Results using a self-expanding stent alone in the treatment of severe symptomatic carotid bifurcation stenosis

Bussiére, Miguel; Pelz, David M.; Kalapos, Paul; Lee, Donald; Gulka, Irene; Leung, Andrew; Lownie, Stephen P.

doi:10.3171/jns/2008/109/9/0454

Cited by 41 publications

(48 citation statements)

References 31 publications

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“…Previous studies reported that the perioperative clinical results were favorable despite postdilatation procedure. 6,7,18,19) However, few studies have examined the degree of stent expansion on follow-up. 8) In this study, we investigated stent expansion and changes et al 8) indicated that stent expansion was more marked in patients in whom a closed-cell stent with a weak radial force was used.…”

Section: Discussionmentioning

confidence: 99%

Expansion of Stent and Lumen Diameters on Follow-up after Carotid Artery Stenting in Patients with Carotid Artery Stenosis

Fujimoto

Hashimoto

Nishiguchi

et al. 2017

JNET

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Purpose:We examined postoperative stent and lumen expansions after carotid artery stenting (CAS) in patients with carotid artery stenosis. Furthermore, we investigated factors influencing the stent and lumen expansions in a follow-up period.Subjects: 134 cases (128 patients) who underwent CAS and performed follow-up cerebral angiography 12 months after CAS were enrolled into this study. The stenosis rate based on the stent and lumen diameters on follow-up angiography as a percentage of that immediately after CAS was evaluated.Results: Both the stent and lumen diameters were significantly dilated 12 months after CAS (p <0.001). There were no significant stent-type-related differences in the stent expansion rate. In the symptomatic stenosis group, this expansion rate was significantly higher than in the asymptomatic stenosis group (p = 0.02). With respect to the presence or absence of a high signal intensity on time of flight (TOF) magnetic resonance (MR) images, the stent expansion rate was significantly higher in the high signal intensity group (p = 0.006). In patients with a plaque/sternocleidomastoid muscle signal intensity ratio of ≥1.50 on plaque images, it was significantly higher than in those with a value of <1.50 (p = 0.006).However, there were no significant differences in the lumen expansion rate among the groups. Conclusion:Both the stent and vascular lumen were dilated 12 months after CAS. Plaque fragility influenced the stent expansion rate; however, there were no significant factor-related differences in the vascular lumen expansion rate.

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Section: Discussionmentioning

confidence: 99%

Expansion of Stent and Lumen Diameters on Follow-up after Carotid Artery Stenting in Patients with Carotid Artery Stenosis

Fujimoto

Hashimoto

Nishiguchi

et al. 2017

JNET

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“…6,18 This procedure is particularly effective for the treatment of postendarterectomy restenosis, 7 and, due to the avoidance of balloon angioplasty, it results in less hemodynamic instability. 5 Although progressive SES expansion can be seen up to 6 months postprocedure, 9 our results show that PCS is less likely to give a satisfactory longterm result in the presence of significant plaque calcification and the absence of soft plaque (PLAC score of B3 or 4).…”

Section: Discussionmentioning

confidence: 99%

“…Our technical and imaging follow-up protocols for CAS have been published previously. 6,18 We use an 8 × 40-mm SES to ensure good plaque coverage and maximal chronic outward force on the stenotic area. Our preference is to avoid the use of EPDs and balloons whenever the plaque morphology appears favorable on preoperative CTA.…”

Section: Methodsmentioning

confidence: 99%

“…11,23,27 In an attempt to lessen the technical complexity, risks, and cost of CAS, several groups have shown that the procedure can be performed safely in the majority of cases without the use of EPDs and balloon angioplasty. 3,6,17,18 Our group has shown that primary carotid stenting (PCS) performed using SESs alone can be successful in treating more than 80% of patients with severe, symptomatic carotid stenosis who are ineligible for endarterectomy. 6,18 Potential drawbacks of this balloonless approach include inadequate intraprocedural arterial expansion and early restenosis.…”

mentioning

confidence: 99%

“…3,6,17,18 Our group has shown that primary carotid stenting (PCS) performed using SESs alone can be successful in treating more than 80% of patients with severe, symptomatic carotid stenosis who are ineligible for endarterectomy. 6,18 Potential drawbacks of this balloonless approach include inadequate intraprocedural arterial expansion and early restenosis.…”

mentioning

confidence: 99%

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Plaque morphology (the PLAC Scale) on CT angiography: predicting long-term anatomical success of primary carotid stenting

