MedWorm: Carotid Angioplasty

ASA: Stenting Carotid on a Par with Endarterectomy (CME/CE)

MedPage Today Cardiovascular — Fri, 26 Feb 2010 18:16:41 +0100

SAN ANTONIO (MedPage Today) -- Angioplasty and carotid stenting appears to be as safe, effective, and durable as endarterectomy for treatment of patients with both symptomatic and asymptomatic carotid stenosis, researchers said here. (Source: MedPage Today Cardiovascular)

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Biaxial mechanical properties of intact and layer-dissected human carotid arteries at physiological and supraphysiological loadings

AJP: Heart and Circulatory Physiology — Wed, 24 Feb 2010 22:23:38 +0100

Specimens of intact wall tubes of human common carotid arteries (CCA), internal carotid arteries (ICA) (n = 11, age 77.6 yr, SD 6.3), and related adventitia and media-intima tubes are mechanically examined. Cyclic, quasi-static extension-inflation tests at different axial stretches are performed on preconditioned tube specimens. Stress-free configurations show significant stress releases in the circumferential direction of the intact CCA and ICA walls and in the axial directions of the intact CCA walls and the CCA and ICA adventitias. All investigated tissues exhibit strong nonlinear, pseudoelastic mechanical behavior with small hysteresis. The "inversion" feature, where the pressure/axial stretch relationship becomes a vertical line, is found only for intact walls. Axial "inversion stretc...

Adenosine Receptor A2A Deficiency in Leukocytes Increases Arterial Neointima Formation in Apolipoprotein E-Deficient Mice.

Arteriosclerosis, Thrombosis and Vascular Biology — Thu, 18 Feb 2010 00:00:00 +0100

CONCLUSIONS: A2AR plays a complex role in inflammation and tissue injury. The deficiency of A2AR enhances the homing ability of leukocytes and increases the formation of the arterial neointima after injury. A2AR antagonists are being tested for the treatment of neurodegenerative and other chronic diseases. An evaluation of the effect of A2AR antagonists on arterial restenosis after arterial angioplasty should be conducted. PMID: 20167656 [PubMed - as supplied by publisher] (Source: Arteriosclerosis, Thrombosis and Vascular Biology)

Racial and Ethnic Differences in the Use of High-Volume Hospitals and Surgeons [Original Article]

Archives of Surgery — Mon, 15 Feb 2010 20:50:40 +0100

Conclusions Minority patients in New York City are doubly disadvantaged in their surgical care; they are substantially less likely to use both high-volume hospitals and surgeons for procedures with an established volume-mortality association. Better information is needed about which providers minority patients have access to and how they select them. (Source: Archives of Surgery)

Cryoplasty of the Venous Anastomosis for Prevention of Intimal Hyperplasia in a Validated Porcine Arteriovenous Graft Model.

PubMed: Eur J Vasc Endovasc ... — Thu, 11 Feb 2010 00:00:00 +0100

CONCLUSION: Our results suggest that preventive cryoplasty of the venous anastomosis might help to reduce IH in those cases that develop most profound IH. PMID: 20153668 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

FDA approves rosuvastatin for primary prevention of cardiovascular disease

NeLM - News — Wed, 10 Feb 2010 00:00:00 +0100

Source: FDA Area: News The U.S. Food and Drug Administration (FDA) has approved rosuvastatin (CrestorT) for the primary prevention of cardiovascular disease to reduce the risk of stroke, heart attack, and the risk of arterial revascularisation procedures (including coronary artery bypass graft, or bypass grafting of a peripheral artery or carotid artery, or angioplasty or stent placement) in individuals who have no clinically evident heart disease but are at an increased risk of heart disease due to the combined effect of the following risk factors: . Age (> 50 years in men; > 60 years in women), and . An elevated high-sensitivity C-reactive protein level (> 2 mg/L), and . Presence of at least one additional cardiovascular risk factor (e.g., high blood pressure, ...

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Multiple Coaxial Catheter System for Reliable Access in Interventional Stroke Therapy

CardioVascular and Interventional Radiology — Thu, 04 Feb 2010 06:44:23 +0100

In conclusion, building up a triple or quadruple coaxial system proved to be safe and efficient in our experience for the mechanical thrombectomy treatment of acute ischemic stroke. Content Type Journal ArticleCategory Technical NoteDOI 10.1007/s00270-010-9815-0Authors Zsolt Kulcsár, Geneva University Hospital Neurointerventional Division, Department of Clinical Neurosciences Geneva SwitzerlandHasan Yilmaz, Geneva University Hospital Neurointerventional Division, Department of Clinical Neurosciences Geneva SwitzerlandChristophe Bonvin, Geneva University Hospital Neurology Division, Department of Clinical Neurosciences Geneva SwitzerlandKarl O. Lovblad, Geneva University Hospital Diagnostic Neuroradiology Division, Department of Radiology Geneva SwitzerlandDaniel A. Rüfenacht, Gene...

Complications of Angioplasty and Stenting of Cervicocerebral Arteries in Iran [ORIGINAL ARTICLE]

Asian Cardiovascular and Thoracic Annals — Tue, 02 Feb 2010 09:27:46 +0100

Angioplasty and stenting of the cervicocerebral arteries is a novel treatment for atherosclerotic stenosis, which has periprocedural complications. Data were collected prospectively from 2007 to 2009 in a multicenter cohort of patients undergoing interventions for cervicocerebral stenosis. Retrospective assessment of the 2003–2006 archives of the same interventionists and a review of their published work is the second part of this national survey. In 592 extracranial internal carotid artery angioplasty and stenting procedures in 581 patients (73% male; mean age, 63.4 ± 7 years), transient ischemic attack, stroke, intracerebral hemorrhage, and death occurred in 1.7%, 1.7%, 0.34%, and 1.52%, respectively. In 114 extracranial vertebral artery angioplasty and stenting procedures i...

Systematic Preoperative Coronary Angiography and Stenting Improves Postoperative Results of Carotid Endarterectomy in Patients with Asymptomatic Coronary Artery Disease: A Randomised Controlled Trial

Journal of Vascular Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Objective: To evaluate the usefulness of systematic coronary angiography followed, if needed, by coronary artery angioplasty (percutaneous coronary intervention (PCI)) on the incidence of cardiac ischaemic events after carotid endarterectomy (CEA) in patients without evidence of coronary artery disease (CAD). (Source: Journal of Vascular Surgery)

Despite Higher Utilization of Carotid Angioplasty and Stenting (CAS) in 2006, Postprocedure Stroke, Mortality Rates, Hospital Charges, and Discharges to Nursing Skilled Facilities Remain Higher for CAS than for Carotid Endarterectomy Compared with 2005

Journal of Vascular Surgery — Mon, 01 Feb 2010 00:00:00 +0100

This study compared, at the national level, trends in utilization, mortality, and stroke of carotid angioplasty and stenting (CAS) and carotid endarterectomy (CEA) during 2005-2006. (Source: Journal of Vascular Surgery)

Indications and Applications for Extracranial Carotid Artery Stent Placement

Current Cardiology Reports — Mon, 25 Jan 2010 17:02:31 +0100

Abstract Treatment of high-grade symptomatic carotid stenosis via carotid endarterectomy has been shown to be superior to medical management alone in several studies. Carotid angioplasty and stenting (CAS) has emerged as an alternative approach to endarterectomy to reduce the associated perioperative risks. Several anatomic and physiologic factors that increase the risk of stroke and/or death associated with endarterectomy have been identified. The alternative approach of CAS has been found to be noninferior to endarterectomy for high surgical risk patients with severe symptomatic carotid stenosis and the use of this procedure is supported by the current widely accepted guidelines. In patients with standard surgical risk, the differential benefit of CAS compared with endar...

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Inhaled CO Decreases Fibrin Deposition and Activates Fibrinolysis: A Potential Mechanism of Vasoprotection

Journal of Surgical Research — Mon, 25 Jan 2010 16:41:55 +0100

Conclusions: Our findings demonstrate that a brief exposure to inhaled CO did not change platelet adherence to injured carotid arteries 1 day post-injury but did reduce fibrin deposition compared with RA treated rats. This brief inhaled CO treatment was also associated with a prolonged reduction in PAI-1 expression that was more dramatic than achieved with in vitro CO treatment. Taken together, inhaled CO reduces fibrin deposition following vascular injury potentially by increasing fibrinolytic activity through the prolonged down-regulation of PAI-1. This may be represent another mechanism by which brief CO treatment can have such a dramatic effect on inhibiting IH. (Source: Journal of Surgical Research)

Protein Kinase-C Delta Mediates Arterial Injury Responses through Regulation of Vascular Smooth Muscle Cell Apoptosis

Journal of Surgical Research — Mon, 25 Jan 2010 16:41:54 +0100

Introduction: Endovascular intervention has been proven to be a cost-effective approach in revascularization of peripheral arterial disease. However, the long-term efficacy of endovascular procedures is often limited by restenosis, which is primarily caused by excessive intimal hyperplasia after vascular injury. Intimal hyperplasia is a complex process involving vascular smooth muscle cell (VSMC) proliferation, migration, apoptosis and extracellular matrix deposition. Apoptosis of VSMC has been shown to influence intimal hyperplasia, presumably through reduction of the lesion cell numbers. However, how apoptosis is regulated after vascular injury is not fully understood. We have previously demonstrated Protein Kinase-C delta (PKCδ) is an integral mediator of VSMC apoptosis in vitro. Here,...

