Carotid artery stent placement with distal balloon protection: technical considerations.

Background And Purpose: Most neurologic events that complicate the carotid artery stent placement procedure are embolic. Strategies are being developed and evaluated for their ability to minimize the clinical embolic risk. The purpose of this study was to determine the feasibility, safety, and technical considerations of performing carotid artery stent placement with use of a distal balloon antiembolization system.

Carotid artery stenting for the high surgical risk patients.

Obstructive atherosclerotic carotid bifurcation disease is responsible for approximately 30% of stroke cases in the United States. Any successful treatment of this disease should demonstrate significant and durable reduction in the related risk for stroke without compromising the patient safety. The indications for CAS are evolving as the techniques, the stents and catheter technology advance.

Microembolization during carotid stenting with the distal-balloon antiemboli system.

Background: The distal-balloon protection system is being evaluated for its efficacy in preventing embolic neurological events during carotid stenting (CAS). We sought to determine the effect of this system on the frequency of the Doppler-detected microembolic signals (MES) during CAS.

Methods: Using transcranial Doppler, we compared the frequency of MES during CAS in 2 groups; 39 patients without distal protection and 37 with the distal-balloon protection system (GuardWire, Percusurge, Sunnyville, CA).

Percutaneous coronary intervention in a sequential radial artery graft anastomosed to the descending aorta, left circumflex artery and obtuse marginal artery.

We report percutaneous coronary intervention performed on a lesion located in a sequential radial artery graft anastomosed to the descending aorta, distal circumflex artery and obtuse marginal artery. Coronary angiography revealed an 80% stenosis in the mid-segment of the sequential radial artery graft. Conventional balloon angioplasty was performed through the proximal anastomosis at the descending aorta.

Long-term clinical outcome after implantation of medium Palmaz (biliary) stents in very large native coronary arteries.

Intracoronary stenting has been shown to improve acute and long-term clinical results compared with coronary angioplasty. However, clinical outcome after medium Palmaz biliary (PB) stent implantation in very large native coronary arteries (> 4 mm in diameter) is unknown. This study evaluated restenosis and long-term clinical outcome after PB stenting in large native coronary arteries.

Multicenter evaluation of carotid artery stenting with a filter protection system.

Objectives: The aim of this study was to evaluate the feasibility and safety of carotid artery stenting (CAS) with a filter protection system.

Background: Neurologic events linked to the embolization of particulate matter to the cerebral circulation may complicate CAS. Strategies designed to capture embolic particles during carotid intervention are being evaluated for their efficacy in reducing the risk of these events.

Carotid stenting with distal-balloon protection via the transbrachial approach.

Purpose: To document the feasibility of brachial artery access for carotid stenting with distal-balloon protection of the internal carotid artery (ICA).

Technique: Via percutaneous access to the brachial artery, a large double-curve catheter is advanced into the aortic arch over a hydrophilic guidewire to cannulate the left common carotid artery. Following sheath exchange, a GuardWire distal-protection balloon is positioned within the left ICA distal to the stenosis.

Subarachnoidal hemorrhage following carotid stenting with the distal-balloon protection.

A 61-year-old man underwent carotid stenting with the distal-balloon protection system for symptomatic carotid artery stenosis. During the procedure, progressive elevation of the systolic blood pressure occurred, reaching a peak of 220 mm Hg immediately following deflation of the distal balloon. This was associated with severe headaches and progressive deterioration in the mental status to a coma.

Effect of the distal-balloon protection system on microembolization during carotid stenting.

Background: The distal-balloon protection system is being evaluated for its efficacy in preventing embolic neurological events during carotid stenting (CAS). We sought to determine the effect of this system on the frequency of Doppler-detected microembolic signals (MES) during CAS.

Methods And Results: Using transcranial Doppler, we compared the frequency of MES during CAS in 2 groups: 39 patients without distal protection and 37 who used the distal-balloon protection system (GuardWire).

Procedural safety and short-term outcome of ambulatory carotid stenting.

Background And Purpose: Ambulatory procedures increase patient comfort and enhance cost-effectiveness. We sought to determine the feasibility and safety of ambulatory carotid stenting.

Methods: A selected group of patients was admitted and discharged the same day after the carotid stenting procedure.

Embolization via collateral circulation during carotid stenting with the distal balloon protection system.

Purpose: To describe a potential route for embolization to the middle cerebral artery (MCA) during carotid stenting with the distal balloon protection system.

