Angiographic Patterns and Outcomes Achieved by Proximal Balloon Occlusion in Symptomatic Carotid Artery Stenosis Stenting

Dargazanli, Cyril; Mahmoudi, Mehdi; Cappucci, Matteo; Collemiche, François-Louis; Labreuche, Julien; Habza, Othmane; Gascou, Grégory; Lefèvre, Pierre‐Henri; Mourand, Isabelle; Gaillard, Nicolas; Charif, Mahmoud; Derraz, Imad; Arquizan, Caroline; Costalat, Vincent

doi:10.1007/s00062-019-00770-8

Cited by 15 publications

(12 citation statements)

References 26 publications

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“…In the context of carotid stenting using the simple flow blockage technique, we previously reported data from January 2015 to 2018 in 75 patients, focusing on the angiographic pattern [ 10 ]. In this previous study, only 40 patients (53.3% of the cohort) benefited from a MRI follow-up [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

“…In cases of clopidogrel resistance (230–240 P2Y12 reaction units PRU by the VerifyNow P2Y12 assay or platelet inhibition rate < 20%) [ 10 ], prasugrel (20 mg) was given the day before the intervention and platelet inhibition was tested again before the procedure.…”

Section: Methodsmentioning

confidence: 99%

“…All procedures were performed under conscious sedation by experienced interventional neuroradiologists. A baseline angiographic run was performed after the inflation of the balloon guiding catheter in the common carotid artery, and was allowed to determine the different angiographic patterns [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

“…Indeed, the embolic protection technique during CAS as proximal balloon occlusion (PBA), and distal filter protection (DFP) can provide similar levels of protection from periprocedural stroke and 30-day mortality [ 9 ]. In the dynamic of developing the safest CAS procedure, an innovative approach (simple flow blockage technique [SFB]) was reported as a combination of proximal balloon occlusion and flow blockage, which is inspired from a mechanical thrombectomy technique [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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MRI Outcomes Achieved by Simple Flow Blockage Technique in Symptomatic Carotid Artery Stenosis Stenting

Hak

Arquizan

Mahmoudi

et al. 2022

JPM

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In this study, we aimed to determine the frequency and clinical impact of new ischemic lesions detected with diffusion-weighted-imaging-MRI (DWI-MRI) as well as the clinical outcomes after carotid artery stenting (CAS) using the simple flow blockage technique (SFB). This is a retrospective study with data extraction from a monocentric prospective clinical registry (from 2017 to 2019) of consecutive patients admitted for symptomatic cervical ICA stenosis or web. Herein, patients benefited from DWI-MRI before and within 48 h of CAS for symptomatic ICA stenosis or web. The primary endpoint was the frequency of new DWI-MRI ischemic lesions and the secondary (composite) endpoint was the rate of mortality, symptomatic stroke or acute coronary syndrome within 30 days of the procedure. All of the 82 CAS procedures were successfully performed. Among the 33 patients (40.2%) with new DWI-MRI ischemic lesions, 30 patients were asymptomatic (90.9%). Irregular carotid plaque surface with (n = 13, 44.8%) or without ulceration (n = 12, 60.0%) was associated with higher rates of new DWI-MRI lesions by comparison to patients with a regular plaque (n = 7, 25%) (p = 0.048) using the univariate analysis. Less than half of this CAS cohort using the SFB technique had new ischemic lesions detected with DWI-MRI. Among these patients, more than 90% were asymptomatic. Irregularity of the plaque seems to increase the risk of peri-procedural DWI-MRI lesions.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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MRI Outcomes Achieved by Simple Flow Blockage Technique in Symptomatic Carotid Artery Stenosis Stenting

Hak

Arquizan

Mahmoudi

et al. 2022

JPM

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“…With this protection, high-intensity transient signals during monitoring by transcranial Doppler US are rarely experienced. Distal filter protection is rarely used in our institute because migration of small particulate debris (smaller than the filter pores) into the cerebral artery can occur, and advancement of the filter device across an unstable lesion is not always safe 24–26. Distal balloon protection combined with proximal protection has an advantage because the same procedure is possible regardless of plaque characteristics, and it is effective for unstable plaques or severe stenosis causing problems and difficulty in lesion crossing 27 28…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of an open-cell stent and double-balloon protection for unstable plaques: analysis of 184 consecutive carotid artery stentings

Funakoshi¹,

Imamura

Tani

et al. 2019

J NeuroIntervent Surg

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IntroductionIn our institute, most cases of carotid artery stenosis are treated by carotid artery stenting (CAS) with an open-cell stent and double-balloon protection, even if plaques are unstable. This study was performed to examine the outcome of CAS with an open-cell stent and double-balloon protection for unstable plaques.MethodsA total of 184 CAS procedures in our institute between October 2010 and February 2018 were assessed. Ultrasonography findings of low-echo plaques, plaque ulceration, or both were defined as unstable plaques. A plaque-to-muscle ratio (PMR) of >1.8 on T1-weighted black blood imaging using spin-echo was also defined as an unstable plaque. Seventy-four unstable plaques on ultrasonography and 86 unstable plaques evaluated by PMR were included. Open-cell stents and double-balloon protection (proximal balloon protection during lesion crossing and distal balloon protection after lesion crossing) were used in all cases.ResultsOn ultrasonography, perioperative asymptomatic thromboembolization was significantly more frequent in the unstable plaque group (39/74, 52.7%) than in the stable plaque group (41/110, 37.3%, p=0.0384). Asymptomatic thromboembolization was also significantly more frequent in the PMR >1.8 group (44/86, 51.2%) than in the PMR <1.8 group (36/98, 36.7%, p=0.0489). However, symptomatic thromboembolization was rare (n=5, 2.7%), and all of these patients had minor stroke. During the 4-year follow-up, the risk of ipsilateral stroke was 0.28% and 0.27% per year in patients with symptomatic and asymptomatic lesions, respectively.ConclusionsThe outcomes of CAS with an open-cell stent and double-balloon protection are acceptable. This method is effective and safe, even if carotid artery stenosis comprises unstable plaques.

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Symptomatic High-Risk Post-Irradiation Internal Carotid Artery Stenosis: Angioplasty and Stenting Under Proximal Flow Control (Arrest/Reversal) and Distal Embolic Protection

Cohen,

Israel,

Gomori

et al. 2024

The Ischemic Stroke Casebook

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Angiographic Patterns and Outcomes Achieved by Proximal Balloon Occlusion in Symptomatic Carotid Artery Stenosis Stenting

Cited by 15 publications

References 26 publications

MRI Outcomes Achieved by Simple Flow Blockage Technique in Symptomatic Carotid Artery Stenosis Stenting

MRI Outcomes Achieved by Simple Flow Blockage Technique in Symptomatic Carotid Artery Stenosis Stenting

Safety and efficacy of an open-cell stent and double-balloon protection for unstable plaques: analysis of 184 consecutive carotid artery stentings

Symptomatic High-Risk Post-Irradiation Internal Carotid Artery Stenosis: Angioplasty and Stenting Under Proximal Flow Control (Arrest/Reversal) and Distal Embolic Protection

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