Results Of Carotid Artery Stenting Research Articles

Treatment Results of Carotid Artery Stenting with an Open-Cell Stent: Analysis of 734 Consecutive Cases at a Single Center

In carotid artery stenting (CAS) for internal carotid artery stenosis (ICS), the stent is often selected according to the plaque properties and arterial tortuosity. In our institute, an open-cell stent is used as the first-line stent regardless of the characteristics of the lesion. This study was performed to examine the outcome of CAS with an open-cell stent as the real-world results. In total, 811 CAS procedures using open-cell stents were performed for ICS from April 2002 to December 2019. Of these patients, we excluded those with hyperacute conditions for which CAS was performed within 3 days of onset, those in whom acute mechanical thrombectomy was performed simultaneously with CAS, and those with stenosis due to arterial dissection. Thus, 734 patients were retrospectively analyzed. Perioperative and long-term outcomes and risk factors for perioperative infarction were investigated. The periprocedural stroke rate and mortality rate were 3.7% (27/734) and 0.4% (3/734), respectively. Low-echoic plaque was a significant risk factor for periprocedural stroke in both univariate (P < 0.03) and multivariate (odds ratio, 2.69; 95% confidence interval, 1.14-6.66; P = 0.02) analyses. Cerebral infarction and high-grade restenosis were observed in 15 (2.0%) and 17 (2.3%) patients during a median 50-month follow-up. CAS with open-cell stents showed good results in terms of both the postoperative stroke incidence and long-term severe restenosis rate. However, low-echoic plaque was a risk factor for perioperative stroke incidence, which should be considered when deciding on the indication for CAS with an open-cell stent.

Comparative Study of the Early and Late Results of Carotid Artery Stenting in Conditions of Hostile or Favorable Arterial Anatomy

Comparative Study of the Early and Late Results of Carotid Artery Stenting in Conditions of Hostile or Favorable Arterial Anatomy

Treatment results of carotid artery stenting in a developing country

The purpose of this study was to investigate the details of minor complications of carotid artery stenting in a developing country. This was a retrospective, single-center study conducted on the target group consisting of 65 symptomatic patients who underwent carotid artery stenting. We assessed technical success rate, periprocedural complication within 30 days (hypotension, bradycardia, acute kidney injury, vasospasm, a transient ischemic attack, stroke, myocardial infarction, and death), and the differences between groups with and without complications. Minor periprocedural complications occurred in 15 patients. In all, 8 (12.3%) had transient hypotension, 6 (9.2%) had bradycardia, 7 (10.7%) had acute kidney injury, 2 (3.1%) had vasospasm, and 1 (1.5%) had transient ischemic attack. A greater rate of minor complications was observed in women (p=0.051). The results of the carotid artery stenting procedures performed in a developing country were acceptable.

Randomize Kontrollü Çalışmalara Dayalı Karotis Arter Stentleme ve Karotis Endarterektominin Orta Dönem Metaanalizi Bulguları

Randomize Kontrollü Çalışmalara Dayalı Karotis Arter Stentleme ve Karotis Endarterektominin Orta Dönem Metaanalizi Bulguları

Carotid artery stenting: a single-center experience

Aim: This study aimed to present the results of carotid artery stenting (CAS) in the treatment of patients with symptomatic and asymptomatic carotid artery stenosis (Cs).&#x0D; Material and Method: Between September 2016 and June 2021, patients who underwent CAS in the interventional radiology department were reviewed, retrospectively. The demographic data of patients, comorbidities, carotid stenosis rates, and early and late complication rates after treatment were recorded from medical records. Acute stent thrombosis, stroke, and death in the first 30 days after CAS were considered early periprocedural complications. Doppler ultrasonography (USG) examinations were scanned at 6 months after the procedure and restenosis rates were investigated.&#x0D; Results: There were a total of 113 patients; 31.2% female and 68.8% male. Symptomatic Cs was present in 62.8% (n=71) and asymptomatic Cs in 37.2% (n=42) of the patients. The technical success rate was determined as 98.2%. Micro-thromboembolism (n=4), pseudoaneurysm at the femoral insertion site (n=2), and acute stent thrombosis (n=1) were observed as early complications. Restenosis was detected 6 months after stenting in 1 patient (1.4%) with symptomatic Cs on Doppler USG. The mortality rate was 0.8% (n=1). &#x0D; Conclusion: CAS is an effective and safe treatment method in symptomatic and asymptomatic patients with Cs.

