Results of carotid artery stenting with distal embolic protection with improved systems: Protected Carotid Artery Stenting in Patients at High Risk for Carotid Endarterectomy (PROTECT) trial

Matsumura, Jon S.; Gray, William A.; Chaturvedi, Seemant; Yamanouchi, Dai; Lei, Peng; Verta, Patrick

doi:10.1016/j.jvs.2011.10.120

Cited by 47 publications

(31 citation statements)

References 24 publications

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“…2 According to the Protected Carotid Artery Stenting in Patients at High Risk for Carotid Endarterectomy (PROTECT) trial evaluating the safety of this EPD, supra-aortic catheterization carries a procedure-related major stroke risk of 0.5%. 4 Compared with our case, filter placement during carotid artery stenting requires a much shorter deployment time. However, with systemic heparinization and removal of the filters before protamine administration, bilateral carotid filter placement was considered relatively safe.…”

Section: Discussionmentioning

confidence: 62%

Bilateral Embolic Protection Devices for High-Risk Cardiac Surgery in a Patient With Recent Embolic Stroke

Downey

Zalewski

Takayama

et al. 2014

Circ: Cardiovascular Interventions

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C erebral embolic protection devices (EPDs) such as carotid filters were first introduced as an adjunct to carotid artery stenting out of concern for increased rates of procedurerelated atheromatous plaque embolization compared with carotid endarterectomy. Here, we report the use of a carotid filter device for embolic protection during high-risk coronary artery bypass grafting and ventricular assist device explantation in a patient with a recent history of embolic cerebrovascular accident from severe aortic atherosclerosis. Case ReportA 67-year-old man with no known history of coronary artery disease presented to an outside hospital with acute shortness of breath. Initial chest x-ray demonstrated complete opacification of the lung spaces consistent with decompensated pulmonary edema. The ECG demonstrated pan-ST segment depressions with ST elevation in lead V1 and was concerning for severe left main coronary artery stenosis. He was transferred to Columbia University Medical Center in cardiogenic shock for emergent angiography and evaluation for coronary intervention.At catheterization, left ventriculography showed an ejection fraction of 15% to 20% with global hypokinesis. Coronary angiography revealed a right dominant system with a thrombotic 90% stenosis of a trifurcating distal left main coronary artery (Figure [A]). The right coronary artery was occluded proximally and filled retrograde via the left circulation (Figure [B]). Despite initial stabilization after aggressive diuresis, insertion of an intra-aortic balloon pump, and aspiration thrombectomy of the left main coronary artery, the patient continued to decompensate. A CentriMag biventricular assist device (BiVAD) was implanted (Thoratec, CA). During the BiVAD implantation, transesophageal echocardiography revealed that the aorta was severely atherosclerotic ( Figure [C]). On the first postoperative day, the patient was thought to have mild left lower extremity weakness, but this finding was attributed to ongoing postoperative sedation. The following day when the patient was fully awake, he was noted to have a left lower extremity motor deficit. No arrhythmic episodes were documented after his initial procedure. A neurology consultation was obtained and a head computed tomography was performed. The computed tomography showed multiple scattered hypodensities involving the posterior right frontal lobe, left occipital lobe, and bilateral cerebellar hemispheres consistent with embolic infarcts (Figure [D]). These findings, in combination with the patient's left lower extremity weakness, were presumed secondary to aortic manipulation during BiVAD implantation. His neurological status improved significantly during the next few days, and he had only minor residual deficits. In preparation for definitive cardiac management, he underwent a myocardial viability study that demonstrated global hypokinesis but no scar in the distribution of the left anterior descending artery. He was then scheduled for BiVAD explant and coronary artery bypass grafting.Given his calc...

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Section: Discussionmentioning

confidence: 62%

Bilateral Embolic Protection Devices for High-Risk Cardiac Surgery in a Patient With Recent Embolic Stroke

Downey

Zalewski

Takayama

et al. 2014

Circ: Cardiovascular Interventions

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“…Recently published studies suggest further improvement in CAS. Rosenfield et al 23 and Matsumura et al, 24 using a new guidewire-centered distal EPD, reported a 30-day MACCE rate of 2.9% and 2.3%, respectively. These data, combined with the WISE trial data, suggest that improvement in outcome could be related to improved embolic protection technology and significant advances in cognitive and technical expertise that have developed since the historical control studies were conducted.…”