The Role of Doxycycline as an Inhibitor of Intimal Hyperplasia after Balloon Angioplasty Arterial Injury

Journal of Surgical Research — Mon, 25 Jan 2010 16:41:13 +0100

Objective: Intimal hyperplasia (IH) is the most common indicator for secondary intervention in peripheral vascular disease. The major cellular processes contributing to IH development are extracellular matrix (ECM) degradation and vascular smooth muscle cell (VSMC) migration and proliferation. Matrix metalloproteinases (MMPs) are implicated in vascular remodeling due to their ability to selectively degrade components of the ECM. Members of the tetracycline family of antibiotics are potent MMP inhibitors, doxycycline being one of the more potent inhibitors with better absorption and a longer half-life than the parent compound. We have previously shown doxycycline inhibits MMP activity and VSMC migration in vitro. Moreover, doxycycline has been found to inhibit cell proliferation in other ce...

Nitric Oxide-Dependent Bone Marrow Progenitor Mobilization by Carbon Monoxide Enhances Endothelial Repair After Vascular Injury.

Circulation — Mon, 18 Jan 2010 00:00:00 +0100

Conclusions-Collectively, the present data demonstrate that CO accelerates EC proliferation and vessel repair in a manner dependent on NO generation and enhanced recruitment of bone marrow-derived endothelial progenitor cells. PMID: 20083679 [PubMed - as supplied by publisher] (Source: Circulation)

Indications and Applications of Arterial Stents for Stroke Prevention in Atherosclerotic Intracranial Stenosis

Current Cardiology Reports — Mon, 11 Jan 2010 18:25:05 +0100

Abstract Intracranial stenosis accounts for 8–10% of all ischemic strokes in North America, a frequency slightly less than that of extracranial carotid stenosis. Among patients presenting with transient ischemic attack or stroke due to intracranial stenosis, the risk of recurrent stroke in the first year after initial symptoms is about 14%. Those with high-risk features (recent stroke and severe stenosis) have up to a 23% rate of recurrent stroke in the year after their initial event. Angioplasty with stenting has emerged as a potential treatment strategy, particularly in high-risk patients, although evidence is currently limited to uncontrolled prospective trials and retrospective case series. In this article, we critically review the clinical results supporting the use...

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Transarterial Thrombin Injection Secured with an Embolic Protection Device as a Treatment for a Superior Mesenteric Artery Pseudoaneurysm

CardioVascular and Interventional Radiology — Fri, 08 Jan 2010 09:08:51 +0100

We report a 71-year-old male with a SMA pseudoaneurysm who was successfully treated with a transarterial thrombin injection secured with an embolic protection device used in carotid angioplasty. To our knowledge, this is the first case of a SMA pseudoaneurysm treated by this method. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00270-009-9791-4Authors Robert Juszkat, Poznań University of Medical Sciences Department of Radiology Szpital Kliniczny nr 1, Ul. Długa ½ 61-848 Poznan PolandZbigniew Krasiński, Poznań University of Medical Sciences Department of Radiology Szpital Kliniczny nr 1, Ul. Długa ½ 61-848 Poznan PolandMateusz Wykrętowicz, Poznań University of Medical Sciences Department of Radiology Szpital Kliniczny nr 1, Ul. Długa ½ 61-848 Poznan PolandRy...

Design of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST)

International Journal of Stroke — Thu, 07 Jan 2010 00:00:00 +0100

The objective is to compare the efficacy of CAS versus CEA in patients with symptomatic ([ge]50%) or asymptomatic ([ge]60%) extracranial carotid stenosis. The Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) is a prospective, randomized, parallel, two-arm, multi-center trial with blinded endpoint adjudication. Primary endpoints are analyzed using standard time-to-event statistical modeling with adjustment for major baseline covariates. Primary analysis is on an intent-to-treat basis. The primary outcome is the occurrence of any stroke, myocardial infarction, or death during a 30-day peri-procedural period, and ipsilateral stroke during follow-up of up to four years. Secondary outcomes include restenosis and health-related quality of life. (Source: International Journal o...

Protein kinase C delta mediates arterial injury responses through regulation of vascular smooth muscle cell apoptosis

Cardiovascular Research — Tue, 05 Jan 2010 16:18:14 +0100

Conclusion The expression of PKC is upregulated in the arterial wall in response to injury. This induction appears to be a mechanism of arterial response that negatively influences the degree of intimal hyperplasia by stimulating VSMC apoptosis. (Source: Cardiovascular Research)

Protamine reduces bleeding complications associated with carotid endarterectomy without increasing the risk of stroke

Journal of Vascular Surgery — Mon, 04 Jan 2010 00:00:00 +0100

Conclusion: Protamine reduced serious bleeding requiring reoperation during CEA without increasing the risk of MI, stroke, or death, in this large, contemporary registry. In light of significant complications referable to bleeding, liberal use of protamine during CEA appears warranted. (Source: Journal of Vascular Surgery)

Determining who trains vascular surgery fellows in endovascular techniques

Journal of Vascular Surgery — Mon, 04 Jan 2010 00:00:00 +0100

Conclusion: Vascular surgeons involved in resident education have been able to retrain themselves in endovascular techniques such that they are now able to provide greater than 80% of the endovascular experience to vascular surgery residents. (Source: Journal of Vascular Surgery)

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A Reference Standard-Based Quality Assurance Program for Radiology

Journal of the American College of Radiology : JACR — Fri, 01 Jan 2010 00:00:00 +0100

The authors have developed a comprehensive radiology quality assurance (QA) program that evaluates radiology interpretations and procedures by comparing them with reference standards. Performance metrics are calculated and then compared with benchmarks or goals on the basis of published multicenter data and meta-analyses. Additional workload for physicians is kept to a minimum by having trained allied health staff members perform the comparisons of radiology reports with the reference standards. The performance metrics tracked by the QA program include the accuracy of CT colonography for detecting polyps, the false-negative rate for mammographic detection of breast cancer, the accuracy of CT angiography detection of coronary artery stenosis, the accuracy of meniscal tear detection on MRI, ...

Access complications during endovascular aortic repair.

The Journal of Cardiovascular Surgery — Fri, 01 Jan 2010 00:00:00 +0100

This article will discuss a multitude of access related complications and their treatment. Preoperative imaging is paramount to the success of endovascular procedures. Intraoperative adjuncts, such as iliac artery angioplasty/stenting, the "pull-down" technique, and aorto mono iliac/femoral systems will be discussed. Occasionally, challenging iliac or femoral anatomy may preclude access through these vessels and the endovascular specialist may need to gain direct access through the aorta or via the carotid artery. In addition, the advantages and disadvantages of an entirely percutaneous technique will be discussed. Finally, peri-operative complications such as rupture, dissection, pseudoaneurysm and infection will be discussed and various treatment modalities reviewed. As stent graft techn...

Crossing an Ultracritical Carotid Stenosis for Carotid Angioplasty

Vascular and Endovascular Surgery — Wed, 30 Dec 2009 05:49:26 +0100

In this report, the authors describe an approach using a 0.012-inch hydrophilic system to overcome this technical obstacle. (Source: Vascular and Endovascular Surgery)

Carotid Artery Stenting for Stenosis Following Cervical Radiotherapy: Report of Early Failure With Associated Stent Fracture

Vascular and Endovascular Surgery — Wed, 30 Dec 2009 05:49:26 +0100

We report the case of a 64-year-old man who was treated with bilateral CAS for stenoses, which developed 7 years following thyroidectomy, neck dissection, and radiotherapy. Although long considered an ideal alternative to CE in this clinical setting, CAS in this case was complicated by multiple episodes of recurrent stenosis in his left carotid, managed by balloon angioplasty. Severe, early recurrence in his right carotid associated with a type III stent fracture was managed by CE. Close surveillance and intervention prevented neurologic morbidity. This case, combined with emerging published experience, argues for reappraisal of the general consensus that CAS is an ideal alternative to CE for radiotherapy-associated carotid stenoses. (Source: Vascular and Endovascular Surgery)

Retinal Embolization During Carotid Angioplasty and Stenting: Periprocedural Data and Follow-Up

CardioVascular and Interventional Radiology — Thu, 24 Dec 2009 19:56:04 +0100

Abstract The purpose of this study was to prospectively evaluate the incidence of retinal emboli during carotid angioplasty and stenting (CAS) and to correlate emboli with clinical findings and transcranial Doppler (TCD)-detected cerebral embolic load. Between 2001 and 2005, 33 CAS procedures in 32 patients (23 [72%] male, 19 [58%] symptomatic, mean age 72.5 years [range 54.6 to 83.9]) scheduled for CAS were included in this study. Bilateral fundoscopy with retinal photography was performed by an experienced ophthalmologist immediately before, immediately after (fundoscopy only), and 1 day after the procedure and again at long-term follow-up (mean 37 months). Visual field testing was performed before CAS and again at long-term follow-up. TCD-detected cerebral...

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Biaxial mechanical properties of intact and layer-dissected human carotid arteries at physiological and supra-physiological loadings.

American Journal of Physiology. Heart and Circulatory Physiology — Thu, 24 Dec 2009 00:00:00 +0100

Authors: Sommer G, Regitnig P, Költringer L, Holzapfel GA Specimens of intact wall tubes of human common carotid arteries (CCA), internal carotid arteries (ICA) (n = 11, age 77.6 yrs, SD 6.3) and related adventitia and media-intima tubes are mechanically examined. Cyclic, quasi-static extension-inflation tests at different axial stretches are performed on pre-conditioned tube specimens. Stress-free configurations show significant stress releases in the circumferential direction of the intact CCA and ICA walls and in the axial directions of the intact CCA walls and the CCA and ICA adventitias. All investigated tissues exhibit strong nonlinear, pseudo-elastic mechanical behavior with small hysteresis. The 'inversion'-feature where the pressure/axial stretch relationship becomes a ve...