Pelz¹,

Lownie²,

Lee³

et al. 2015

JNS

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C arotid angioplasty and stenting (CAS) has evolved into an alternative to carotid endarterectomy (CEA) for the treatment of atherosclerotic carotid stenosis, particularly since the publication of the Carotid Revascularization Endarterectomy versus Stent Trial (CREST) in 2010. 4 In the CREST, as in most other randomized controlled trials and large case series, the standard technical protocols include the use of embolic protection devices (EPDs), self-expanding stents (SESs), and balloons preand postdilation. It has, however, been shown that EPDs do not catch all debris generated by balloons and that these expensive devices may cause complications themselves. 10Every pass of a device through an atherosclerotic stenosis generates distal emboli.2,31 Balloon angioplasty, both before and after stent insertion, releases significant amounts of embolic debris 20,24,26,28,33 and often results in significant hemodynamic instability, defined as bradycardia (< 60 beats/min) and hypotension (systolic blood pressure < 90 mm Hg).27 Some major centers now rarely perform prestent balloon angioplasty, deliberately undersize poststent abbreviatioNs CAS = carotid angioplasty and stenting; CEA = carotid endarterectomy; CREST = Carotid Revascularization Endarterectomy versus Stent Trial; CTA = CT angiography; EPD = embolic protection device; NASCET = North American Symptomatic Carotid Endarterectomy Trial; PCS = primary carotid stenting; PLAC = Predicting Long-term outcome with Angioplasty of the Carotid artery; PSV = peak systolic velocity; SES = self-expanding stent. obJect Carotid angioplasty and stenting has emerged as an alternative to carotid endarterectomy for the treatment of atherosclerotic carotid stenosis. Primary carotid stenting, performed using self-expanding stents alone without deliberate use of embolic protection devices and balloon angioplasty, has been shown to be effective and faster, cheaper, and potentially safer than conventional techniques. However, the long-term morphological results of this technique have not been established. The aim of this study was to determine whether preprocedural carotid plaque imaging at the site of maximal stenosis by using CT angiography (CTA) could predict the long-term morphological outcome of primary carotid stenting. methods One hundred eighty-one patients were treated over an 11-year period. Preprocedural CTA was performed in 102 of these. A morphological scale (the Predicting Long-term outcome with Angioplasty of the Carotid artery [PLAC] Scale), with grades from 0 to 4 and A or B, was used to evaluate the circumferential degree of plaque calcification, and the presence or absence of soft plaque. All patients were followed using duplex carotid ultrasound and plain radiographs. Satisfactory morphological outcome was defined as a peak systolic velocity < 120 cm/s and internal carotid artery/common carotid artery ratio < 1.4. results The average follow-up duration was 29.7 months (median 24.5 months, range 0.3-87 months). Univariate logistic regression demonstrated that a low ca...

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Carotid Angioplasty and Stenting

Baldi

Nielsen²,

Zander

et al. 2013

Multi-Modality Atherosclerosis Imaging and Diagnosis

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Results using a self-expanding stent alone in the treatment of severe symptomatic carotid bifurcation stenosis

Cited by 41 publications

References 31 publications

Expansion of Stent and Lumen Diameters on Follow-up after Carotid Artery Stenting in Patients with Carotid Artery Stenosis

Expansion of Stent and Lumen Diameters on Follow-up after Carotid Artery Stenting in Patients with Carotid Artery Stenosis

Plaque morphology (the PLAC Scale) on CT angiography: predicting long-term anatomical success of primary carotid stenting

Carotid Angioplasty and Stenting

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