Section: Discussionmentioning

confidence: 97%

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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“…Daha sonra konvansiyonel anjiodaki ilerlemelere paralel olarak karotis arter stentlemelerde de ilerlemeler olmuştur (11)(12)(13)(14). Yakın tarihli yapılan çalışmalarda da stentleme ile cerrahinin klinik çalışmalarının benzer olduğunu gösterilmiştir (4,15).…”

Section: Discussionunclassified

Retrospective Evaluation of Carotid Artery Stenting Experience of a Third Stage Neurology Clinic

Özdemir¹,

Kizildağ²,

Ekmekçi³

et al. 2018

TÃ¼rk Beyin Damar Hast Derg

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ÖZETAMAÇ: İskemik inmenin hem primer hem de sekonder korumasında; karotis artere stent (KAS) yerleştirilmesinin etkinliği ve güvenirliği gösterilmiştir. Bizim bu çalışmadaki amacımız, üçüncü basamak nöroloji kliniğince yapılan KAS işlemininin güvenirliğini göstermek ve iki yıllık sonuçlarını klinik ve radyolojik olarak değerlendirmektir. GEREÇ ve YÖNTEM: Temmuz 2015 ile Temmuz 2016 tarihleri arasında hastanemize başvuran, nöroloji kliniğimiz tarafından değerlendirilip, KAS kararı verilen ve stent uygulanan 27 hasta (ortalama yaş 71.6 [58-85]) çalışıldı. Çalışmaya semptomlu olup karotis arterde anjiyografik olarak %50'nin üzerinde darlık olanlarla, semptomsuz olup karotis arterde %70'in üzerinde darlık olan hastalar alındı. BULGULAR: İşlem başarı oranı %96.3 dür (bir hastada işlemden 2 saat sonra stent içinde trombüs gelişti). KAS işlemi uyguladığımız bu hastaların hiçbirisinde ölüm, miyokart enfarktüsü görülmedi. Bu hastaların 6 aylık takiplerinde hiçbir hastada iskemik serebrovasküler olay veya geçici iskemik atak gelişmedi. Kendi kliniğimizce yapılan karotis doppler takiplerinde hiçbir hastada restenoz izlenmedi. SONUÇ: Endovasküler üzerine eğitim almış nöroloji uzmanları tarafından yapılan karotis artere stent yerleştirilmesi işleminin semptomlu veya semptomsuz hastalarda düşük komplikasyon ve yüksek başarı oranları ile güvenli bir şekilde yapılabileceği ve hastaların daha sağlıklı bir şekilde takip edileceği kanaatindeyiz. Anahtar Sözcükler: Karotis arter stentlemesi, iskemik inme, nöroloji kliniği. RETROSPECTIVE EVALUATION OF CAROTID ARTERY STENTING EXPERIENCE OF A THIRD STAGE NEUROLOGY CLINIC ABSTRACTOBJECTIVE: In the protection of both primary and secondary ischemic stroke, the effectiveness and reliability of the placement of carotid artery stent (CAS) has been demonstrated. Our aim in this study is to demonstrate the reliability of the CAM procedure performed in the tertiary care neurology clinic and the clinical and radiological to evaluation the twoyear results. MATERIAL and METHODS: Twenty-seven patients who applied to our hospital between July 2015 and July 2016, were evaluated by our neurology clinic, decided on CAS and stenting were studied (average age 71.6 [58-85]). Patients with symptomatic onset of the carotid artery stenosis over 50% angiographically, asymptomatic and over 70% stenosis in the carotid artery were included. RESULTS: The operation success rate was 96.3% (a thrombus developed in the stent 2 hours after the operation in a single patient). No deaths or myocardial infarction occurred in any of these patients with CAS. No ischemic cerebrovascular event or transient ischemic attack occurred in any of the patients at 6 months follow-up. No restenosis was observed in any of the carotid doppler follow-ups performed in our clinic. CONCLUSION: We believe that carotid artery stent placement performed by neurologists trained in endovascular surgery can be safely performed with low complication and high success rates in symptomatic or asymptomatic patients and that patients will be monitored ...

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Results of carotid artery stenting with distal embolic protection with improved systems: Protected Carotid Artery Stenting in Patients at High Risk for Carotid Endarterectomy (PROTECT) trial

Cited by 47 publications

References 24 publications

Bilateral Embolic Protection Devices for High-Risk Cardiac Surgery in a Patient With Recent Embolic Stroke

Bilateral Embolic Protection Devices for High-Risk Cardiac Surgery in a Patient With Recent Embolic Stroke

Independent Modular Filter for Embolic Protection in Carotid Stenting

Retrospective Evaluation of Carotid Artery Stenting Experience of a Third Stage Neurology Clinic

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