Carotid artery stenting

White, Christopher J.; Ramee, Stephen R.; Collins, Tyrone J.; Jenkins, J. Stephen; Reilly, John P.; Patel, Rajan A.G.

doi:10.1002/ccd.24984

Cited by 33 publications

(10 citation statements)

References 83 publications

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“…Data from our research corresponds to the data received by l other researchers evaluating the application of protection systems during CAS procedure by MRI DWI testing [35,36]. Other researchers also present similar data [25,[37][38][39]. Likelihood of brain damage after CAS procedure depends on various factors, as data from various researchers indicate.…”

Section: Discussionsupporting

confidence: 69%

Early ischemic brain lesions after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging study

Misonis¹,

Palionis²,

Tamošiūnas³

et al. 2013

Seminars in Cardiovascular Medicine

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Summary Aim: The aim of the paper is to evaluate the appearance of the new early ischemic lesions in the brain after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging, and their relationship with clinical and procedural factors. Methods: Carotid artery stenting (CAS) procedures performed by a single interventional cardiologist in years November 2006 to January 2013 were evaluated retrospectively. In total, 227 procedures for 211 patients (mean age 69.8 ± 8.5 years) were performed, from which 171 (75.3%) for male and 56 (24.7%) for female patients. Seventy-two (34.1%) patients had symptomatic stenosis of carotid artery. The following protection systems to avoid the distal microembolism were used during the CAS: (1) Filters: FilterWire EZ (Boston Scientific Corporation); Emboshield NAV (Abbott Vascular); SpideRX (EV3); Defender (Medtronic); FiberNet Filter (Invatec-Medtronic); (2) Occlusion MoMa Baloon System (Invatec-Medtronic). Acute ischemic damages of the brain before and after CAS procedure were diagnosed using magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) sequences. Sixty-five (30.8%) patients underwent MRI test. Exact and asymptomatic χ2 criteria were applied for testing the hypothesis of inter-dependency of the symptoms. Results: Forty-six (70.8%) patients had new ischemic foci in the brain on MRI DWI after CAS procedures. Among those patients, focal damage of the brain was diagnosed in 36 (78.3%) cases; linear damage of the brain - in 9 (19.6%) patients; ipsilateral damage of the brain - in 37 (80.4%) patients; bilateral damage of the brain - in 16 (34.8%) patients, 38 (82.6%) patients were diagnosed with forebrain damage; 4 (8.7%) patients were diagnosed with damage of brainstem; 5 (10.9%) patients were diagnosed with cerebellum damage. Clinical symptoms of brain damage were diagnosed only for 2 (4.3%) patients. Focal damage of the brain was significantly less frequent only for aortic arch type 1, if compared with aortic arch type 2 and 3: 64.3%, 93.3% and 100.0%, respectively (p < 0.05). Focal damage of the brain occurred least in patients (28.6%) with Emboshield NAV protection type, if compared to other types of protection (71.4-100.0%). Linear >10mmbrain damage was less frequent when using FilterWire EZ, Emboshield NAV and SpideRX protection type. Ipsilateral ischemic brain damage also occurred less frequent when using Emboshield NAV protection type; bilateral damage occurred less frequent when using FilterWire EZ, Emboshield NAV and SpideRX protection type. Ischemic forebrain damage was also diagnosed less often in patients for whom protection type FilterWire EZ and Emboshield NAV was applied. Conclusions: Most frequent findings by MRI after CAS procedures were focal, ipsilateral and forebrain damage (about 80%), but less than 5% patients had clinical symptoms. In the case of aorta arch type 1 focal ischemic damage of the brain was significantly less frequent, then in aortic arch type 2 and 3. The localization and extent of brain damage was associated with the type of protection systems that have been used.