[Atherosclerotic carotid stenosis in women.]

Presse Medicale — Tue, 22 Dec 2009 00:00:00 +0100

Authors: Woimant F Atherosclerotic carotid stenosis is a risk factor for myocardial infarction, for vascular death, and for stroke. Medical treatment for atherosclerotic carotid stenosis routinely includes screening for and treatment of both risk factors and other atherosclerotic sites, the prescription of antiplatelets drugs, and patient education about transient ischemic accidents. The benefits of carotid surgery have been demonstrated in symptomatic stenoses with stenosis of 70% or more. In women, the benefits of surgery are slight for asymptomatic stenosis exceeding > 60% and for moderate symptomatic stenosis (50-69%). The treatment decision requires consideration of individual factors such as age, characteristics of the stenosis, and the type of symptoms (hemispheric or retinal...

Successful Recanalization of a Septic Embolus with a Balloon Mounted Stent after Failed Mechanical Thrombectomy

Journal of Neuroimaging — Wed, 16 Dec 2009 00:00:00 +0100

We report the case of a 24-year-old woman who presents with a left internal carotid artery terminus occlusion secondary to a septic emboli from a LVAD. The patient was not a candidate for intravenous thrombolytics due to an elevated international normalized ratio, and thus was taken for intra-arterial treatment. Initial treatment with mechanical thrombectomy and balloon angioplasty was not successful; thus, a balloon-mounted coronary stent was placed to achieve successful recanalization. Fragments of thrombus on the mechanical thrombectomy device revealed gram-positive bacilli on gram stain. Patients with large artery occlusion due to a septic embolus can be successfully treated with endovascular therapies in select patients. J Neuroimaging 2009;XX:1[ndash]3. (Source: Journal of Neuroimagi...

Most Carotid Stenosis Cases Treatable with Medical Therapy (CME/CE)

MedPage Today Cardiovascular — Mon, 14 Dec 2009 20:00:00 +0100

Treating carotid stenosis with intensive medical therapy may eliminate the need for either angioplasty or endarterectomy, a new study suggests. (Source: MedPage Today Cardiovascular)

Predicting embolic potential during carotid angioplasty and stenting: Analysis of captured particulate debris, ultrasound characteristics, and prior carotid endarterectomy

Journal of Vascular Surgery — Mon, 14 Dec 2009 00:00:00 +0100

Conclusions: Considerable variation exists in the number and size of embolic particles generated during CAS. Embolic potential is positively correlated with lesion GSM and the combination of lesion echogenicity, heterogenicity, and irregularity. Restenosis after prior CEA is associated with minimal embolic particulate generation, suggesting that embolic protection may not be necessary for CAS of restenotic lesions. (Source: Journal of Vascular Surgery)

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Systematic Preoperative Coronary Angiography and Stenting Improves Postoperative Results of Carotid Endarterectomy in Patients with Asymptomatic Coronary Artery Disease: A Randomised Controlled Trial

European Journal of Vascular and Endovascular Surgery — Mon, 14 Dec 2009 00:00:00 +0100

Conclusions: Systematic preoperative coronary angiography, possibly followed by PCI, significantly reduces the incidence of postoperative myocardial events after CEA in patients without clinical evidence of CAD. (Source: European Journal of Vascular and Endovascular Surgery)

Periadventitial delivery of anti-EGF receptor antibody inhibits neointimal macrophage accumulation after angioplasty in a hypercholesterolaemic rabbit

International Journal of Experimental Pathology — Sat, 12 Dec 2009 00:00:00 +0100

Monocyte recruitment and their differentiation into macrophages are both early events in native and accelerated atherosclerosis that follows angioplasty. We have investigated the putative functional role of the epidermal growth factor receptor (EGFR) present on rabbit monocytes/macrophages. The impact of periadventitial delivery of an EGFR-specific, blocking monoclonal antibody (ICR62, which inhibits EGF-binding to its receptor) was investigated in a rabbit model of accelerated atherosclerosis induced by a combination of carotid injury and 4 weeks of a 2% cholesterol-diet. Two weeks after the initiation of the diet, a balloon-catheter angioplasty of the left common carotid artery was performed and a collar placed around the injured carotid artery immediately, for the delivery of ICR62 anti...

Gender differences in carotid imaging and revascularization following stroke

Neurology — Mon, 07 Dec 2009 21:01:57 +0100

Conclusions: Although women with ischemic stroke or TIA are less likely than men to undergo carotid screening and revascularization, this difference is largely explained by potential contraindications to surgery and by sex differences in the severity of carotid disease. (Source: Neurology)

Restenosis Following Carotid Endarterectomy in a Multicenter Regional Registry

Journal of Vascular Surgery — Tue, 01 Dec 2009 00:00:00 +0100

Background: Level I evidence has shown that patch angioplasty, when used during conventional carotid endarterectomy (CEA), results in lower rates of restenosis. However, it remains unclear how this information has affected practice patterns and outcomes in real-world vascular surgery settings. (Source: Journal of Vascular Surgery)

Atherosclerotic Plaque Composition and Cerebral Embolization after Carotid Stenting

Journal of Vascular Surgery — Tue, 01 Dec 2009 00:00:00 +0100

Background: Previous studies have investigated the predictive value of clinical and morphologic parameters for distal embolization during carotid interventions. The composition of the atherosclerotic plaque using virtual histology intravascular ultrasound (VH IVUS) imaging at the intervention site has not been evaluated as a marker for cerebral embolization. The purpose of this study was to assess the relationship between atherosclerotic plaque composition determined with VH IVUS and the occurrence of cerebral embolization after carotid angioplasty and stenting (CAS). (Source: Journal of Vascular Surgery)

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Use of intravascular ultrasound as a "Quality Control" technique during carotid stent-angioplasty: are there risks to its use?

The Journal of Cardiovascular Surgery — Fri, 27 Nov 2009 21:26:44 +0100

Authors: Bandyk DF, Armstrong PA Intravascular ultrasound (IVUS) provides high-resolution vessel imaging and has been shown to improve clinical outcomes when used to assess the technical result of peripheral angioplasty procedures. Our vascular group compared anatomic and clinical outcomes of carotid artery stent-angioplasty (CAS) performed with angiogram monitoring alone, or in combination with IVUS imaging to select stent/balloon diameter and interrogate stent deployment region for residual stenosis. A retrospective review of our carotid stent registry (N=306) identified 220 CAS procedures performed with either a digital C-arm fluoroscopy alone (N=110) or in conjunction with IVUS (N=110) with at least 6-month of clinical follow-up. Outcome measures of procedure time, angioplasty ball...

[Carotid dissection during angioplasty for vasospasm induced by subarachnoid haemorrhage. The use of multimodal cerebral monitoring.]

Annales Francaises d'Anesthesie et de Reanimation — Thu, 26 Nov 2009 00:00:00 +0100

We report the case of a 54-year-old woman presenting subarachnoid haemorrhage. She experienced multiple vasospasms and treatment included triple-H (hypervolaemia, hypertension, and haemodilution) and endovascular therapies. Right internal carotid dissection complicated angioplasty of the right middle cerebral artery. Combined brain tissue partial pressure of oxygen monitoring and transcranial echo-Doppler could have facilitated early diagnosis. Despite successful revascularization of right internal carotid by stenting, this complication caused acute stroke with refractory intracranial hypertension. PMID: 19945247 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

A comparative analysis of the outcomes of carotid stenting and carotid endarterectomy in women

Journal of Vascular Surgery — Wed, 25 Nov 2009 00:00:00 +0100

Conclusion: Women with carotid stenosis might have favorable early and late outcomes from CAS with complication rates similar and even lower than those attained with CEA. CAS, performed by trained operators, may be a valid primary choice for treatment of carotid stenosis, particularly in asymptomatic women for whom the risk of surgery seems to be higher. However, before claiming CAS for women, these results need to be confirmed by large RCTs. (Source: Journal of Vascular Surgery)

Discussion

Journal of Vascular Surgery — Wed, 25 Nov 2009 00:00:00 +0100

Dr Marc Mitchell (Jackson, Miss). As I understand your data, it demonstrates good results with both carotid endarterectomy and carotid angioplasty and stenting in both men and women. I think the data makes a strong argument that women benefit from carotid interventions just as men do. On what basis do you conclude that carotid angioplasty and stenting is superior to endarterectomy in women? (Source: Journal of Vascular Surgery)

The anti-inflammatory agent bindarit inhibits neointima formation in both rats and hyperlipidaemic mice

Cardiovascular Research — Mon, 16 Nov 2009 20:06:17 +0100

Conclusion This study demonstrates that bindarit is effective in reducing neointima formation in both non-hyperlipidaemic and hyperlipidaemic animal models of vascular injury by a direct effect on VSMC proliferation and migration and by reducing neointimal macrophage content. All of these data were associated with the inhibition of MCP-1 production. (Source: Cardiovascular Research)

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Thirty-Day Outcome Following Carotid Artery Stenting: A 10-Year Experience from a Single Center

CardioVascular and Interventional Radiology — Thu, 12 Nov 2009 09:51:52 +0100

In conclusion, CAS can be performed safely and effectively, with acceptable mortality, stroke/death, and cardiovascular complication rates. Although technological advances (stent design, cerebral protection devices), perioperative pharmacological management, and increasing experience are all clinically significant factors influencing the short-term results, none appeared to be statistically significant in this patient sample. Content Type Journal ArticleCategory Clinical InvestigationDOI 10.1007/s00270-009-9746-9Authors Christos D. Karkos, Aristotle University of Thessaloniki Fifth Department of Surgery, Medical School, Hippocrateio Hospital Konstantinoupoleos 49 Thessaloniki 546-42 GreeceDimitrios G. Karamanos, Aristotle University of Thessaloniki Fifth Department of Surgery, Medi...

