Endovascular palliation of multivessel blowout syndrome in the setting of a nonresectable neck sarcoma.

Carotid blowout syndrome is a rare life-threatening complication of head and neck malignancy. Current literature has focused exclusively on the carotid system and associated branches. We present a unique case of multivessel blowout in the setting of a large nonresectable neck sarcoma requiring various endovascular techniques for palliation.

Carotid stenting and bivalirudin with and without vascular closure: 3-year analysis of procedural outcomes.

Objectives: The purpose of this study was to examine the outcome of carotid stenting using bivalirudin and the influence of vascular closure devices (VCD) on the incidence and severity of peri-procedural hypotension.

Background: Bivalirudin, a short-acting direct thrombin inhibitor, has been shown to be an effective anticoagulant in coronary interventions, with less risk of bleeding compared with heparin. Routine use of VCD has become the standard of care, facilitating patient ambulation after percutaneous carotid and coronary interventions.

One-year clinical outcomes, midterm survival, and predictors of mortality after carotid stenting in elderly patients.

Background: It has been demonstrated recently that carotid stenting can be performed safely in patients > or =80 years of age. However, it is uncertain whether these patients will derive benefit because longevity after revascularization is an important consideration. This study was conducted to determine survival and predictors of mortality of selected elderly patients after stenting.

Carotid artery stenting in elderly patients: importance of case selection.

Objectives: This study was conducted to determine if carotid stenting (CS) could be safely performed in the elderly.

Background: Age has been shown to be a predictor of neurological complications during CS. We postulated that CS could be safely performed in elderly patients if certain anatomical and clinical markers such as excessive vascular tortuosity, heavy concentric calcification of the lesion, and decreased cerebral reserve were avoided.

Stenting the critical calyceal carotid bifurcation--a technical update.

There are several anatomical appearances of the carotid bifurcation. A calyceal type of bifurcation, superimposed with distal angulation of the internal carotid artery (ICA) and added ICA stenosis can be extremely challenging with regard to placement of embolic protection devices, prolonging manipulation of the lesion, procedure time, increasing contrast use and thus increasing the risk of complications. Certain technical maneuvers can facilitate the procedure and minimize risk.

Realizing the potential of carotid artery stenting: proposed paradigms for patient selection and procedural technique.

Carotid artery stenting, compared with carotid endarterectomy, is emerging as an effective and less invasive method of revascularization for extracranial carotid artery stenosis. Carotid stenting is established as the treatment of choice for certain high-risk patient subsets, and ongoing clinical trials are evaluating this method across a broader clinical spectrum, including asymptomatic patients. For carotid stenting to reach its full potential, an acceptable risk of periprocedural complications, particularly in low-risk patients, must be ensured (the "3% rule").

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.

Fatal cerebral hemorrhage early after subclavian artery endovascular therapy.

We report a case of cerebral hyperperfusion syndrome complicated by a fatal intracranial hemorrhage as a consequence of endovascular recanalization of an occluded left subclavian artery. This entity is thought to be secondary to the failure of the normal autoregulatory mechanism controlling cerebral blood flow after recanalization. Patients at risk for this relatively rare complication are not easily identified.

Predictors of restenosis after successful carotid artery stenting.

This study was performed to determine the risk factors for restenosis after successful carotid stenting. Of 222 patients who underwent successful carotid stenting, 179 (81%) had a follow-up study (carotid ultrasound and/or angiogram). Restenosis rate was 6.

Absence of the common carotid artery: a rare vascular anomaly.

Although absence of the common carotid artery (CCA) is a rare anomaly, the specific configuration in our case makes it extremely rare. Clinical, angiographic, ultrasonographic, and embryologic correlations of this anomaly are discussed after the case report.

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.