Case Report: An 82-year-old man with symptomatic severe carotid artery stenosis underwent elective carotid stenting with distal-balloon protection. Despite complete occlusion of the distal internal carotid artery, frequent emboli were detected in the ipsilateral MCA by transcranial Doppler (TCD) during the procedure.

Integrated minimally invasive approaches for the treatment of atherosclerotic vascular diseases: Hybrid procedures.

Patients may develop simultaneous symptoms of atherosclerotic vascular disease from different arterial beds. A concurrent minimally invasive approach to the management of these clinical situations may be an advantage over conventional surgical procedures. This study describes two separate case series of patients undergoing coronary/peripheral (n = 38) and peripheral/peripheral procedures (n = 10).

Immediate and late clinical outcomes of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis: a 5-year prospective analysis.

Background: Carotid stenting is a less invasive percutaneous procedure than carotid endarterectomy for the treatment of carotid stenosis. Reports suggest that it can be performed with periprocedural complication rates similar to those of carotid endarterectomy. The purpose of this study was to determine short- and long-term outcomes in the largest prospective cohort of carotid stenting patients.

Safety, efficacy, and durability of carotid artery stenting for restenosis following carotid endarterectomy: a multicenter study.

Purpose: To present the results of a multicenter registry established to collect data on carotid stent procedures in patients with restenosis following carotid endarterectomy.

Methods: The procedural details, outcomes, and late follow-up results were collected from 14 centers in the United States. Thirty-day and late stroke and death rates were analyzed.

Techniques of carotid artery stenting: the state of the art.

The technique of carotid stenting has undergone significant refinement since its introduction and continues to improve as experience with the procedure matures and more suitable equipment becomes available. Improved stent designs and the utilization of cerebral protection devices are expected to significantly impact on the technique, its ultimate outcomes, and widespread application. In using the currently available technology for carotid stenting, patient selection and meticulous attention to procedural details are very important in minimizing embolic events.

Carotid stenting for severe radiation-induced extracranial carotid artery occlusive disease.

Purpose: To present our experience with carotid artery stenting as an alternative treatment to endarterectomy in patients with radiation-induced carotid artery occlusive disease.

Methods And Results: Fourteen patients (10 males; mean age 61 years, range 52 to 79) underwent percutaneous stenting of 15 carotid arteries for severe radiation-induced extracranial stenoses. Technical success was achieved in all patients, with reduction of the mean stenosis from 77% +/- 6% to 8% +/- 2%.

Percutaneous treatment of catheter-induced dissection of the left main coronary artery and adjacent aortic wall: a case report.

Left main coronary artery dissection complicating selective coronary angiography is uncommon. Moreover, aortic root dissection associated with coronary intervention is underreported and may require urgent surgical intervention. During percutaneous coronary angioplasty of a catheter-induced left main coronary artery dissection, retrograde dissection of the adjacent aortic root occurred.

Extracranial vertebral artery stent placement: in-hospital and follow-up results.

Object: The authors summarize their experience with stent deployment in the treatment of vertebrobasilar artery (VBA) insufficiency. This is an underdiagnosed condition, and the incidence of significant vertebral artery (VA) stenosis has been underappreciated. Medical therapy has been the mainstay of treatment because of the high rate of morbidity associated with surgical correction of VA stenosis.

Early results of percutaneous intervention for severe coexisting carotid and coronary artery disease.

Fifty-one patients with severe coexisting carotid and symptomatic coronary artery occlusive disease successfully underwent staged or simultaneous coronary angioplasty and carotid stenting. One pericardial effusion and 2 minor strokes with full recovery occurred in the hospital, but no major neurologic events, myocardial infarction, or death were observed and no repeat revascularization was required within the 30-day follow-up.

Immediate and late outcomes of subclavian artery stenting.

Stenting for subclavian artery occlusive disease is being increasingly utilized. To determine the immediate and late outcome of subclavian artery stenting, we studied 38 consecutive patients in whom the procedure was attempted. Technical and clinical success was achieved in 35 patients without complications.

Carotid artery stenting in patients with high neurologic risks.

Forty-four patient with high neurologic risks (Mayo class IV) successfully underwent carotid artery stenting with combined major stroke and death rates of 4.5%. Late follow-up at a mean of 23 +/- 1.

Consultation before thrombolytic therapy in acute myocardial infarction. Second National Registry of Myocardial Infarction (NRMI 2) Investigators.

Among 57,398 thrombolytic recipients in the National Registry of Myocardial Infarction 2, consultation with another physician was sought in 64% before initiating lytic therapy, although presenting features were typical, rather than atypical, in most patients. Consultation significantly delayed the administration of lytic therapy and was associated with increased hospital mortality.