The Carotid Revascularization Endarterectomy versus Stenting Trial: credentialing of interventionalists and final results of lead-in phase.

The success of carotid artery stenting in preventing stroke requires a low risk of periprocedural stroke and death. A comprehensive training and credentialing process was prerequisite to the randomized Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) to assemble a competent team of interventionalists with low periprocedural event rates. Interventionalists submitted cases to a multidisciplinary Interventional Management Committee.

"Buddy wire" technique to overcome proximal coronary tortuosity during rotational atherectomy.

We report a case in which rotational atherectomy was planned for the treatment of a severely calcified obstructive lesion in the middle right coronary artery. Severe proximal vessel tortuosity prevented the advancement of the Rotablator burr. We utilized the "buddy wire" technique, allowing facilitated advancement of the Rotablator and successful atherectomy and stenting.

Carotid artery stenting: is there a need to revise ultrasound velocity criteria?

Objectives: Ultrasound (US) velocity criteria have not been well-established for patients undergoing carotid artery stenting (CAS). A potential source of error in using US after CAS is that reduced compliance in the stented artery may result in elevated velocity relative to the native artery. We measured arterial compliance in the stented artery, and developed customized velocity criteria for use early after CAS.

Management of mobile floating carotid plaque using carotid artery stenting.

Purpose: To present management techniques for dealing with mobile floating carotid plaque (MFCP), which represents an indeterminate risk of embolic cerebrovascular events.

Case Reports: Two high-risk patients with a history of carotid endarterectomy were diagnosed with MFCP by duplex ultrasound scanning. One patient had a left hemispheric transient ischemic attack while the other was asymptomatic with a moderate stenosis.

Pixel distribution analysis of B-mode ultrasound scan images predicts histologic features of atherosclerotic carotid plaques.

Background: The correlation of B-mode ultrasonographic morphology with histologic characteristics of atherosclerotic carotid plaques remains ill-defined. The classification of plaques with recently reported measures of plaque echogenicity and heterogeneity has been unsatisfactory. We used computer-assisted duplex ultrasound (DU) scan image analysis to determine echogenicity of specific tissues in control subjects.

Carotid artery closure for endarterectomy does not influence results of angioplasty-stenting for restenosis.

Objective: Carotid angioplasty and stenting (CAS) has been recommended by some authors for the management of postendarterectomy restenosis. However, some authors have expressed concern about the influence of primary closure and patch angioplasty performed during carotid endarterectomy (CEA) on the incidence rate of complications after CAS.

Methods: We analyzed our consecutive series of 54 CAS procedures performed for restenosis after prior CEA.