Optical coherence tomography assessment of newgeneration mesh-covered stents after carotid stenting

Umemoto, Takuya; Donato, Gianmarco de; Pacchioni, Andrea; Reimers, Bernhard; Ferrante, Giuseppe; Isobe, Mitsuaki; Setacci, Carlo

doi:10.4244/eij-d-16-00866

Cited by 33 publications

(35 citation statements)

References 35 publications

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“…This was proved by a recently published study that confirmed a low rate of plaque protrusion in nine patients treated with the CASPER stent, examined by optical frequency domain imaging 4. Umemoto et al analyzed the Roadsaver stent with optical coherence tomography and reported an incidence of plaque prolapse in 20.7% in five patients after stenting 30. No neurological complications (stroke or transient ischemic attack) occurred during the procedural and postprocedural periods.…”

Section: Discussionmentioning

confidence: 87%

“…No neurological complications (stroke or transient ischemic attack) occurred during the procedural and postprocedural periods. In comparison with conventional stents, mesh-covered stents, like the CASPER, showed less frequent plaque prolapse 30. The CASPER stent is comparable in flexibility to open-cell stents with an excellent conformability to the vessel wall.…”

Section: Discussionmentioning

confidence: 92%

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Reduction of cerebral DWI lesion burden after carotid artery stenting using the CASPER stent system

Müller-Thies-Broussalis

Griessenauer

Mutzenbach

et al. 2018

J NeuroIntervent Surg

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 92%

Reduction of cerebral DWI lesion burden after carotid artery stenting using the CASPER stent system

Müller-Thies-Broussalis

Griessenauer

Mutzenbach

et al. 2018

J NeuroIntervent Surg

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“…6 Thus, easily identifiable lesion characteristics may identify patients who would best be treated with CEA rather than CAS. Newer stent designs 7 , proximal protection 8 , and carotid flow reversal 9 may potentially improve CAS-related complications while operator training as well as close attention to aggressive medical treatment remain important for both revascularization modalities. 10 For those patients in whom periprocedural stroke cannot be prevented, new endovascular methods for acute treatment may limit brain injury.…”

Section: Discussionmentioning

confidence: 99%

Periprocedural Stroke and Myocardial Infarction as Risks for Long-Term Mortality in CREST

Jones

Howard

Roubin

et al. 2018

Circ: Cardiovascular Quality and Outcomes

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BACKGROUND: The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) previously reported increased mortality in patients who sustained a periprocedural stroke or cardiac event (myocardial infarction or biomarker only) in follow-up to 4 years. We now extend these observations to 10 years. METHODS AND RESULTS: CREST is a randomized, controlled trial designed to compare the outcomes of carotid stenting (CAS) versus carotid endarterectomy (CEA). Proportional hazards models were used to assess the association between mortality and periprocedural stroke, myocardial infarction (MI), or biomarker only events. Over 10-year follow up, patients with periprocedural stroke were at 1.74-times the risk of death compared to those without stroke (adjusted HR=1.74; 95% CI 1.21–2.50; p˂0.003). This increased risk was driven by increased early (between 0 and 90 days) mortality (adjusted HR=14.41; 95% CI 5.33–38.94; p˂0.0001), with no significant increase in late (between 91 days and 10 years) mortality (adjusted HR=1.40; 95% CI 0.93–2.10; p=0.11). Patients with a protocol MI were at 3.61-times increased risk of death compared to those without MI (adjusted HR=3.61; 95% CI 2.28–5.73; p˂0.0001), with an increased hazard both early (adjusted HR=8.20; 95% CI 1.86–36.2; p=0.006) and late (adjusted HR=3.40; 95% CI 2.09–5.53; p˂0.0001). Patients with a biomarker only event were at 2.04-times increased risk overall (adjusted HR=2.04; 95% CI 1.09–3.84; p=0.03) than those without myocardial infarction, with an increased early hazard (adjusted HR = 8.44; 95% CI 1.09–65.5; p=0.04), and a suggestive but non-significant association toward higher 91-day to10-year risk (1.88; 95% CI 0.97–3.64; p=0.062) contributing to the increased risk. CONCLUSIONS: In the CREST trial, patients with periprocedural events demonstrate a substantial increase in future mortality to 10 years. For stroke, this risk is largely confined to an early time frame while periprocedural MI or biomarker only events confer a continuous increased mortality over 10 years. Strategies to reduce periprocedural events and to optimize the evaluation and management of patients with cardiac events should be considered in efforts to reduce not only early but long-term mortality. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov Identifier: NCT00004732

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“…14 Since then, several authors have studied carotid plaque morphology and composition. 12,[14][15][16][17][18][19][20][21][22] Others have described the use of OCT for detecting plaque prolapse and stent-strut malapposition during CAS (Fig. 1).…”

Section: Current Optical Applicationsmentioning

confidence: 99%

“…1). 12,15,[19][20][21][22][23][24][25] Several limitations of carotid atherosclerotic OCT imaging exist. Clinicians have described satisfactory imaging without proximal balloon occlusion, though it is our institutional experience that the highest quality images are obtained with proximal occlusion.…”

Section: Current Optical Applicationsmentioning

confidence: 99%

Perspective review on applications of optics in cerebral endovascular neurosurgery

2019

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Cerebral endovascular neurosurgery has transformed the way we manage cerebrovascular disease. Several landmark trials have demonstrated the effectiveness of endovascular techniques leading to continued technological development and applications for various diseases. The utilization of optical technologies and devices is already underway in the field of endovascular neurosurgery. We discuss the contemporary paradigms, challenges, and current optical applications for the most common cerebrovascular diseases: carotid atherosclerotic disease, cerebral aneurysms, intracranial atherosclerosis, and dural arteriovenous fistulas. We also describe needs-based opportunities for future optical applications, with the goal of providing researchers a sense of where we feel optical technologies could impact the way we manage cerebral disease.

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Optical coherence tomography assessment of newgeneration mesh-covered stents after carotid stenting

Cited by 33 publications

References 35 publications

Reduction of cerebral DWI lesion burden after carotid artery stenting using the CASPER stent system

Reduction of cerebral DWI lesion burden after carotid artery stenting using the CASPER stent system

Periprocedural Stroke and Myocardial Infarction as Risks for Long-Term Mortality in CREST

Perspective review on applications of optics in cerebral endovascular neurosurgery

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