<b>Acute Thromboembolic Events During Carotid Artery Angioplasty and Stenting:</b>Etiology and a Technique of Neurorescue

Green, Douglas W.; Sánchez, Luis A.; Parodi, Juan C.; Geraghty, Patrick J.; Ferreira, Luis Mariano; Sicard, Gregorio A.

doi:10.1583/05-1526.1

Cited by 16 publications

(13 citation statements)

References 21 publications

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“…These stents have considerably more bare metal surface area than coronary stents and have the potential for enhanced thrombogenicity. Several studies using diffusion‐weighted magnetic resonance imaging have shown a high incidence of micro‐emboli during CS, and acute carotid stent thrombosis, although rare, has been reported [20–23]. A direct thrombin inhibitor, such as bivalirudin, in conjunction with dual anti‐platelet blockade with aspirin and clopidogrel, may be important prophylaxis against thrombus formation during CAS.…”

Section: Discussionmentioning

confidence: 99%

Carotid stenting and bivalirudin with and without vascular closure: 3‐year analysis of procedural outcomes

Schneider¹,

Polena²,

Roubin³

et al. 2010

Cathet Cardio Intervent

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This was a negative study, with no significant difference on prolonged hypotensive events in patients with vascular closure device and bivalirudin, compared with those with manual compression and bivalirudin. Vascular closure devices were safe and effective with a low incidence of complications. In carotid artery stenting, bivalirudin is safe with low incidence of major bleeding and acceptable 30-day adverse event rates (stroke and death).

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Section: Discussionmentioning

confidence: 99%

Carotid stenting and bivalirudin with and without vascular closure: 3‐year analysis of procedural outcomes

Schneider¹,

Polena²,

Roubin³

et al. 2010

Cathet Cardio Intervent

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“…16,17 If a distal embolism develops, thrombolytic therapy with a recombinant tissue plasminogen activator or its analogue is theoretically ineffective because the embolus is comprised of plaque rather than thrombic material. 18 The effi cacy of infused platelet glycoprotein IIb/IIIa antagonist or abciximab, reported to be highly effective in thromboembolic events associated with neurointerventions, [19][20][21] may be limited to the prevention of secondary thrombus formation in the occluded vessel.…”

Section: Discussionmentioning

confidence: 99%

Intraprocedural plaque protrusion resulting in cerebral embolism during carotid angioplasty with stenting

et al. 2008

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An 82-year-old man with an asymptomatic left high-grade carotid stenosis was treated with carotid artery stenting (CAS) under distal protection. The procedure consisted with predilation with a 5 x 40 mm percutaneous transluminal angioplasty (PTA) balloon, deployment of a 10 x 20 mm self-expandable stent, post-dilation with a 7 x 20 mm PTA balloon, and aspiration of debris with 60 ml of blood. The cervical carotid angiogram immediately after deflation of the distal blocking balloon demonstrated a small in-stent filling defect of the contrast medium that protruded from the anterior wall of the carotid artery. The following cranial carotid angiogram showed abrupt occlusion of the left middle cerebral artery (MCA). Because the in-stent lesion had vanished in the repeat study after recognition of this embolic event, it was suggested that an embolus had been liberated from the in-stent lesion, reaching the left MCA and obliterating it. In this case, the embolus was speculated to originate in the ruptured plaque, which protruded into the stent through the cells of the device and became liberated into the bloodstream. Attention should be paid so as not to overlook any plaque protrusion, which may be seen subsequently as a cerebral embolism on the angiogram obtained immediately after CAS.

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“…26 Embolism can occur both in CEA and in CAS. 27,28 Embolism related to the procedure can be assessed by transcranial Doppler sonography and cerebral MR imaging with DWI. However, there is no consensus regarding the true incidence and relevance of these events.…”

Section: Figmentioning

confidence: 99%

Unprotected Carotid Artery Stenting in Symptomatic Patients with High-Grade Stenosis: Results and Long-Term Follow-Up in a Single-Center Experience

Oteros¹,

Jimenez-Gomez²,

Bravo-Rodríguez³

et al. 2012

AJNR Am J Neuroradiol

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Acute Thromboembolic Events During Carotid Artery Angioplasty and Stenting:Etiology and a Technique of Neurorescue

Cited by 16 publications

References 21 publications

Carotid stenting and bivalirudin with and without vascular closure: 3‐year analysis of procedural outcomes

Carotid stenting and bivalirudin with and without vascular closure: 3‐year analysis of procedural outcomes

Intraprocedural plaque protrusion resulting in cerebral embolism during carotid angioplasty with stenting

Unprotected Carotid Artery Stenting in Symptomatic Patients with High-Grade Stenosis: Results and Long-Term Follow-Up in a Single-Center Experience

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