Systematic Review of Randomized Controlled Trials of Patch Angioplasty Versus Primary Closure During Carotid Endarterectomy.

Stroke — Thu, 12 Nov 2009 00:00:00 +0100

Authors: Rerkasem K, Rothwell PM PMID: 19910540 [PubMed - as supplied by publisher] (Source: Stroke)

MMP-2 and MMP-9 Alteration in Response to Collaring in Rabbits: The Effects of Endothelin Receptor Antagonism

Journal of Cardiovascular Pharmacology and Therapeutics — Wed, 11 Nov 2009 02:11:41 +0100

In this study, we investigate the possible role of gelatinases and the effect of a nonselective ETA/ETB receptor antagonist, TAK-044 (5 mg/kg body weight/day, subcutaneously [sc]), on these enzymes. Our results demonstrated that both MMP-2 and MMP-9 activities increased in response to collaring in placebo group, while treatment with TAK-044 significantly suppressed both gelatinase activities and proMMP-2 levels, and inhibited intimal thickening in collared arteries. These results suggest that either enhanced MMP expression or endothelin receptor antagonism may be involved in the formation of intimal thickening in this model. (Source: Journal of Cardiovascular Pharmacology and Therapeutics)

Systematic Review of the Perioperative Risks of Stroke or Death After Carotid Angioplasty and Stenting.

Stroke — Thu, 05 Nov 2009 00:00:00 +0100

CONCLUSIONS: Risks of CAS vary substantially across studies. Risks are overall higher than those of CEA in symptomatic patients. Some factors are likely to help select good candidates for CAS. PMID: 19892997 [PubMed - as supplied by publisher] (Source: Stroke)

Carotid angioplasty and stenting: will it ever replace endarterectomy?

International Journal of Stroke — Wed, 04 Nov 2009 00:00:00 +0100

(Source: International Journal of Stroke)

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Carotid artery stenting: A systematic review of randomized clinical trials.

VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Knur R Carotid occlusive disease is responsible for a significant proportion of major adverse cardiovascular events (death, stroke, myocardial infarction). Effective prevention by means of revascularization is a sufficient treatment, if performed at a center with an acceptably low procedural complication rate. Carotid surgery is the currently accepted standard of treatment for revascularization of extra cranial carotid occlusive disease. This has been validated by randomized clinical trials that have demonstrated its efficacy over best medical therapy. However, less invasive protected carotid artery stenting (CAS) has emerged as a potential therapeutic alternative to carotid endarterectomy (CEA) for the treatment of carotid atherosclerotic disease. Over the past decade several...

Src-dependent STAT-3-mediated Expression of Monocyte Chemoattractant Protein-1 Is Required for 15(S)-Hydroxyeicosatetraenoic Acid-induced Vascular Smooth Muscle Cell Migration [Mechanisms Of Signal Transduction]

Journal of Biological Chemistry — Fri, 30 Oct 2009 13:37:01 +0100

To understand the role of human 15-lipoxygenase 1 (15-LOX1) in vascular wall remodeling, we have studied the effect of the major 15-LOX1 metabolite of arachidonic acid, 15(S)-hydroxyeicosatetraenoic acid (15(S)-HETE), on vascular smooth muscle cell (VSMC) migration both in vitro and in vivo. Among 5(S)-HETE, 12(S)-HETE, and 15(S)-HETE, 15(S)-HETE potentially stimulated more vascular smooth muscle cell (VSMC) migration. In addition, 15(S)-HETE-induced VSMC migration was dependent on Src-mediated activation of signal transducer and activator of transcription-3 (STAT-3). 15(S)-HETE also induced monocyte chemoattractant protein-1 (MCP-1) expression via Src-STAT-3 signaling, and neutralizing anti-MCP-1 antibodies completely negated 15(S)-HETE-induced VSMC migration. Cloning and characterization...

Carotid Endarterectomy versus Carotid Angioplasty Cui Bono.

PubMed: Eur J Vasc Endovasc ... — Wed, 28 Oct 2009 00:00:00 +0100

CONCLUSIONS: At the present time, CEA remains the intervention of choice in the management of carotid bifurcation disease. PMID: 19879167 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

An evaluation of gender and racial disparity in the decision to treat surgically arterial disease

Journal of Vascular Surgery — Mon, 19 Oct 2009 00:00:00 +0100

Conclusion: Our data reveal that gender was not an independent predictor of intervention for PAD or carotid artery disease; however, Caucasian race independently predicted a greater likelihood of intervention in PAD patients with critical limb ischemia and in the carotid artery disease cohort. This study demonstrates the importance of performance assessments in uncovering unsuspected treatment disparities. (Source: Journal of Vascular Surgery)

Arterial gene transfer of the TGF-{beta} signalling protein Smad3 induces adaptive remodelling following angioplasty: a role for CTGF

Cardiovascular Research — Tue, 13 Oct 2009 16:17:16 +0100

Conclusion Medial gene transfer of Smad3 promotes adaptive remodelling by indirectly influencing the behaviour of adventitial fibroblasts. This arterial cell–cell communication is likely to be mediated by Smad3-dependent production of CTGF. (Source: Cardiovascular Research)

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Carotid angioplasty and stenting in anatomically high-risk patients: Safe and durable except for radiation-induced stenosis

Journal of Vascular Surgery — Mon, 28 Sep 2009 17:45:35 +0100

Conclusion: CAS is as technically feasible, safe, and durable in anatomically high-risk patients as in medically high-risk patients, with similar rates of periprocedural stroke and death and late restenosis. However, patients with radiation-induced stenosis appear to be at an increased risk for restenosis. (Source: Journal of Vascular Surgery)

Angioplasty and stenting of symptomatic and asymptomatic vertebral artery stenosis: to treat or not to treat

European Journal of Neurology — Wed, 16 Sep 2009 23:00:00 +0100

Conclusions: Angioplasty and stenting appears to be technically feasible and safe in asymptomatic and symptomatic vertebral stenosis. More studies are needed in order to clarify its role in primary and secondary prevention of vertebrobasilar stroke. High risk anterior circulation lesions should be taken into account as a possible indication in patients with asymptomatic vertebral stenosis. (Source: European Journal of Neurology)

Immediate and 30-Day Clinical Outcome of Patients Treated with the TwinOne Cerebral Protection System: Multicenter Experience in 217 Cases

CardioVascular and Interventional Radiology — Wed, 16 Sep 2009 19:10:22 +0100

In conclusion, this cerebral protection system is simple to use, allows a quick intervention and short occlusion time, and has a low rate of complications. Content Type Journal ArticleCategory Clinical InvestigationDOI 10.1007/s00270-009-9686-4Authors Jacques Theron, CHU Côte de Nacre Department of Neuroradiologie Avenue de la Côte de Nacre Caen 14000 FranceCarlo Venturi, Policlinico “Le Scotte,” Azienda Ospedaliera Senese Department of Neuroradiology Viale M. Bracci 1 53100 Siena ItalyJuergen Reul, Klinik für Neuroradiologie–KKH Siegen Weidenauer Strasse 76 57074 Siegen GermanyZoran Milosevic, University Clinical Center Ljubljana Neurology Department Zaloška c. 7 1000 Ljubljana SloveniaLeopoldo Guimaraens, Hospital General de Catalonia Department of Therapeutic Neuroangiog...

Percutaneous versus surgical revascularization for symptomatic carotid artery disease

Current Cardiology Reports — Wed, 16 Sep 2009 12:31:34 +0100

Abstract Stroke is the third leading cause of death worldwide and the number one disease associated with permanent disability. In 2006, the estimated total cost of stroke in the United States was a staggering $60 billion. Significant stenosis of the internal carotid artery is responsible for 10% to 20% of all strokes, and current recommendations suggest that patients with symptomatic carotid artery stenosis undergo revascularization for stroke prevention or risk reduction. Since the 1950s, carotid endarterectomy (CEA) has been the dominant modality of revascularization. However, carotid artery angioplasty, introduced in the 1980s, and subsequent carotid artery stenting (CAS), have greatly improved in recent years and provide a viable alternative to CEA, particularly for ce...

Octogenarians are not at Increased Risk for Periprocedural Stroke following Carotid Artery Stenting

Annals of Vascular Surgery — Mon, 14 Sep 2009 00:00:00 +0100

Background: We analyzed the risk of adverse events following carotid angioplasty and stenting (CAS) in patients (Source: Annals of Vascular Surgery)

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Redo Surgery or Carotid Stenting for Restenosis after Carotid Endarterectomy: Results of Two Different Treatment Strategies

Annals of Vascular Surgery — Mon, 14 Sep 2009 00:00:00 +0100

Conclusion: CAS is feasible and safe in treating CR. Furthermore, midterm overall survival and need for treatment of re-recurrence is equal to CEA. However, reoperation is an established option and remains the treatment of choice when contraindications for CAS are evident. (Source: Annals of Vascular Surgery)

Carotid Stent Fracture with Recurrent High-Grade Stenosis

Annals of Vascular Surgery — Mon, 14 Sep 2009 00:00:00 +0100

We present a case of a 66-year-old male with carotid stent fracture who developed recurrent, high-grade, asymptomatic carotid artery stenosis that was treated with repeat carotid angioplasty and stenting. (Source: Annals of Vascular Surgery)

Computed tomography angiography, perfusion computed tomography, and a drug-eluting stent for the treatment of in-stent restenosis of the middle cerebral artery.