Contemporary Results of Carotid Artery Stenting Using Low-Profile Dual-Metal Layer Nitinol Micromesh Stents in Relation to Single-Layer Carotid Stents

Purpose: To evaluate patients characteristics, procedural details, perioperative outcomes, and midterm results of carotid artery stenting (CAS) performed with the Roadsaver/Casper stent (Terumo Corp, Tokyo, Japan) as compared to concurrent patients treated with other commercially available carotid stents. Materials and Methods: This is a single-center, retrospective, nonrandomized study including 200 consecutive patients who underwent a total of 205 elective CAS procedures due to severe internal carotid artery stenosis between April 2015 and December 2018. Procedural data and outcomes for patients treated with the Roadsaver/Casper stent implantation (100 procedures, in 97 patients) vs first-generation carotid stents implantations (90 procedures, in 88 patients) were compared. Fifteen patients were treated with CGuard carotid stent (InspireMD, Tel Aviv, Israel), and outcomes were reported separately. Primary endpoints were the occurrence of major adverse cerebrovascular events (MACE), including death, ipsilateral stroke, and transitory ischemic attack (TIA). Secondary endpoints were the rate of intrastent stenosis, the need for reintervention, and the occurrence of adverse cardiovascular events, including myocardial infarction, arrhythmias, and need for inotropic support. Results: No difference in demographics and preoperative risk factors were observed between patients treated with and without the Roadsaver/Casper stent. The mean procedure time was shorter in the Roadsaver/Casper group (40.7±16.9 vs 49.4±27.3 minutes; p=0.008), while radial percutaneous access was more frequent (24% vs 5%; p<0.001). The rate of stroke/TIA/death at 30 days was 3% in the Roadsaver group vs 1% in the first-generation stent group (p=0.623). The primary patencyrate was 100% and 93.4% at 1- and 3-year of follow-up in the Roadsaver/Casper groupand 99% and 94.3% in the other stent group, respectively (p=0.95). Conclusions: In this real-world cohort of patients undergoing CAS, the Roadsaver/Casper stent was used to treat more symptomatic and vulnerable carotid plaques as compared to other carotid stents. Nevertheless, patients treated with this low-profile dual-layer micromesh stent showed low events rates at both 30 days and follow-up, similar to that observed for other stents.

Results of carotid artery stenting. Lessons learned in a Belgian ‘real world’ practice*

Objective/Background Carotid artery stenting (CAS) is a valuable solution for the treatment of carotid artery stenosis in a high-risk patient population for carotid endarterectomy (CEA). In literature however, there are concerns about the death and stroke rates of CAS in the ‘real world’ practice. Since Belgium is a small country with a broad offer of medical care, and there is no reimbursement for CAS, only small numbers of patients can be treated per vascular department. Methods In our department 45 CAS were performed from January 2006 until May 2018. Patient characteristics, indication for treatment and choice of treatment, minor stroke, major stroke and death rates were analyzed retrospectively. Results Of these patients 8/45 (18%) had a symptomatic carotid artery stenosis and 37/45 (82%) had an asymptomatic stenosis. A total minor stroke rate of 3/45 (6.6%) was recorded, but no major stroke (0%) or death (0%). Of the 37 patients who were asymptomatic at the start, 1 suffered a minor stroke (1/37, 2.7%) peri-operatively. Conclusion Real world data from a low volume center show that CAS performed in patients with high risk for CEA yields acceptable outcome that is comparable to the literature. Since CAS is a delicate procedure we advice to centralize the procedure to an dedicated experienced interventionalist and to perform rigorous quality control of your 'real world' data.