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Section: Discussionsupporting

confidence: 69%

Early ischemic brain lesions after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging study

Misonis¹,

Palionis²,

Tamošiūnas³

et al. 2013

Seminars in Cardiovascular Medicine

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“…To improve the outcome after CAS, the identification of patients likely to be at highrisk for new lesions after CAS is necessary. There is growing evidence that CAS is associated with a higher periprocedural complication rate in octogenarians than in other age groups 2,10,11 .…”

Section: Introductionmentioning

confidence: 99%

“…Other authors advocate the importance of anatomical characteristics as predictors of the complications associated with CAS [11][12][13][14] . However, it remains unclear and controversial which factor is the most important.…”

Section: Introductionmentioning

confidence: 99%

Anatomical Risk Factors for Ischemic Lesions Associated with Carotid Artery Stenting

et al. 2014

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The purpose of this study was to investigate the anatomical risk factors for ischemic lesions detected by diffusion-weighted imaging (DWI) associated with carotid artery stenting (CAS). DWI was performed within four days after CAS in 50 stenotic lesions between January 2008 and September 2013. We retrospectively analyzed the correlation between the anatomical factors and ischemic lesions associated with CAS. Post-procedural DWI revealed new ischemic lesions after 24 (48%) of the 50 CAS procedures. All three patients with common carotid artery tortuosity, defined as the presence of severe angulation (less than 90 degrees) in the common carotid artery, developed new ischemic lesions. However, there were no significant differences between the patients with and without tortuosity, likely due to the small number of cases. Meanwhile, seven of eight patients with internal carotid artery tortuosity, defined as the presence of severe angulation (less than 90 degrees) in the cervical segment of the internal carotid artery, developed new ischemic lesions. A multivariate analysis showed internal carotid artery tortuosity (odds ratio: 11.84, 95% confidence interval: 1.193–117.4, P= 0.035) to be an independent risk factor for the development of ischemic lesions associated with CAS. Anatomical factors, particularly severe angulation of the internal carotid artery, have an impact on the risk of CAS. The indications for CAS should be carefully evaluated in patients with these factors.

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“…Each EPD requires an individual learning curve; and (3) relationship between thromboembolic events and complex vascular geometries and high-risk lesion morphological features. 20,21 The Wirion EPS design, including full guidewire compatibility, has a potential for ease of use, excellent deliverability, short learning curve, and rapid and safe crossing of the target lesion, with limited considerations for vessel tortuosity and lesion morphology.…”

Section: Discussionmentioning

confidence: 99%

Independent Modular Filter for Embolic Protection in Carotid Stenting

Scheinert

Reimers

Cremonesi

et al. 2017

Circ: Cardiovascular Interventions

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Background-Embolic protection during carotid artery stenting reduces the rate of thromboembolic events. The Wirion Embolic Protection System is used to deploy an independent distal filter using any 0.014″ guidewire. WISE study (Wirion Study Europe) evaluated the safety and performance of Wirion Embolic Protection System in patients undergoing carotid artery stenting. Methods and Results-A prospective, multicenter, nonrandomized, open-label, single-arm study of carotid artery stenting in high surgical risk patients was performed. The primary end point, a composite of death, stroke, and myocardial infarction at 30 days, was compared with performance goal derived from historical controls. Secondary end points were components of the primary end point and the device, angiographic, procedural, and clinical success rates. Preplanned interim analysis was performed on the first 120 patients. At interim analysis, the primary end point was significantly lower for the Wirion Embolic Protection System group, compared with historical data (3.3% versus 6.3%, respectively; P value =0.0008). Analysis of primary end point components in the WISE group, compared with the historical control group, shows numerically lower mortality (0% versus 1.7%, respectively; P=0.21), stroke (2.5% versus 4.6%, respectively; P=0.18), and myocardial infarction (0.8% versus 1.5%, respectively; P=0.50). Device, angiographic, procedural, and clinical success was achieved in 99.2%, 99.1%, 98.3%, and 96.6% of cases, respectively. Conclusions-The data suggest that independent modular filter use in carotid artery stenting in high surgical risk patients is safe and effective. The outcomes suggest that use of an independent modular filter may be associated with a lower rate of embolic complications associated with carotid stent placement. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01783639.

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Carotid artery stenting

Cited by 33 publications

References 83 publications

Early ischemic brain lesions after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging study

Early ischemic brain lesions after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging study

Anatomical Risk Factors for Ischemic Lesions Associated with Carotid Artery Stenting

Independent Modular Filter for Embolic Protection in Carotid Stenting

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