Journal of Neurosurgery — Thu, 10 Sep 2009 23:00:00 +0100

Authors: Kim SR, You SH, Yoon WK, Kim YW, Kim SD, Park IS, Baik MW The authors report a case of in-stent restenosis (ISR) of the middle cerebral artery (MCA) following bare-metal stent (BMS) deployment and subsequent treatment using a drug-eluting stent (DES). This 65-year-old woman presented with frequent transient ischemic attacks. Initial studies revealed occlusion of the left internal carotid artery and severe stenosis of the right MCA with decreased cerebral perfusion in the bilateral MCA territories. Stent-assisted angioplasty of the right MCA was performed using a BMS, and satisfactory results were obtained with no complications. Six months after the procedure the patient presented with recurrent symptoms, and workups revealed ISR with decreased cerebral perfusion. A DES was suc...

Clinical Trial Summary: Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS)

Cardiosource — Tue, 08 Sep 2009 00:00:00 +0100

CAVATAS was a randomized, prospective, multicenter, exploratory, clinical trial designed to compare endovascular treatment (percutaneous transluminal angioplasty and stenting) with conventional surgery in patients with severe carotid artery stenosis. (Source: Cardiosource)

[Articles] Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial

Lancet Neurology — Mon, 07 Sep 2009 23:00:00 +0100

Endovascular treatment (angioplasty with or without stenting) is an alternative to carotid endarterectomy for carotid artery stenosis but there are scarce long-term efficacy data showing that it prevents stroke. We therefore report the long-term results of the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS). (Source: Lancet Neurology)

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[Articles] Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial

Lancet Neurology — Mon, 07 Sep 2009 23:00:00 +0100

In the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), early recurrent carotid stenosis was more common in patients assigned to endovascular treatment than it was in patients assigned to endarterectomy (CEA), raising concerns about the long-term effectiveness of endovascular treatment. We aimed to investigate the long-term risks of restenosis in patients included in CAVATAS. (Source: Lancet Neurology)

Carotid surgery better long-term than angioplasty and stents

theHeart.org — Fri, 04 Sep 2009 19:30:59 +0100

Results from CAVATAS are in, and they suggest that carotid endarterectomy provides superior long-term outcomes over endovascular treatment. (Source: theHeart.org)

Carotid Surgery Better Long-Term Than Angioplasty and Stents

Medscape Today Headlines — Fri, 04 Sep 2009 15:57:16 +0100

Results from CAVATAS are in, and they suggest that carotid endarterectomy provides long-term outcomes superior to those of endovascular treatment. Medscape Medical News (Source: Medscape Today Headlines)

Patients Who Have Material Causing Narrowing In Neck Artery Removed Rather Than Angioplasty Have Lower Chance Of Narrowing Recurring And Stroke

Health News from Medical News Today — Thu, 03 Sep 2009 09:00:00 +0100

Two Articles published Online First and in the October edition of The Lancet Neurology provide long-term data that show that, for patients with a narrowing of the carotid artery supplying blood to brain (carotid stenosis), removal of the material causing the narrowing(endarterectomy [surgery]) could be a better option than balloon angioplasty with or without stenting (endovascular treatment [ET]). (Source: Health News from Medical News Today)

Lancet: Carotid surgery may best stenting in stroke prevention

Cardiovascular Business News — Tue, 01 Sep 2009 03:51:47 +0100

Two studies published Aug. 28 in Lancet Neurology provide long-term data showing that for patients with carotid stenosis, endarterectomy could be a better option than balloon angioplasty with or without stenting (endovascular treatment). Surgery reduces the risk of both short-term and long-term stroke, and reduces the risk of repeat stenosis—which itself reduces the risk of stroke. (Source: Cardiovascular Business News)

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Stent-assisted percutaneous angioplasty for extra-cranial carotid disease:experience at Singapore General Hospital.

Annals of the Academy of Medicine, Singapore — Mon, 31 Aug 2009 23:00:00 +0100

CONCLUSION: CAS is a technically feasible and a relatively safe alternative to endarterectomy to treat extracranial carotid stenosis, especially in patients who are inoperable or at high surgical risk. PMID: 19816633 [PubMed - in process] (Source: Annals of the Academy of Medicine, Singapore)

Surgery Better Than Angioplasty for Narrowed Neck Artery

MedlinePlus Health News — Mon, 31 Aug 2009 15:18:40 +0100

British study finds a reduced risk of stroke afterwards Source: HealthDay Related MedlinePlus Topics: Angioplasty, Carotid Artery Disease, Stroke (Source: MedlinePlus Health News)

Long-Term Outcome Of Endovascular Treatment Versus Endarterectomy In Patients With Carotid Stenosis (CAVATAS Study)

Health News from Medical News Today — Mon, 31 Aug 2009 07:00:00 +0100

Patients with carotid stenosis, a narrowing of the carotid artery that supplies blood to the brain, could have a better treatment outcome by removing the material causing the narrowing with a surgery called endarterectomy. The other alternative is balloon angioplasty with or without the placing of a stent (small wire mesh tube in the artery) also known as endovascular treatment (ET). (Source: Health News from Medical News Today)

Restenosis More Common After Angioplasty Than Surgery

Modern Medicine — Sun, 30 Aug 2009 23:00:00 +0100

Although patients treated for carotid artery stenosis with endovascular treatment are significantly more likely to have restenosis than those treated with carotid endarterectomy, stroke risk for both groups is low, according to two papers from the Carotid And Vertebral Artery Transluminal Angioplasty Study published online Aug. 29 in The Lancet. (Source: Modern Medicine)

Long-term Risks Lower for Surgical Treatment of Carotid Stenosis (CME/CE)

MedPage Today Cardiovascular — Fri, 28 Aug 2009 22:31:00 +0100

Carotid endarterectomy was more effective than balloon angioplasty at preventing restenosis and showed a trend toward reducing the risk of stroke, according to two studies reporting on a long-running, randomized trial of treatments for carotid stenosis. (Source: MedPage Today Cardiovascular)

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Treatment of limb-shaking TIAs with external carotid artery stenting

Clinical Neurology and Neurosurgery — Thu, 27 Aug 2009 13:41:54 +0100

We present a case in which a patient with preexisting left internal carotid artery (ICA) occlusion developed limb-shaking TIAs secondary to severe stenosis of her left external carotid artery (ECA). After angioplasty and stenting of her left ECA, her symptoms resolved. (Source: Clinical Neurology and Neurosurgery)

Predictors of clinically significant postprocedural hypotension after carotid endarterectomy and carotid angioplasty with stenting

Journal of Vascular Surgery — Wed, 26 Aug 2009 12:56:50 +0100

Conclusions: Postprocedural hypotension occurs more commonly with CAS than CEA and is associated with increased postprocedural myocardial infarction and length of stay, and death. Nitrates and tobacco use predict a higher incidence of postprocedural hypotension. High-risk patients should be aggressively managed to prevent the increased morbidity and mortality due to postprocedural hypotension. (Source: Journal of Vascular Surgery)

Safety and efficacy of carotid angioplasty and stenting for radiation-associated carotid artery stenosis

Journal of Vascular Surgery — Tue, 25 Aug 2009 00:00:00 +0100

Conclusions: This study suggests that the durability of CAS and the characteristics of captured embolic particles are not altered by a history of neck XRT. This supports the safety and efficacy of CAS for the treatment of patients with a history of neck XRT. Prior neck XRT may predispose the patient to the de novo development of stenoses at locations that were not previously treated. (Source: Journal of Vascular Surgery)

Mild glucose intolerance in pregnancy and risk of cardiovascular disease: a population-based cohort study.

cmaj — Sun, 23 Aug 2009 23:00:00 +0100

Authors: Retnakaran R, Shah BR BACKGROUND: Pregnant women commonly receive screening for gestational diabetes mellitus by use of a 50 g glucose challenge test, followed by a diagnostic oral glucose tolerance test for those whose glucose challenge test result is abnormal. Although women with gestational diabetes have an increased risk of cardiovascular disease, it is not known whether mild glucose intolerance during pregnancy is also associated with cardiovascular disease. Thus, we sought to determine whether pregnant women with an abnormal glucose challenge test result but without gestational diabetes have an increased risk of cardiovascular disease. METHODS: We conducted a retrospective population-based cohort study that included all women in Ontario aged 20-49 years with live deliver...

Medical (Nonsurgical) Intervention Alone Is Now Best for Prevention of Stroke Associated With Asymptomatic Severe Carotid Stenosis. Results of a Systematic Review and Analysis.