Perioperative and Follow-up Results of Carotid Artery Stenting and Carotid Endarterectomy in Patients with Carotid Near-Occlusion

The aim was to compare perioperative and follow-up results of carotid artery stenting (CAS) and carotid endarterectomy (CEA) in patients with carotid near-occlusion (NO). A retrospective analysis was conducted from January 2012 to June 2017 on consecutive patients with NO in our center. Perioperative complications, recurrence rate of ischemic stroke, restenosis rate, and mortality in follow-up were compared between the CAS group and CEA group. 92 patients (CAS group, 54 and CEA group, 38) were identified. Perioperative (30-day) results were as follows: the rate of new lesions on diffusion-weighted imaging (DWI) was higher in the CAS group (n=31, 57.4%) than in the CEA group (n=13, 34.2%) (P=0.03); no differences were found in ischemic stroke, transient ischemic attack (TIA), cardiac infarction, and death rate between the two groups. Results from follow-up with a mean period of 28.3 (range from 3 to 60) months were as follows: the restenosis rate was lower in the CAS group (n=1, 1.8%) than the CEA group (n=4, 10.5%) (P=0.04); no differences were found in ischemic stroke, TIA, and the death rate between the two groups. Kaplan-Meier survival curves showed that the five-year survival rate was 85.8% of the CAS group and 82.7% of the CEA group (P=0.61); the five-year rate of freedom from target-lesion restenosis was 93.3% of the CAS group and 80.4% of the CEA group (P=0.02). Both CAS and CEA can be used for carotid NO with the same rate of TIA/stroke and long-term survival. The rate of new lesions on DWI after CAS was higher than that in CEA in the perioperative period. CAS had a lower restenosis rate than CEA in follow-up, which might be more beneficial for remodeling of the distal internal carotid artery.

Clinical Results of Carotid Artery Stenting (CAS) in Patients over 80 Years Old: Strategy and Usefulness of Tailored-CAS Algorithm Based on Lesion Morphology and Plaque Characteristics

Purpose: Carotid artery stenting (CAS) reduces the risk of ischemic stroke in patients with carotid artery stenosis, although recent randomized trials showed an increase in periprocedural stroke risk in elderly patients undergoing CAS. Recently, the safety and efficacy of tailored-CAS was reported. We retrospectively compared the clinical results of tailored-CAS between patients >80 and <80 years old.

CAR 2. Results of Carotid Artery Stenting in a Belgian “Real-World” Practice

CAR 2. Results of Carotid Artery Stenting in a Belgian “Real-World” Practice

Three-Year Clinical Results of Carotid Artery Stenting in Treating Patients with Contralateral Carotid Artery Occlusion

Patients presenting a carotid stenosis and contralateral carotid occlusion (CCO) have been historically considered at high risk of carotid surgical treatment, and there are few data regarding short-term recovery after stenting therapy in patients with CCO. The aim of this study is to evaluate the short-term recovery and safety of stenting for patients with CCO and different subgroup population. We retrospectively reviewed the records of consecutive patients with CCO who were treated with stenting endovascular methods between 2008 and 2014. The postoperative outcomes were analyzed according to age, ischemic symptom, cerebral infarction history, and collateral situation subgroups, respectively. Fifty-eight consecutive patients with CCO were treated and 49 (84.5%) completed a 3-year follow-up. There were significant higher stroke, myocardial infarction, or death events in the aged (≥75 years old) group and poor collateral group (P = .007 and .0024, respectively). There was no difference in the 3-year primary endpoint incidence between the cerebral ischemia symptom subgroups and cerebral infarction history subgroups. Event-free survival, aged group, and poor collateral group were lower (P = .007 and P = .0024, respectively). Carotid artery stenting (CAS) for patients with common carotid artery is a safe and effective therapy. Factors such as age 75 years or older and poor collateral are associated with a higher 3-year rate of postprocedural stroke, myocardial infarction and death, and lower event-free survival in patients with CCO treated by CAS. Meanwhile, our data do not show a significant impact of cerebral ischemic symptom and cerebral infarction history on clinical outcome of patients with CCO undergoing CAS.

