Top

Neuroradiology

Published in:

01-03-2012 | Interventional Neuroradiology

Unprotected carotid artery stenting: complications in 6 months follow-up

Authors: Reza Mohammadian, Bahram Sohrabi, Reza Mansourizadeh, Farideh Mohammadian, Babak Nasiri, Sajad Haririan

Published in: Neuroradiology | Issue 3/2012

Abstract

Introduction

The most serious complications of carotid artery stenting (CAS) are related to the release of particles into the cerebral circulation. Although embolic protection devices may reduce the incidence of cerebral embolization, their use may be associated with additional complications including spasm or dissection. In this report, we present our experience with patients who underwent unprotected CAS.

Methods

We prospectively enrolled patients with symptomatic internal carotid artery stenosis from October 2008 to June 2010.Stenosis diagnosed based on carotid duplex and/or CT angiography findings and confirmed by digital subtraction angiography. All stenting procedures were done without using a protection device. Neurologist evaluated neurological situation of the patients, 24 h, 30 days, 3 and 6 months after stenting. Patients had carotid duplex scan scheduled on the third and sixth month after the procedure.

Results

Overall, 116patients underwent stenting; technical success rate was 100% .Mean age of patients was 68.48 ± 9.84 years, and 69% of the patients were male. One patient (1/116, 0.86%) developed transient ischemic attack during the procedure. One non-neurologic death (1/116, 0.86%) occurred 18 h after the procedure because of myocardial infarction. In 1-month follow-up, only one patient (1/115, 0.87%) presented with neurological complication as a consequence of thalamic hemorrhagic. Six months follow-up revealed two cases (2/115, 1.74%) with in-stent restenosis which one of them was severe and symptomatic and underwent angioplasty.

Conclusion

Unprotected carotid stenting appears to accompany with low early and late complications. Cerebral embolization during CAS is not the only cause of these complications and the use of cerebral protection devices may therefore not prevent all major complications including myocardial infarction, hyperperfusion syndrome, and re-stenosis.

Goodney PP, Schemerhone ML, Powell RJ (2006) Current status of carotid artery stenting. J Vasc Surg 43:406–411PubMedCrossRef

van Heesewijk HP, Vos JA, Louwerse ES, van den Berg JC, Overtoom TT, Ernst SM, Mauser HW, Moll FL, Ackerstaff RG, Carotid PTA and Stenting Collaborative Research Group (2002) New brain lesions at MR imaging after carotid angioplasty and stent placement. Radiology 224:361–365PubMedCrossRef

Reimers B, Corvaja N, Moshiri S, Sacca S, Albiero R, Di Mario C, Pascotto P, Colombo A (2001) Cerebral protection with filter devices during carotid artery stenting. Circulation 104:12–15PubMedCrossRef

Al-Mubarak N, Roubin GS, Vitek JJ, Iyer SS, New G, Leon MB (2001) Effect of the distal-balloon protection system on microembolization during carotid stenting. Circulation 104:1999–2002PubMedCrossRef

Kastrup A, Groschel K, Krapf H, Brehm BR, Dichgans J, Schulz JB (2003) Early outcome of carotid angioplasty and stenting with and without cerebral protection devices: a systematic review of the literature. Stroke 34:813–819PubMedCrossRef

Cremonesi A, Manetti R, Setacci F, Setacci C, Castriota F (2003) Protected carotid stenting: clinical advantages and complications of embolic protection devices in 442 consecutive patients. Stroke 34:1936–1941PubMedCrossRef

Eckert B, Zeumer H (2003) Editorial comment—carotid artery stenting with or without protection devices? Strong opinions, poor evidence. Stroke 34:1941–1943PubMedCrossRef

Perona F, Castellazzi G, Valvassori L, Boccardi E, de Girolamo L, Cornalba GP et al (2009) Safety of unprotected carotid artery stent placement in symptomatic and asymptomatic patients: a retrospective analysis of 30-day combined adverse outcomes. Radiology 250(1):178–183PubMedCrossRef

Tietke MWK, Kerby T, Alfke K, Riedel C, Rohr A, Jensen U et al (2010) Complication rate in unprotected carotid artery stenting with closed-cell stents. Neuroradiology 52:611–618PubMedCrossRef

10.

Barbato JE, Dillavou E, Horowitz MB, Jovin TG, Kanal E, David S et al (2008) A randomized trial of carotid artery stenting with and without cerebral protection. J Vasc Surg 47:760–765PubMedCrossRef

11.

Theiss W, Hermanek P, Mathias K et al (2008) Predictors of death and stroke after carotid angioplasty and stenting a subgroup analysis of the pro-CAS data. Stroke 39(8):2325–2330PubMedCrossRef

12.

Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR, Warlow CP, Barnett HJM, Carotid Endarterectomy Trialists' Collaboration (2003) Analysis of pooled data from the randomized controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 361:107–116PubMedCrossRef

13.

Jordan WD Jr, Voellinger DC, Doblar DD, Plyushcheva NP, Fisher WS, McDowell HA (1999) Microemboli detected by transcranial doppler monitoring in patients during carotid angioplasty versus carotid endarterectomy. Cardiovasc Surg 7:33–38PubMedCrossRef

14.