Stroke — Wed, 19 Aug 2009 23:00:00 +0100

In conclusion, current vascular disease medical intervention alone is now best for stroke prevention associated with asymptomatic severe carotid stenosis given this new evidence, other cardiovascular benefits, and because high-risk patients who benefit from additional carotid surgery or angioplasty/stenting cannot be identified. PMID: 19696421 [PubMed - as supplied by publisher] (Source: Stroke)

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Magnetic Tagging Increases Delivery of Circulating Progenitors in Vascular Injury

Journal of the American College of Cardiology: Cardiovascular Interventions — Sun, 16 Aug 2009 23:00:00 +0100

Conclusions Using an externally applied magnetic device, we have been able to enhance EPC localization at a site of common carotid artery injury. This technology could be more widely adapted to localize cells in other organs and may provide a useful tool for the systemic injection of cell therapies. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Stent-protected angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy: SPACE2 – a three-arm randomised-controlled clinical trial

International Journal of Stroke — Tue, 11 Aug 2009 23:00:00 +0100

Moderate to severe ([ge]70%) asymptomatic stenosis of the extracranial carotid artery leads to an increased rate of stroke of approximately 11% in 5 years. Patients with asymptomatic carotid stenosis, however, are also at a higher risk of nonstroke vascular events. The estimated annual risks of such events in patients with asymptomatic stenosis are 7% for a coronary ischaemic event and 4[ndash]7% for overall mortality. The superiority of carotid endarterectomy compared with medical treatment in symptomatic carotid disease is established, provided that the surgical procedure can be performed with a perioperative morbidity and mortality of (Source: International Journal of Stroke)

Outcomes of angioplasty and stenting at the common carotid origin

Surgical Neurology — Mon, 10 Aug 2009 00:00:00 +0100

Conclusion: In this series, angioplasty and stenting were effective in relieving stenosis at the common carotid origin and have low rates of ischemic complications. (Source: Surgical Neurology)

Commentary

Surgical Neurology — Mon, 10 Aug 2009 00:00:00 +0100

Stenosis or dissection at the origin of the common carotid is not frequent. Angioplasty and stenting are good choices. The results in this series are good or excellent. (Source: Surgical Neurology)

Neurofibromatosis type 1 and multiple traumatic cervical arterial injuries : a case report

Cases Journal — Thu, 06 Aug 2009 23:00:00 +0100

Conclusion: Patients with medical history of neurofibromatosis type I, are at risk to develop blunt cervical vascular injury. This association has to be known by emergency and intensivist physicians to optimize screening of cerebrovascular injuries and treat early such devastating lesions. (Source: Cases Journal)

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Change in Cerebral Perfusion after Carotid Angioplasty with Stenting Is Related to Cerebral Vasoreactivity: A Study Using Dynamic Susceptibility-Weighted Contrast-Enhanced MR Imaging and Functional MR Imaging with a Breath-Holding Paradigm [FUNCTIONAL]

American Journal of Neuroradiology — Thu, 06 Aug 2009 23:00:00 +0100

CONCLUSIONS: fMRI could be a reproducible tool in evaluating CVR. After CAS, early CBF changes on the lesion side are more prominent in patients with impaired CVR. Baseline CVR might predict early CBF increase after CAS. (Source: American Journal of Neuroradiology)

Placement of Covered Stents for the Treatment of Direct Carotid Cavernous Fistulas [INTERVENTIONAL]

American Journal of Neuroradiology — Thu, 06 Aug 2009 23:00:00 +0100

CONCLUSIONS: Although a larger sample and expanded follow-up are needed, our series shows that covered stents can be used in the treatment of DCCFs with symptomatic relief. (Source: American Journal of Neuroradiology)

Acute Cerebrovascular Accident Presenting as Possible Carotid Artery Dissection After Motor Vehicle Crash: Report of a Case

The Journal of Emergency Medicine — Fri, 31 Jul 2009 23:00:00 +0100

We report a case of a patient who had a potentially confusing presentation, with features consistent with an acute cerebrovascular accident, and also consistent with a traumatic arterial dissection. Case: A 43-year-old diabetic, hypertensive man arrived at our Emergency Department after a single-vehicle, frontal-impact motor vehicle crash. Emergency Medical Services first responders found the man seated in his crashed van, stating that he sneezed and then crashed into a tree at approximately 60 kilometers per hour, after veering leftward off the road. The patient denied any difficulty controlling the car before the sneeze and crash, and manifested a dense left-sided paralysis with slurred speech. He also complained of pain at the right side of the posterior aspect of the upper neck and low...

Outcome of carotid endarterectomy under local anaesthesia with respect to the patients' risk profile.

VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases — Fri, 31 Jul 2009 23:00:00 +0100

Conclusions: With the routine use of LA, CEA was not associated with worse outcome in high-risk patients. Considering the data reported in the literature, it does not appear justified to refer high-risk patients principally to carotid angioplasty and stenting (CAS) when LA can be chosen to perform CEA. PMID: 19736633 [PubMed - in process] (Source: VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases)

Proposed duplex velocity criteria for carotid restenosis following carotid endarterectomy with patch closure

Journal of Vascular Surgery — Tue, 28 Jul 2009 11:47:42 +0100

This study includes 200 CEAs randomized into 100 with polytetrafluoroethylene (PTFE) ACUSEAL patch and 100 with Hemashield Finesse patch. All patients underwent immediate postoperative duplex ultrasounds, which were repeated at 1 month and every 6 months thereafter. Patients with a peak systolic velocity (PSV) of the internal carotid artery ([ICA], just distal to the patch) of ≥130 c/s underwent computed tomography angiogram (CTA). PSVs, end diastolic velocities (EDV), and internal carotid artery/common carotid artery (ICA/CCA) ratios were correlated to completion arteriograms/CTAs. Receiver operator characteristic curves analyses were used to determine optimal velocity criteria in detecting ≥30%, ≥50%, and ≥70% restenosis.Results: One hundred ninety-five pairs of imagings (duplex ...

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Carotid angioplasty and stenting

MayoClinic.com Full Feed — Sat, 25 Jul 2009 01:45:00 +0100

— Overview covers definition, risks and results of this stroke treatment. Sponsored by:Chemotherapy.com - http://www.chemotherapy.com (Source: MayoClinic.com Full Feed)

Video: Carotid angioplasty and stenting

MayoClinic.com Full Feed — Fri, 24 Jul 2009 05:00:00 +0100

Carotid angioplasty and stenting — See how this stroke treatment is done. Sponsored by:Chemotherapy.com - http://www.chemotherapy.com (Source: MayoClinic.com Full Feed)

Combined carotid stenting and urgent coronary artery surgery in unstable angina patients with severe carotid stenosis [Institutional report - Coronary]

Interactive CardioVascular and Thoracic Surgery — Wed, 22 Jul 2009 23:00:00 +0100

We report in-hospital and 30-day outcomes of 23 consecutive patients admitted with unstable angina, who underwent carotid angioplasty and stenting (CAS) immediately prior to urgent coronary artery surgery, from October 2007 to October 2008. Aspirin and unfractioned heparin were administrated during carotid stenting and clopidogrel was only started after cardiac surgery. All patients remained event-free during and immediately after the carotid stenting procedure. One patient died due to sepsis 22 days after cardiac surgery. There was neither stroke nor myocardial infarction at follow-up. No patient needed a cardiac or carotid re-intervention. This new approach (combined carotid stenting and coronary artery surgery) provides a less radical intervention, can be performed with a low perip...

Optimal cut-off criteria for duplex ultrasound for the diagnosis of restenosis in stented carotid arteries: review and protocol for a diagnostic study

BMC Neurology — Tue, 21 Jul 2009 23:00:00 +0100

DiscussionTo address the deficiencies of the existing studies, we propose a prospective cohort study nested within the International Carotid Stenting Study (ICSS), an international multi-centre trial in which over 1,700 patients have been randomised between stenting and CEA. In this cohort we will enrol a minimum of 300 patients treated with a stent. All patients undergo regular DUS examination at the yearly follow-up visit according to the ICSS protocol. To avoid verification bias, an additional computed tomography angiography (CTA) will be performed as a reference test in all consecutive patients, regardless the degree of stenosis on the initial DUS test. (Source: BMC Neurology)

Carotid endarterectomy (CEA), carotid artery stenting (CAS) and stroke recovery which of them are better for recovery of brain functions or prevention of cognitive decline?

Journal of the Neurological Sciences — Fri, 17 Jul 2009 11:09:27 +0100

Introduction. For many years CEA has been considered the gold standard concerning surgical approach for symptomatic and asymptomatic ICA stenosis. Despite this, there still remains some risk of CI or death and complications resulting from surgery. In recent years, there has been increasing enthusiasm for carotid angioplasty and CAS as an alternative or complementary method to CEA for these situations. It has some advantages, and showed promising results but with a higher complication rate compared to CEA. At present, there are no data concerning the relationship between these procedures and recovery of brain functions. (Source: Journal of the Neurological Sciences)

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Carotid angioplasty and stenting: Treatment of postcarotid endarterectomy restenosis is at least as safe as primary stenosis treatment

Journal of Vascular Surgery — Sun, 05 Jul 2009 23:00:00 +0100

Conclusions: CAS for restenosis after CEA has a complication rate lower than primary CAS. The time interval between CEA and CAS did not influence micro embolic load. (Source: Journal of Vascular Surgery)

Patches for carotid artery endarterectomy: Current materials and prospects

Journal of Vascular Surgery — Mon, 29 Jun 2009 16:07:47 +0100

Patch angioplasty is commonly performed after carotid endarterectomy. Randomized prospective trials and meta-analyses have documented improved rates of perioperative and long-term stroke prevention as well as reduced rates of restenosis for patches compared with primary closure of the arteriotomy. Although use of vein patches is considered to be the gold standard for patch closure, newer generations of synthetic and biologic materials rival outcomes associated with vein patches. Future bioengineered patches are likely to optimize patch performance, both by achieving minimal stroke risk and long-term rates of restenosis as well as by minimizing the risk of unusual complications of prosthetic patches such as infection and pseudoaneurysm formation. In addition, lessons from bioengineered patc...

Role of endothelial progenitor cell mobilization after percutaneous angioplasty procedure.

