilateral carotid artery stenting (CAS). A total of 747 patients at increased risk for carotid endarterectomy (CEA) were enrolled in a prospective registry at 47 US sites of the Boston Scientific EPI: A Carotid Stenting Trial for Risk Surgical Patients (BEACH) trial. Among them, 78 (10.4%) patients underwent contralateral CAS > 30 days after the primary CAS procedure. Patients were followed at 1, 6, and 12 months, and annually thereafter for 3 years. The primary endpoint was the cumulative incidence of non Q-wave myocardial infarction within 24 hours, periprocedural (<or=30 days) death, stroke or Q-wave MI, and late ipsilateral stroke or death due to neurological events from 31 days up to 12 months. The bilateral patients are independent from the pivotal cohort. Mean follow-up was 885 + 320 days in the bilateral and 861 + 343 in the pivotal group. The primary endpoint occurred in 6.8% (5/73) of the bilateral patients and 8.9% (40/447) of the pivotal group (P = .66). There were no statistically significant differences between the bilateral and the pivotal groups with regard to any of the components of the primary or secondary endpoints. The univariate 1-year major adverse event (MAE) free survival was 93.6% and 91.6% in the bilateral and pivotal groups, respectively (P = .55). Multivariate logistic regression analysis with adjustment for various clinical baseline factors revealed no differences in the primary endpoint when comparing the bilateral with the pivotal groups at 30 days (odds ratio [OR]: 0.8673, 95% confidence interval [CI] 0.4590-1.6389, P = .66) or 1 year (OR: 0.9102, 95% CI 0.5503-1.5053, P = .73). Bilateral carotid stenting is an effective treatment strategy in patients determined to be at high-risk for CEA with no increase in morbidity or mortality results extended out to one year in a prospective multicenter trial.