China
Africa
Explore chapters and articles related to this topic
Stents
Published in Vikram S. Kashyap, Matthew Janko, Justin A. Smith, Endovascular Tools & Techniques Made Easy, 2020
Arterial stenting follows the same principles and indications that have been established for open intervention. In the lower extremities, disabling claudication and critical limb ischemia are the main indications for treatment. Similarly, patients who present with severe arm claudication and ischemic ulcers of the hand may benefit from endovascular stenting. Visceral stenting focuses on the treatment of patients with medically refractory hypertension due to renal artery stenosis and mesenteric ischemia from celiac artery and superior mesenteric artery stenosis. Carotid stenting is reserved for patients who are high operative risk for conventional carotid endarterectomy. The indications for peripheral vascular stent placement are summarized in Table 10.1.
Beneficial Effect of Carotid Endarterectomy in Symptomatic Patients with High-Grade Carotid Stenosis
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
The precise role and methods of carotid stenting are currently under clinical investigation. The lesson of how comparative, randomized clinical trials established the value of CEA, if followed, will provide reliable future guidelines.
Acute ischemic stroke
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Atherosclerosis, or plaque buildup, can develop in the large carotid and vertebral arteries leading to the brain. This plaque can either narrow the lumen to restrict blood flow or can also develop thrombus that can break off and cause artery-to-artery embolism and infarction (Livesay and Hickey, 2014). Patients with symptomatic carotid stenosis greater than 70% may benefit from surgical intervention to reopen narrowed vessels. This can be achieved by carotid endarterectomy or carotid stenting. The type of surgery depends on many factors, including location of the stenosis and comorbidities of the patient. Timing of the surgery does not need to be emergent, but within 2 weeks is recommended (Kernan et al., 2014).
Long-term outcomes of symptomatic and asymptomatic patients undergoing carotid endarterectomy in an average-volume community hospital
Published in Acta Chirurgica Belgica, 2021
José M. Alvarez Gallesio, Patricio Gimenez Ruiz, Michel David, Martin Devoto, Alejandro Caride, Raúl A. Borracci
Carotid endarterectomy continues to be the standard treatment for carotid artery stenosis according to current evidences [21–23]. Although carotid stenting had tried to replace surgical treatment, the two largest randomized controlled trials CREST [24] and ICSS [25] reported higher periprocedural stroke rates with the endovascular treatment. Including only symptomatic patients, the ICSS had doubled the risk of stroke compared with carotid endarterectomy, and mortality rate was about three times higher. Notwithstanding the positive carotid endarterectomy short-term results, it is necessary to know its long-term outcomes. For instance, CREST trial described the outcomes over an eight-year period. In this article, we reported ten-year outcomes of a single community hospital with a mean follow-up of 4.6 years.
Neurotrophins in carotid atherosclerosis and stenting
Published in Annals of Medicine, 2023
Teodora Yaneva-Sirakova, Latchezar Traykov, Kiril Karamfiloff, Ivo Petrov, Julieta Hristova, Dobrin Vassilev
Carotid angiography was done in the patients referred for stenting. All stenoses were assessed in at least two orthogonal planes. The quantitative analysis was done with software for angiographic analysis Dicom Works version 3.1.5.b, after proper calibration of the catheters in every case. Significant carotid stenos were those, which according to the NASCET method were at least 70%. We used carotid stenting as a method of treatment after a multidisciplinary discussion (‘Brain team’) between neurologist, cardiologist, angiologist and the leading interventionalist in carotid stenting in our center. The procedure was standard of treatment for the given patient, based entirely on medical grounds. The decision was based on the neurological symptoms, significance of the stenosis, atherosclerotic burden of the aortic arch, individual surgical risk. Those of the patients, who were not suitable for stenting, were referred for endarterectomy and were not included in this study. All the stenting procedures were done by a team of 2 interventionalists with cardiologic and angiology specialization, experience of more than 10 years in carotid stenting. Four (13%) of the patients were stented without distal protection, as it was impossible to introduce the spider through the tight stenosis. Carotid stenting was done on the basis of current guidelines and was preferred to endarterectomy in the cases that were suitable for stenting, as far as this procedure is gaining speed. There is also quite a lot of data on the endarterectomy, but the full potential of carotid stenting is still under investigation, especially when predictors of success are concerned.
Is it possible to prevent cerebral embolization by improving the design and technology of carotid stent implantation?
Published in Expert Review of Cardiovascular Therapy, 2020
Olesia Osipova, Irina Popova, Vladimir Starodubtsev, Savr Bugurov, Andrey Karpenko
1. Procedural and post-procedural cerebral ischemic events still represent the most frequent complications of endovascular carotid revascularization. The difference in the effect of various stent designs on the incidence of embolic complications after carotid stenting has not been proven. The stent is just one component that can minimize the risk of embolism. Most often, the choice of stent does not have a critical effect on the outcome of treatment and is determined by the anatomy of the vessel. Symptomatic and asymptomatic carotid artery stenosis can be safely treated with double-layer and single-layer carotid stents.