Classification for Carotid Artery Stenting Complications:Manifestation, Management, and Prevention

Abstract

Carotid artery stenting is a rapidly evolving method for treating carotid artery disease. Various intraprocedural and postprocedural complications have been reported in the literature. However, the absence of a unified classification scheme for these complications makes it difficult, if not impossible, to study their precise incidence, predictors, and management. The aim of this article is to propose the first joint classification of periprocedural complications, to analyze their incidence and etiology, and suggest possible ways to manage and prevent them. This classification is intended to be used as a common platform for prompt recognition, evaluation, treatment, and universal study of the complications during carotid stenting procedures. For this purpose, the opinions of the major experts on carotid interventions worldwide were merged with all the available information reported in the English-language literature to present as accurately as possible the management and prevention of carotid stenting complications according to this proposed classification.

Highly‐calcific carotid lesions endovascular management in symptomatic and increased‐stroke‐risk asymptomatic patients using the CGuard™ dual‐layer carotid stent system: Analysis from the PARADIGM study

“…Routine DW‐MRI imaging and clinical data showed that the stent effectively minimizes probability of cerebral embolization associated with the “cheese grater” effect . Furthermore, the MicroNet sealing properties also translate into the capacity to prevent/close vessel perforation whose risk is known to be increased with calcification . These features position CGuard EPS as a potentially well‐suited device in addressing the challenges of HCCS endovascular revascularization.…”

“…While HCCS remains, on the one hand, a significant clinical challenge in case of indications to carotid revascularization coexisting with contraindications to CEA, recent developments in carotid stent design might expand the feasibility to treat HCCS using the endovascular route . However, absence of reproducible and easily‐applicable angiographic scoring system(s) to evaluate calcification severity has been a restricting factor in the research in the field …”

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

“…22 It has been associated with insufficient antiplatelet therapy and antiplatelet agent resistance. 23 The first patient received previous treatment with aspirin (100 mg per day) and clopidogrel (75 mg per day) for 5 days before the procedure, but the antiplatelet response in this patient was unknown because there was no aggregometry analysis method at that time. More recently, in the second patient, an aggregometry test showed clopidogrel resistance, so the aspirin dose was increased empirically to 300 mg per day.…”

Locking between a Cerebral Protection Device and a Stent-Delivering Catheter during Carotid Artery Stenting

“…However, the CPD itself may cause fatal complications, with mechanical or iatrogenic sequelae occurring with an incidence of 0.9% (4/442) 1,3,4 . In addition to sequelae such as vascular spasm or dissection, some unpredictable mechanical accidents -such as locking between devices or incomplete stent expansion -may result in catastrophic outcomes requiring surgical removal of the locked devices [5][6][7] .…”