Long-Term Results of Carotid Artery Stenting in Veterans With Prior Head and Neck Cancer

Long-Term Results of Carotid Artery Stenting in Veterans With Prior Head and Neck Cancer

Clinical results of carotid artery stenting versus carotid endarterectomy

Objective:To review our results of carotid artery stenting (CAS) and carotid endarterectomy (CEA).Methods:We evaluated the medical records of patients undergoing carotid artery revascularization procedure, between 2001 and 2013 in Baskent University Hospital, Ankara, Turkey. Carotid artery stenting or CEA procedures were performed in patients with asymptomatic carotid stenosis (≥70%) or symptomatic stenosis (≥50%). Demographic data, procedural details, and clinical outcomes were recorded. Primary outcome measures were in 30-day stroke/transient ischemic attacks (TIA)/amaurosis fugax or death. Secondary outcome measures were nerve injury, bleeding complications, length of stay in hospital, stroke, restenosis (ICA patency), and all-cause death during long-term follow-up.Results:One hundred ninety-four CEA and 115 CAS procedures were performed for symptomatic and/or asymptomatic carotid artery stenosis. There is no significant differences 30-day mortality and neurologic morbidity between CAS (13%) and CEA procedures (7.7%). Length of stay in hospital were significantly longer in CEA group (p=0.001). In the post-procedural follow up, only in symptomatic patients, restenosis rate was higher in the CEA group (p=.045). The other endpoints did not differ significantly.Conclusions:Endovascular stent treatment of carotid artery atherosclerotic disease is an alternative for vascular surgery, especially for patients that are high risk for standard CEA. The increasing experience, development of cerebral protection systems and new treatment protocols increases CAS feasibility.

Open Versus Endovascular Treatment for Patients with Post-Carotid Endarterectomy Restenosis: Early and Long-term Results

The aim of this study is to assess and compare the short- and long-term results of carotid artery stenting (CAS) and redo surgery in patients with restenosis after carotid endarterectomy (CEA). From January 1988 to December 2014, 44 consecutive patients were treated for carotid restenosis (CR): 23 redo-CEA (52.3%) and 21 CAS (47.7%). Data from these patients were prospectively collected in a dedicated database. Early results and 3-year end points were analyzed and compared between groups with χ2 test, Kaplan-Meier curves, and Breslow test. Demographic characteristics and comorbidity were similar in both groups, except for arterial hypertension and chronic renal insufficiency which were higher in the CAS group. CR was symptomatic in 7 patients in the redo-CEA group (30.4%) and 1 (4.8%) in CAS (P=0.04). No differences were found in the time period between primary CEA and reintervention, critical carotid stenosis, or contralateral carotid occlusion. Median follow-up was 61.5months. In the redo-CEA group, 1 patient (4.3%) had a perioperative transient ischemic attack and 3 (13%) experienced cranial nerve injury with complete regression at 30days. No differences were found between groups in terms of early and long-term mortality, neurologic morbidity, and overall morbidity. The rate of secondary restenosis and freedom from reintervention was similar in both groups during follow-up. Both CAS and redo-CEA are suitable options for patients with CR. CAS might be the treatment of choice due to the risk of cranial nerve injuries in redo-CEA. When CAS is contraindicated, redo-CEA remains a safe and effective treatment option.

The Effect of Stent Cell Geometry on Carotid Stenting Outcomes.