Current Pharmaceutical Design — Sat, 27 Jun 2009 15:42:04 +0100

Authors: Barsotti MC, Di Stefano R, Spontoni P, Chimenti D, Balbarini A Circulating endothelial progenitor cells (EPCs) are bone marrow-derived cells, contributing to endothelial cell regeneration of injured vessels as well as neovascularization of ischemic lesions. EPC levels and function are inversely correlated with cardiovascular risk factors, can predict the occurrence of adverse events and atherosclerotic disease progression. Ischemia and inflammation are the primary triggers for EPC mobilization and homing, however, vascular trauma, as it occurs during surgical procedures, has been demonstrated to stimulate EPC mobilization even in absence of tissue ischemia. The effect of angioplasty on EPCs is not well defined, mainly because of the different and sometimes contrasting clinical...

Utility of Intravascular Ultrasound Examination during Carotid Stenting

Annals of Vascular Surgery — Tue, 23 Jun 2009 23:00:00 +0100

Conclusion: IVUS examination provides complementary information to that obtained using conventional diagnostic procedures. It may be useful for characterizing the composition and measurement of the target lesion, choosing the type and size of the stent, and evaluating the results after the procedure. (Source: Annals of Vascular Surgery)

Texas Governor Signs Landmark Early Heart Disease Detection Screening Legislation

News from Angioplasty.Org — Tue, 23 Jun 2009 06:58:00 +0100

Today Governor Rick Perry of Texas signed the nation's first preventive cardiovascular screening bill for early detection of coronary artery disease. The legislation, which will take effect on September 1, requires Texas insurers to pay up to $200 for a either a non-contrast computed tomography (CT) scan measuring coronary artery calcification, commonly known as a Calcium scoring exam, or ultrasonography for measuring carotid intima-media thickness and plaque. (Source: News from Angioplasty.Org)

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Pathogenetic role of hypercholesterolemia in a novel preclinical model of vascular injury in pigs

Atherosclerosis — Mon, 22 Jun 2009 00:00:00 +0100

Conclusion: We developed for the first time a porcine vascular injury model with mild hypercholesterolemia able to significantly increase the degree of stenosis and showed the pathogenetic role of hypercholesterolemia on intimal hyperplasia. New therapeutical strategies to prevent restenosis can be tested in this preclinical hypercholesterolemic model resembling human disease. (Source: Atherosclerosis)

Refractory In-stent Restenosis Following Carotid Artery Stenting: A Case Report and Review of Operative Management

Vascular and Endovascular Surgery — Sun, 21 Jun 2009 23:00:00 +0100

In-stent restenosis following carotid artery stenting is a challenging problem that vascular surgeons will likely encounter with increasing frequency. The following describes a patient who developed progressive in-stent restenosis 3 years after carotid artery stenting, which was treated with operative therapy after failed balloon angioplasty. A review of the literature describing surgical approaches to the treatment of in-stent restenosis was also performed. (Source: Vascular and Endovascular Surgery)

Endovascular Treatment of Carotid Stenosis Associated with Incidental Intracranial Aneurysm

Annals of Vascular Surgery — Thu, 18 Jun 2009 23:00:00 +0100

We present a case of a 73-year-old woman with a history of arterial hypertension and diabetes who had a severe symptomatic ICA stenosis (>90%) and an incidental ipsilateral cerebral aneurysm. The carotid stenosis was treated with angioplasty and stenting using a distal cerebral protection system. The patient was anticoagulated and maintained on antiplatelet therapy according to a standard protocol. Microcoil embolization of the aneurysm was performed 5 months after an intracranial stent was implanted. No growth has been observed in the aneurysm of the arterial lumen since the carotid intervention. There were no complications after the procedures during the postoperative period. This case shows that the incidental presence of an ipsilateral intracranial aneurysm does not appear to be a cont...

Carotid highly-calcified de novo stenosis and cutting-balloon angioplasty: a tool to prevent haemodynamic depression?

The Journal of Cardiovascular Surgery — Sun, 31 May 2009 23:00:00 +0100

CONCLUSIONS: HD is a common occurrence after CAS, especially in patients with both long and calcified plaque. Only a tailored procedure with a correct remodelling of the plaque allows to avoid both HD and elastic recoil of the target lesion. PMID: 19543195 [PubMed - in process] (Source: The Journal of Cardiovascular Surgery)

Outcome of carotid artery stenting at 2 years follow-up: comparison of nitinol open cell versus stainless steel closed cell stent design.

The Journal of Cardiovascular Surgery — Mon, 18 May 2009 23:00:00 +0100

CONCLUSIONS: At 2-year follow-up after carotid artery stenting, there is no difference in clinical outcome or in stent patency among patients treated with open versus closed cell design stents. Subsequently the type of carotid stent design does not seem to impact the overall midterm outcome after carotid artery stenting. PMID: 19455089 [PubMed - as supplied by publisher] (Source: The Journal of Cardiovascular Surgery)

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One stage carotid artery stenting and open heart surgery:a novel approach.

The Journal of Cardiovascular Surgery — Mon, 18 May 2009 23:00:00 +0100

CONCLUSIONS: The low complication rate suggests that CAS and cardiac surgery in one stage offers a safer therapeutic option compared to combined carotid endarterectomy and cardiac surgery. It may also be safer than with the staged CAS and coronary artery bypass grafting approach as well. PMID: 19455088 [PubMed - as supplied by publisher] (Source: The Journal of Cardiovascular Surgery)

Choice of access for percutaneous carotid angioplasty and stenting: a comparative study on cervical and femoral access.

The Journal of Cardiovascular Surgery — Mon, 18 May 2009 23:00:00 +0100

Authors: Mathieu X, Piret V, Bergeron P, Petrosyan A, Abdulamit T, Trastour JC Carotid angioplasty and stenting (CAS) is a well established technique. CAS indications currently still limited are yet evolving. The choice of the access is defined by the risk factors of the patient among whom ''the vascular anatomy'' is essential. The authors will focus here on the accesses, their advantages and their drawbacks. They made a retrospective study relating 314 patients treated by CAS. No significant difference in term of morbidity or mortality between the cervical or femoral access was found but a clear tendency in favor of the cervical access which avoids the arch manipulations. It can be concluded that various access offer better options for CAS and must be discussed depending on the patien...

Acute fracture of ACCULINK carotid stent during post dilation

Catheterization and Cardiovascular Interventions — Thu, 07 May 2009 23:00:00 +0100

We describe a case of carotid stent procedure during carotid angioplasty in a 70-year-old man. Management of this complication with an overview of current literature is discussed. © 2009 Wiley-Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

Long-Term Outcome of Endovascular Treatment versus Medical Care for Carotid Artery Stenosis in Patients Not Suitable for Surgery and Randomised in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS)

Cerebrovascular Diseases — Thu, 07 May 2009 16:41:48 +0100

Cerebrovasc Dis 2009;28:1-7 (DOI:10.1159/000215936) (Source: Cerebrovascular Diseases)

Transarterial coil embolization of a carotid-cavernous fistula which occurred during stent angioplasty

Acta Neurochirurgica — Tue, 05 May 2009 05:49:53 +0100

We present a case of carotid-cavernous fistula development secondary to injury of the cavernous segment of the internal carotid artery (ICA) during stent angioplasty and its treatment by transarterial coil embolization. Probable causes of this complication and its treatment method are discussed. To the best of our knowledge, this is the first report of such a case. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00701-009-0351-0Authors Won Ki Yoon, Holy Family Hospital, The Catholic University of Korea Department of Neurosurgery Seoul KoreaYoung Woo Kim, Holy Family Hospital, The Catholic University of Korea Department of Neurosurgery Seoul KoreaSeong Rhim Kim, Holy Family Hospital, The Catholic University of Korea Department of Neurosurgery Seoul KoreaIk Seong Park, H...

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New data about stenting versus endarterectomy for symptomatic carotid artery stenosis

Current Treatment Options in Cardiovascular Medicine — Sat, 02 May 2009 05:50:06 +0100

Opinion statement Patients with symptomatic carotid artery stenosis should be counseled on diet, exercise, moderation of alcohol consumption, smoking cessation, and avoidance of environmental tobacco smoke. Medical therapy generally includes a platelet antiaggregant, blood pressure control, and a statin. Other medical therapy depends on specific patient characteristics. Carotid endarterectomy in addition to best medical therapy is of proven benefit in reducing the risk of ipsilateral stroke compared with best medical therapy alone in patients with symptomatic high-grade stenosis, provided the operation can be performed safely. Although limited, data are available to support carotid angioplasty/stenting in patients with symptomatic high-grade stenosis in whom endarterectomy ...

Delayed stenosis as a consequence of angioplasty for subarachnoid hemorrhage-induced vasospasm. Case report.

Neurosurgical Focus — Thu, 30 Apr 2009 23:00:00 +0100

This report presents an illustrative case study and reviews the pathophysiology of angioplasty and restenosis. PMID: 19409002 [PubMed - in process] (Source: Neurosurgical Focus)

Primary stenting for recurrent stenosis following carotid endarterectomy.

The Canadian Journal of Neurological Sciences — Thu, 30 Apr 2009 23:00:00 +0100

CONCLUSIONS: In this series, primary stent placement without use of angioplasty balloons was a safe and effective treatment for symptomatic restenosis following carotid endarterectomy. PMID: 19534334 [PubMed - in process] (Source: The Canadian Journal of Neurological Sciences)

Endovascular management of takayasu arteritis: is it a durable option?

