Carotid artery stenting using the proximal or dual protection method for near occlusion of the cervical internal carotid artery

Sakamoto, Shigeyuki; Kiura, Yoshihiro; Kajihara, Yosuke; Shibukawa, Masaaki; Okazaki, Taro; Matsushige, Toshinori; Shinagawa, Katsuhiro; Mukada, Kazutoshi; Kurisu, Kaoru

doi:10.1007/s10143-013-0481-y

Cited by 19 publications

(18 citation statements)

References 18 publications

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“…Eleven studies with IPD available were included in the meta‐analysis ( Fig . ), including an observational study from University Medical Centre Utrecht. Of the remaining 21 studies, IPD could not be retrieved because the authors did not respond (7; response rate 78 per cent), IPD were not available (12), or the study was an RCT (2).…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of the outcomes of treatment of internal carotid artery near occlusion

Meershoek¹,

Vries²,

Veen

et al. 2019

British Journal of Surgery

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Background Guidelines recommend treating patients with an internal carotid artery near occlusion (ICANO) with best medical therapy (BMT) based on weak evidence. Consequently, patients with ICANO were excluded from randomized trials. The aim of this individual‐patient data (IPD) meta‐analysis was to determine the optimal treatment approach. Methods A systematic search was performed in MEDLINE, EMBASE and the Cochrane Library databases in January 2018. The primary outcome was the occurrence of any stroke or death within the first 30 days of treatment, analysed by multivariable mixed‐effect logistic regression. The secondary outcome was the occurrence of any stroke or death beyond 30 days up to 1 year after treatment, evaluated by Kaplan–Meier survival analysis. Results The search yielded 1526 articles, of which 61 were retrieved for full‐text review. Some 32 studies met the inclusion criteria and pooled IPD were available from 11 studies, including some 703 patients with ICANO. Within 30 days, any stroke or death was reported in six patients (1·8 per cent) in the carotid endarterectomy (CEA) group, five (2·2 per cent) in the carotid artery stenting (CAS) group and seven (4·9 per cent) in the BMT group. This resulted in a higher 30‐day stroke or death rate after BMT than after CEA (odds ratio 5·63, 95 per cent c.i. 1·30 to 24·45; P = 0·021). No differences were found between CEA and CAS. The 1‐year any stroke‐ or death‐free survival rate was 96·1 per cent for CEA, 94·4 per cent for CAS and 81·2 per cent for BMT. Conclusion These data suggest that BMT alone is not superior to CEA or CAS with respect to 30‐day or 1‐year stroke or death prevention in patients with ICANO. These patients do not appear to constitute a high‐risk group for surgery, and consideration should made to including them in future RCTs of internal carotid artery interventions.

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Section: Resultsmentioning

confidence: 99%

Meta-analysis of the outcomes of treatment of internal carotid artery near occlusion

Meershoek¹,

Vries²,

Veen

et al. 2019

British Journal of Surgery

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“…1,2,4,6,[9][10][11][12][13][14][15][16][17][18][19][20]28,31,45,[47][48][49][50][51]55,59,60,62,64,68,69,71,72 Pseudo-Occlusion. The term "pseudo-occlusion" was used for cases with raised intracranial pressure by Newton and Couch in 1960.…”

Section: Figmentioning

confidence: 99%

“…Images from Sekhar et al can be called "near-occlusion with full collapse." "Pseudo-occlusion" has been used for the appearance of a collapsed artery, [1][2][3][4][5][6][7][8][9]11,[13][14][15][16][17][18][19][20][45][46][47][48][56][57][58][59][60][61][62][65][66][67][68][69][70] but also quite literally when diagnosis changed from occlusion to patent after re-review (not necessarily with distal collapse. 10,12,55,63,64,81 String Sign.…”

Section: Figmentioning

confidence: 99%

“…1 Various terms have been used to describe near-occlusion, which can mislead students or those doing literature searches: near-occlusion (or "near total occlusion" [45][46][47][48][49][50][51] ), pseudo-occlusion, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]43,45,47,48,50-70 string sign, 1-5,7,9-13,16,18-20,22,24,26,30, 11,12,18,45 99% stenosis, 66 hairline residual lumen, 20,43 and incomplete occlusion. 1 Calculating percentage stenosis for carotid near-occlusion is fallacious, and near-occlusion assessment is advised before measuring for percentage stenosis.…”

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confidence: 99%

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Carotid Near-Occlusion: A Comprehensive Review, Part 1—Definition, Terminology, and Diagnosis

Johansson

Fox

2015

AJNR Am J Neuroradiol

105

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SUMMARY:Carotid near-occlusion is distal ICA luminal collapse beyond a tight stenosis, where the distal lumen should not be used for calculating percentage stenosis. Near-occlusion with full ICA collapse is well-known, with a threadlike lumen. However, near-occlusion without collapse is often subtle and can be overlooked as a usual severe stenosis. More than 10 different terms have been used to describe near-occlusion, sometimes causing confusion. This systematic review presents what is known about carotid near-occlusion. In this first part, the foci are definition, terminology, and diagnosis. ABBREVIATION: ECA ϭ external carotid artery

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“…Reported outcomes were highly heterogeneous and ranged from a 30-day stroke/death risk of 0–11.1% for CEA [11–13, 20] to 0–9.2% for CAS [5–7, 16–18] and 0–43% for best medical treatment (BMT) [8, 12, 19]. Furthermore, analyses of published studies are hampered by both a variety in inclusion criteria and the reporting of different clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Carotid endarterectomy in patients with recurrent symptoms associated with an ipsilateral carotid artery near occlusion with full collapse

et al. 2018

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ObjectiveNear occlusion (NO) of the internal carotid artery (ICA) with full collapse (NOFC) is a rare condition, with a prevalence of around 1%. Guidelines on carotid stenosis recommend a conservative treatment in patients with a single-event ipsilateral to a NOFC, but the optimal treatment for patients with recurrent symptoms associated with NOFC remains uncertain. We describe a consecutive series of patients with recurrent symptoms associated with NOFC (RSNOFC) who underwent carotid endarterectomy (CEA).MethodsFrom 2008 to 2017, 17 consecutive patients with RSNOFC were treated according to our standardized multidisciplinary work-up and protocol and included for this single-center cohort study. NO was defined according to the angiographic North American Symptomatic Carotid Endarterectomy Trial criteria. Only patients with NOFC were included in this study.ResultsStandard longitudinal CEA was performed in 15 patients, whereas in 2 patients the ICA was ligated with concomitant endarterectomy of the ECA. Within 30 postoperative days, one patient died from a hemorrhagic infarction. During follow-up (median 23 months) one patient died of unknown cause 90 days after CEA. No TIA, stroke, myocardial infarction or re-stenosis occurred in the remaining patients.ConclusionIn patients with RSNOFC, CEA may be considered a potential treatment option. Although procedural risks in this small subgroup may be higher as compared to patients with low-to-moderate risk anatomy, this risk may outbalance the natural course.

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Carotid artery stenting using the proximal or dual protection method for near occlusion of the cervical internal carotid artery

Cited by 19 publications

References 18 publications

Meta-analysis of the outcomes of treatment of internal carotid artery near occlusion

Meta-analysis of the outcomes of treatment of internal carotid artery near occlusion

Carotid Near-Occlusion: A Comprehensive Review, Part 1—Definition, Terminology, and Diagnosis

Carotid endarterectomy in patients with recurrent symptoms associated with an ipsilateral carotid artery near occlusion with full collapse

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