The aim of this study was to investigate the effect of stent cell geometry on midterm results of carotid artery stenting (CAS). One hundred fifty-five patients underwent CAS between February 2010 and December 2012. Ninety-one open- and 84 closed-cell stents were used in this non-randomized, retrospective study. Periprocedural complications were defined as the ones happened during the procedure or within 30 days afterwards. Starting from the 6th month after the procedure, in-stent restenosis was detected with multidetector computed tomography angiography and classified into four groups from focal restenosis to occlusion. Eleven complications were encountered in the periprocedural period (four on the open- and seven on the closed-cell group). Total complication rate was 6.3% (11/175). No significant difference was detected in terms of periprocedural complications between two groups (p = 0.643). There was statistically significant difference between stent design groups in regard to radiological findings (p = 0.002). Sixteen of open-cell stents and three of closed-cell stents had focal restenosis. One closed-cell stent had diffuse proliferative restenosis and one open-cell stent had total occlusion. In-stent restenosis was more common in open-cell stent group, which have larger free cell area than closed-cell stents. Although our radiologic findings promote us to use closed-cell design if 'possible', no difference was detected in terms of clinical outcomes.

同一の手技，同一のステントを用いたCAS の長期成績

【目的】頚動脈ステント留置術（CAS）において，同一の手術手技，同一のステントを用いて治療し，その長期成績を調べた．【対象と方法】2007 年10 月より2012 年7 月までに当施設で，同一術者が，頚部頚動脈狭窄27 病変に対して，distal balloon protection 下に，同一のステント（Precise 10 mm×4 cm）を用いてCAS を施行した．そのうち24 病変に対して2 年以上の長期フォローを行った．【結果】1 例で術中にステント留置側の脳梗塞が生じ神経学的脱落症状を残したが，他には術後フォロー期間中にステント留置側の脳卒中の発生はなかった．1 例に術後2 年でステント留置部の無症候性再狭窄をきたし，再度CAS を施行した．【結論】症例経験が少ない術者，施設であっても，手術手技を統一して行うことにより，標準的な長期成績を達成できた．

Carotid Artery Stenting in Symptomatic High Risk Patients: A Single Center Experience

Introduction: Stroke is one of the leading causes of permanent disability and death. Stroke is generally associated with ischemia and carotid artery stenosis is the reason in nearly one third of the cases. The aim of the present study was to investigate the short and mid term results of carotid artery stenting (KAS) procedures performed in high risk patients due to carotid artery disease who were admitted to cardiology clinic of our institution.Patients and Methods: The study group consisted of 14 consecutive high risk patients in whom KAS was performed in the cardiology clinic of our institution due to atherosclerotic carotid artery disease between October 2011 and October 2013. Procedural success, in-hospital and out-hospital stroke, myocardial infarction and all causes of mortality were evaluated.Results: Angiographic success was achieved in all patients. In-hospital and out-hospital acure coronary syndrome was not observed. One patient developed permanent stroke 24 hours after the procedure. This stroke was related with non-intervened carotid artery. This patient died 32 days after the procedure. Procedure related stroke or death was not occurred in any of the patients.Conclusion: KAS is a safe procedure in high risk patients for appropriately equipped experienced operators.