Ohki T, Marin ML, Lyon RT (1998) Ex vivo human carotid artery bifurcation stenting: correlation of lesion characteristics with embolic potential. J Vasc Surg 27:463–471PubMedCrossRef

15.

Manninen HI, Rasanen HT, Vanninen RL, Vainio P, Hippel MM, Kosma V (1999) Stent placement versus percutaneous transluminal angioplasty of human carotid arteries in cadavers in situ: distal embolization and findings at intravascular US, MR imaging, and histopathologic analysis. Radiology 212:483–492PubMed

16.

Orlandi G, Fanucchi S, Fioretti C et al (2001) Characteristics of cerebral microembolism during carotid stenting and angioplasty alone. Arch Neurol 58(9):1410–1413PubMedCrossRef

17.

Grunwald IQ, Papanagiotou P, Politi M et al (2006) Endovascular treatment of unruptured intracranial aneurysms: occurrence of thromboembolic events. Neurosurgery 58(4):612–618PubMedCrossRef

18.

Vos JA, van den Berg JC, Ernst SMPG, Suttorp MJ, Overtoom TTC, Mauser HW, Vogels OJM (2005) Carotid angioplasty and stent placement: comparison of transcranial Doppler US data and clinical outcome with and without filtering cerebral protection devices in 509 patients. Radiology 234:493–499PubMedCrossRef

19.

Macdonald S, Evans DH, Griffiths PD, McKevitt FM, Venables GS, Cleveland TJ, Gaines PA (2010) Filter-protected versus unprotected carotid artery stenting: a randomised trial. Cerebrovasc Dis 29(3):282–289PubMedCrossRef

20.

Jaeger HJ, Mathias KD, Hauth E, Drescher R, Gissler HM, Hennigs S, Christmann A (2002) Cerebral ischemia detected with diffusion weighted MR imaging after stent implantation in the carotid artery. AJNR Am J Neuroradiol 23:200–207PubMed

21.

Wholey MH, Wholey M, Mathias K et al (2000) Global experience in cervical carotid artery stenting. Cathet Cardiovasc Interv 50:160–167CrossRef

22.

Connors JJ III, Seidenwurm D, Wojak JC et al (2000) Treatment of atherosclerotic disease at the cervical carotid bifurcation: current status and review of literature. AJNR Am J Neuroradiol 21:444–450PubMed

23.

Phatouros CC, Higashida RT, Malek AM et al (2000) Carotid artery stent placement for atherosclerotic disease: rationale, technique and current status. Radiology 217:26–41PubMed

24.

Wholey MH, Jarmolowski CR, Wholey M, Eles GR (2003) Carotid artery stent placement: ready for prime time? J Vasc Interv Radiol 14:1–10PubMedCrossRef

25.

Jaeger HJ, Mathias KD, Drescher R et al (2001) Diffusion weighted MR imaging after angioplasty or angioplasty plus stenting of arteries supplying the brain. AJNR Am J Neuroradiol 22(7):1251–1259PubMed

26.

Wholey MH, Al-Mubarek N (2003) Updated review of the global carotid artery stent registry. Cathet Cardiovasc Interv 60(2):259–266CrossRef

27.

Rapp JH, Wakil L, Sawhney R et al (2007) Subclinical embolization after carotid artery stenting: new lesions on diffusion-weighted magnetic resonance imaging occur postprocedure. J Vasc Surg 45(5):867–872PubMedCrossRef

28.

Ringleb PA, Allenberg J, Bruckmann H et al (2006) 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non inferiority trial. Lancet 368(9543):1239–1247PubMedCrossRef

29.

Wholey MH, Wholey M (2003) Current status in cervical carotid artery stent placement. J Cardiovasc Surg (Torino) 44:331–339

30.

Hauth EAM, Drescher R, Christian Jansen H, Gissler M, Schwarz M, Forsting M, Jaeger HJ, Mathias KD (2006) Complications and follow-up after unprotected carotid artery stenting. Cardiovasc Intervent Radiol 29:511–518PubMedCrossRef

31.

Fiehler J, Jansen O, Berger J, Eckstein HH, Ringleb PA, Stingele R (2008) Differences in complication rates among the centers in the SPACE study. Neuroradiology 50(12):1049–1053PubMedCrossRef

Title: Unprotected carotid artery stenting: complications in 6 months follow-up
Authors: Reza Mohammadian
Bahram Sohrabi
Reza Mansourizadeh
Farideh Mohammadian
Babak Nasiri
Sajad Haririan
Publication date: 01-03-2012
Publisher: Springer-Verlag
Published in: Neuroradiology / Issue 3/2012
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-011-0867-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Unprotected carotid artery stenting: complications in 6 months follow-up

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2012

Enterovirus 71-related encephalomyelitis: usual and unusual magnetic resonance imaging findings

Discriminant analysis to classify glioma grading using dynamic contrast-enhanced MRI and immunohistochemical markers

CT angiography for evaluation of cerebral vasospasm following acute subarachnoid haemorrhage

Hypoactivation of the primary sensorimotor cortex in de novo Parkinson’s disease

Alteration of brain viscoelasticity after shunt treatment in normal pressure hydrocephalus

Perfusion-weighted MR imaging in persistent hemiplegic migraine