Endovascular carotid interventions

Cremonesi, Alberto; Zuffi, Andrea; Gieowarsingh, Shane; Martins, Estêvão Carvalho de Campos; Castriota, Fausto

doi:10.4244/eijv5i7a145

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…Mean age in our series was 71.2 years, very similar to the mean age reported in the EMPiRE study, 2 of 70.2 years. With relation to comorbidities, our results were also similar to those observed by Clair et al 2 and Parodi et al 22 : there was a predominance of systemic hypertension, coronary disease, and diabetes mellitus.…”

Section: Discussionsupporting

confidence: 92%

“…In the EMPiRE study 2 the use of flow reversal failed in only 3.7% of the cases, especially due to anatomic abnormalities, balloon rupture during inflation, or inability to adequately position the device. Parodi et al 22 also obtained a high rate of success (99%), probably as a result of the careful selection of patients based on anatomic characteristics.…”

Section: Discussionmentioning

confidence: 96%

“…The results obtained by those authors confirmed this hypothesis, and several other studies have corroborated the importance of the circle of Willis for flow reversal and cerebral protection. 2,22,24,26 In our sample, cerebral arteries were also monitored both before and after the procedure. In one case of our series, the cerebral anterior artery failed to fill, even after stent deployment, and the procedure was followed by a major adverse event in the immediate postoperative period (stroke).…”

Section: Discussionmentioning

confidence: 99%

“…Four-centimeter long stents were needed in 70.8% (17) of the patients. Closed cells and short lengths are desirable stent characteristics, 2,22 because they prevent balloon entrapment and minimize difficulties while removing the balloon. Interestingly, in the case where technical difficulties were faced, an open-cell stent was being used, however there were no negative consequences for our patient in this case.…”

Section: Discussionmentioning

confidence: 99%

“…The EMPiRE 2 study, for example, reported an intolerance rate as low as 2.4%, with only 1.2% of the surgeries requiring interruption and no cases of permanent neurological impairment/deficit. Parodi et al 22 observed 3% of intolerance to flow reversal, with only one patient developing transient hemiparesis; in all other patients, balloons were reinflated and the procedure was completed. Although our intolerance rate was higher, only one of our patients lost consciousness, precisely the one with cerebral circulation abnormalities (Table 1).…”

Section: Discussionmentioning

confidence: 99%

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Initial experience with a reversal-of-flow cerebral protection device in carotid angioplasty

Galego

Colli²,

Donatelli

et al. 2013

J. vasc. bras.

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PURPOSE: To report initial findings with the GORE Flow Reversal System®, with a focus on major/minor adverse events in the 30 first postoperative days. METHODS: The first 24 patients submitted to carotid angioplasty using the GORE system, from June 2010 to May 2012, were retrospectively assessed with regard to indications, anatomic details, technical difficulties, and early clinical outcomes, including major (stroke, death, acute myocardial infarction) and minor (hematoma) adverse events. RESULTS: Systemic hypertension was present in 100% of the patients, diabetes mellitus in 58.3%, and coronary disease in 37.5%. Type II aortic arch was encountered in 62.5% of the patients and atherosclerotic lesion predominantly at the carotid bifurcation affecting the internal and common carotid arteries in 79.2%. Angiographic data revealed contralateral carotid arteries with <50% stenosis in 95.8% of cases and preservation of cerebral blood flow in 95.8%. All procedures but one were technically successful. Mean cerebral flow reversal time was 14.9 minutes, with a statistically significant difference between the first 12 (17.9 minutes) and the last 12 patients treated (11.6 minutes) (p<0.001). Intolerance to flow reversal was observed in 17.4% of the cases. Technical difficulties were experienced in 1 patient (4.2%). Clinical outcomes included 4.2% of stroke and 12.5% of hematomas at arterial puncture sites. CONCLUSION: The system was technically effective. A significant reduction in cerebral flow reversal time was observed, and the rates of early major/minor adverse events were within acceptable limits, suggesting that the device is safe and effective.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Initial experience with a reversal-of-flow cerebral protection device in carotid angioplasty

Galego

Colli²,

Donatelli

et al. 2013

J. vasc. bras.

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Carotid artery stenting

White

Ramee

Collins

et al. 2013

Cathet Cardio Intervent

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From the earliest experiences with carotid artery stenting (CAS) presumptive high risk features have included thrombus-containing lesions, heavily calcified lesions, very tortuous vessels, and near occlusions. In addition patients have been routinely excluded from CAS trials if they have contra-indications to dual antiplatelet therapy (aspirin and thienopyridines), a history of bleeding complications and severe peripheral arterial disease (PAD) making femoral artery vascular access difficult. Variables that increase the risk of CAS complications can be attributed to patient characteristics, anatomic or lesion features, and procedural factors. Clinical features such as older age (≥80 years), decreased cerebral reserve (dementia, multiple prior strokes, or intracranial microangiopathy) and angiographic characteristics such as excessive tortuosity (more than two 90° bends within 5 cm of the target lesion) and heavy calcification (concentric calcification ≥ 3 mm in width) have been associated with increased CAS complications. Other high risk CAS features include those that prolong catheter or guide wire manipulation in the aortic arch, make crossing a carotid stenosis more difficult, decrease the likelihood of successful deployment or retrieval of an embolic protection device (EPD), or make stent delivery or placement more difficult. Procedure volume for the operator and the catheterization laboratory team are critical elements in reducing the risk of the procedure. In this article, we help CAS operators better understand procedure risk to allow more intelligent case selection, further improving the outcomes of this emerging procedure.

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What can be done for cerebral embolic protection in TAVI? Analysis in the light of 10 years’ experience with protected carotid artery stenting

Egron¹,

Kütting²,

Marzelle

et al. 2016

Expert Review of Medical Devices

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In the last 30 years, development of minimally invasive percutaneous procedures to treat cardiovascular defects has been thriving. Although these techniques present obvious advantages, like avoiding cardiopulmonary bypass, the passage of catheter systems and the deployment of devices in the blood circulation can cause particle embolization that may result in stroke. In carotid artery stenting, cerebral embolic protection devices (CEPD) such as filtering membranes have been available for already 10 years. In transcatheter aortic valve implantation (TAVI), the development of CEPD is starting and three membrane-based devices are in clinical trials. There are controversial discussions about the efficacy of CEPD in TAVI. The experience with CEPD in carotid artery stenting can help to understand some of the technical issues and shortcomings of current devices and thereby ultimately reduce cerebral complication risks during TAVI procedures.

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Endovascular carotid interventions

Cited by 5 publications

References 12 publications

Initial experience with a reversal-of-flow cerebral protection device in carotid angioplasty

Initial experience with a reversal-of-flow cerebral protection device in carotid angioplasty

Carotid artery stenting

What can be done for cerebral embolic protection in TAVI? Analysis in the light of 10 years’ experience with protected carotid artery stenting

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