Carotid Bypass: A Safe and Durable Solution for Recurrent Carotid Stenosis

The long-term results of carotid artery stenting (CAS) for post-carotid endarterectomy (CEA) restenosis are disappointing (4-year patency rates: ∼75%). Since 1988, our group has offered carotid bypass (CB) as an alternative to redo CEA and later also to CAS in this setting. The aim of this retrospective study was to investigate early and late outcomes associated with CB in this population. Data were collected from patients treated with CB in the year 2000-2012 for significant/symptomatic post-CEA restenosis (or intra-stent restenosis [ISR] after CAS for post-CEA restenosis). All patients had good life expectancy. CB was performed under loco-regional anesthesia. With the aid of sequential vessel clamping, the graft (great saphenous vein [GSV] or polytetrafluoroethylene) was anastomosed with the common carotid artery (side-to-end) and the distal internal carotid artery (end-to-side). Patients were followed with clinical and duplex scan assessments at 1, 3, and 6 months and yearly thereafter. The study population comprised 21 patients (mean age 67.3 years; 17 men). CB was performed for post-CEA restenosis (or ISR after CAS for post-CEA restenosis, n=3) 51.2 months (mean) after the previous operation. GSV grafts were used in half of the cases (n=11; 52.4%); temporary shunting was used in 4 (19%) patients. Intraoperative complications (none fatal) occurred in 4 (19%) patients (3 transient peripheral nerve injuries, 1 cervical hematoma). During follow-up (mean 64.8 months), there were no neurologic complications or restenoses. Overall mortality was 33.3% (6 deaths from acute myocardial infarctions, 1 from a ruptured abdominal aortic aneurysm). For post-CEA restenosis (or ISR after CAS for post-CEA restenosis), CB offers superior long-term patency rates than CAS (or redo angioplasty) and an acceptable risk of cranial nerve damage.

Two-year results of carotid artery stenting.

The effectiveness of carotid artery stenting (CAS) for primary and secondary prevention of ischemic stroke has been demonstrated. The aim of our study was the clinical and radiological evaluation of the reliability of the CAS procedure over a two-year follow-up period. This study included 120 patients (mean age, 68 (48-86) years) admitted to our hospital between December 2010 and March 2013 for whom CAS was decided in the neurology, cardiovascular surgery and cardiology council. Symptomatic cases with more than 50% stenosis by angiography and asymptomatic patients with stenosis of more than 70% were included in the study. 80% of the asymptomatic patients were those detected during the screening before the coronary bypass surgery. The success rate of the procedure was found as 97.5%. No mortality or myocardial infarction was observed in any of the patients in whom CAS was applied successfully. In 1 symptomatic patient (0.8%), ischemic cerebrovascular event with sequelae was observed 24 hours after the procedure. In total, transient ischemic attack was observed in 2 patients (1.7%) 6 and 11 months after the procedure. Asymptomatic restenosis was detected in 3 patients (2.5% of the total, with 2 in the asymptomatic and 1 in the symptomatic group). Symptomatic restenosis was not observed. None of the patients experienced hyperperfusion syndrome. We believe the CAS procedure can be performed safely in symptomatic and asymptomatic patients with low complication and high success rates.

Carotid Artery Stenting in Patients With Acute Coronary Syndrome: A Possible Primary Therapy for Symptomatic Carotid Stenosis

To report the results of carotid artery stenting (CAS) in symptomatic patients (stroke/transient ischemic attack) after recent percutaneous transluminal coronary angioplasty (PTCA) for acute coronary syndrome (ACS). Between January 2009 and July 2011, 28 consecutive patients (18 women; mean age 66 years, range 42-82) underwent protected CAS for symptomatic carotid stenosis following recent PTCA that included bare or drug-eluting stents requiring uninterrupted dual antiplatelet therapy. Primary technical success, neurological complications, major adverse cardiovascular events, and death were evaluated at 30 days and over midterm follow-up. Technical success was 96%; 1 patient suffered a nonfatal major stroke (3.5% 30-day stroke rate) during the procedure. During a median 21.6-month follow-up, 4 (14%) patients died of myocardial infarction (all diabetic smokers with ejection fractions <40%), but there were no new neurological events. Estimated survival was 89.3% at 2 years. Further coronary interventions were performed in 2 diabetic patients with a body mass index >34 kg/m(2). This preliminary experience demonstrated that CAS is a reasonable, safe, and effective treatment for patients with symptomatic carotid artery stenosis who were recently treated with coronary stents requiring uninterrupted dual antiplatelet therapy.