Vascular — Thu, 30 Apr 2009 23:00:00 +0100

Authors: Lee BB, Laredo J, Neville R, Leonel Villavicencio J Interim outcome of endovascular management of Takayasu arteritis (TA) was determined retrospectively to assess the efficacy of angioplasty and/or stenting in 24 patients with 35 lesions in the chronic inactive stage. The renal (n = 16), subclavian/innominate (n = 11), and carotid (n = 5) arteries and abdominal aorta (n = 3) were treated. Twenty-six lesions achieved excellent to good target lesion revascularization with no residual or only minimal residual stenosis, whereas five had a moderate result. Thirty lesions achieved satisfactory hemodynamic correction. Restenosis was observed in 8 lesions treated with angioplasty alone (n = 18) and in 3 lesions treated with angioplasty and stenting (n = 17). All recurrent stenoses und...

Distal filtration versus flow reversal: An ex vivo assessment of the choices for carotid embolic protection

Journal of Vascular Surgery — Wed, 29 Apr 2009 05:07:33 +0100

Conclusion: In our model, both protection strategies were less than ideal. For POFR, high back pressures or multiple aspirations improve the efficiency of cerebral protection but additional fragments were released by pressurized flow even after aspiration of 150 mL of saline. DF devices create a pressure gradient and fragments apparently went around the device with pressurized flow in our PTFE lumen. Over-sizing of DF devices partially corrected this problem and increased over all DF efficiency to be comparable to POFR for smaller fragments but not for larger fragments. (Source: Journal of Vascular Surgery)

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IL-17 Stimulates Migration of Carotid Artery Vascular Smooth Muscle Cells in an MMP-9 Dependent Manner via p38 MAPK and ERK1/2-Dependent NF-kappaB and AP-1 Activation.

Cellular and Molecular Neurobiology — Tue, 28 Apr 2009 23:00:00 +0100

Authors: Cheng G, Wei L, Xiurong W, Xiangzhen L, Shiguang Z, Songbin F Inappropriate vascular remodeling is thought to be the main cause of restenosis following angioplasty. Migration of vascular smooth muscle cells (VSMC) into lumina, which is promoted by degradation of the extracellular matrix by matrix metalloproteinases (MMPs) plays a causal role in pathological vascular remodeling. The aim of the present research is to explore the effects of a novel cytokine, IL-17, on migration of VSMC and MMP-9 secretion. Carotid artery VSMC was isolated from Sprague-Dawley rats. Expression of MMP-9 and cell migration induced by IL-17 and its related signal pathway were detected. The results showed that IL-17-induced migration of VSMC in an MMP-9-dependent manner. IL-17-induced MMP-9 expression ...

Two-year follow-up results of the SPACE study

Journal of Vascular Surgery — Sun, 26 Apr 2009 23:00:00 +0100

The 2-year results of the Stent-protected Percutaneous Angioplasty vs Endarterectomy of Symptomatic Carotid Artery Stenosis (SPACE) study were recently presented at the 2009 International Stroke Conference of the American Heart Association (San Diego, Calif, Feb 18-20, 2009). (Source: Journal of Vascular Surgery)

Carotid Artery Angioplasty and Stenting: Introduction of a New Technique Into an Established Vascular Surgery Center

Vascular and Endovascular Surgery — Tue, 21 Apr 2009 04:00:00 +0100

Conclusion: Restenosis and stroke were observed more frequently in our initial experience in patients undergoing carotid artery angioplasty and stenting compared with carotid endarterectomy patients during the same time period. These differences disappeared in high-risk patients. Further studies, to evaluate the effect of the learning curve on early results as well as follow-up for intermediate and long-term durability of carotid artery angioplasty and stenting in high-risk patients, are required. (Source: Vascular and Endovascular Surgery)

Systemic Hypertension and Transient Ischemic Attack in a 6-Year-Old Girl with Fibromuscular Dysplasia Treated with Percutaneous Angioplasty

CardioVascular and Interventional Radiology — Wed, 15 Apr 2009 08:00:24 +0100

We describe a 6-year-old girl with arterial hypertension secondary to fibromuscular dysplasia with stenoses of both renal arteries and transient ischemic attack due to extracranial right internal carotid artery subtotal occlusion as well as left internal carotid artery stenosis. She was treated with percutaneous angioplasty of both renal and both carotid arteries. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00270-009-9562-2Authors Gustavo Foa-Torres, National University of Cordoba Oulton Institute Cordoba ArgentinaJavier Ganame, University Hospitals Leuven Cardiology Department Herestraat 49 Leuven 3000 BelgiumErnesto Juaneda, Hospital Privado Cordoba ArgentinaAlejandro Peirone, Hospital Privado Cordoba ArgentinaMaria Silvina Barcudi, Hospital Italiano Buenos Aires ...

Incidence and prognosis of >=50% symptomatic vertebral or basilar artery stenosis: prospective population-based study

Brain — Tue, 14 Apr 2009 04:00:00 +0100

The higher risk of early recurrent stroke after posterior circulation transient ischaemic attack or minor stroke versus after carotid territory events could be due to a greater prevalence of large artery stenosis, but there have been few imaging studies, and the prognostic significance of such stenoses is uncertain. Reliable data are necessary to determine the feasibility of trials of angioplasty and stenting and to inform imaging strategies. In the first-ever population-based study, we determined the prevalence of ≥50% apparently symptomatic vertebral and basilar stenosis using contrast-enhanced MRA in consecutive patients, irrespective of age, presenting with posterior circulation transient ischaemic attack or minor ischaemic stroke in the Oxford Vascular Study and related this to the...

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Penumbra Stroke System as an “add-on” for the treatment of large vessel occlusive disease following thrombolysis: first results

European Radiology — Tue, 07 Apr 2009 05:47:55 +0100

We describe our experience of using this new system in acute large vessel occlusive disease following thrombolysis. Fifteen consecutive patients (mean age 60 years) suffering from acute ischemic stroke were treated with the PSS after intravenous or intra-arterial standard treatment with tissue plasminogen activator (n = 14) or ReoPro (n = 1). All patients presented with TIMI 3 before use of the PSS. Carotid stenting (n = 3) and intracranial balloon angioplasty or stenting (n = 2) were performed if indicated. Neurological evaluation was performed using the NIHSS score and the mRS score. Initial median NIHSS score in 12 patients with occlusions in the anterior circulation was 15; three patients with basilar artery occlusion presented with coma. Median symptom to pro...

The role of cerebral hyperperfusion in postoperative neurologic dysfunction after left ventricular assist device implantation for end-stage heart failure.

The Journal of Thoracic and Cardiovascular Surgery — Wed, 01 Apr 2009 04:00:00 +0100

CONCLUSIONS: Our findings showed that normal flow might overwhelm cerebral autoregulation in patients with severe heart failure, suggesting that cerebral hyperperfusion is possible in recipients of mechanical circulatory support with neurologic dysfunction. PMID: 19327532 [PubMed - in process] (Source: The Journal of Thoracic and Cardiovascular Surgery)

Con: Has carotid angioplasty and stenting replaced carotid endarterectomy in all patients? Not yet.

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 01 Apr 2009 04:00:00 +0100

Authors: Eslami MH PMID: 19324284 [PubMed - in process] (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Pro: Has carotid angioplasty and stenting replaced carotid endarterectomy as the treatment of choice for carotid artery disease?

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 01 Apr 2009 04:00:00 +0100

Authors: Kwolek CJ PMID: 19324283 [PubMed - in process] (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Treatment of carotid artery stenosis: medical therapy, surgery, or stenting?

Mayo Clinic Proceedings — Wed, 01 Apr 2009 04:00:00 +0100

Authors: Lanzino G, Rabinstein AA, Brown RD With the aging of the general population and the availability of noninvasive imaging studies, carotid artery stenosis is a disease commonly seen in general medical practice. Differentiation between symptomatic and asymptomatic disease is critical to the treatment course because the natural history differs markedly between them. Antiplatelet therapy and aggressive treatment of vascular risk factors are the mainstays of medical therapy. Class I evidence shows that carotid endarterectomy (CEA) is effective in preventing ipsilateral ischemic events in patients with symptomatic moderate- and high-grade stenosis. The procedure is also effective in selected patients with asymptomatic stenosis, but the benefit is marginal. In the past decade, carotid...

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Carotid Stents Questioned for Radiation-Induced Stenosis

Cardiology News — Wed, 01 Apr 2009 04:00:00 +0100

TUCSON, ARIZ. — Carotid angioplasty and stenting appear to be linked to a disproportionate rate of in-stent restenosis in patients with radiation-induced stenosis. Radiation-induced stenosis was the only high-risk characteristic associated with less-than-optimal outcomes in a retrospective study that deemed the procedure a safe, durable alternative for patients at high risk for endarterectomy, Dr. Susanna H. Shin said at the annual meeting of the Southern Association for Vascular Surgery. (Source: Cardiology News)

Pro: Has Carotid Angioplasty and Stenting Replaced Carotid Endarterectomy as the Treatment of Choice for Carotid Artery Disease?

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 01 Apr 2009 04:00:00 +0100

CAROTID ENDARTERECTOMY (CEA) has been considered the gold standard for the treatment of extracranial carotid artery disease since the publication of the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the Asymptomatic Carotid Atherosclerosis Study (ACAS). These trials demonstrated decreased morbidity and mortality in both symptomatic and asymptomatic patients undergoing the procedure versus medical therapy, and often are used as the comparison between CEA and carotid angioplasty and stenting (CAS). (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Con: Has Carotid Angioplasty and Stenting Replaced Carotid Endarterectomy in All Patients? Not Yet

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 01 Apr 2009 04:00:00 +0100

OVER THE PAST 3 DECADES, the field of surgery has been transformed because of significant advances in technology and innovation. Advances in laparoscopy and robotic surgery have led to fewer and less-invasive operations, and the current surgical landscape may not be recognizable to a practitioner who stopped operating even as late as the 1980s. Vascular surgery has also been transformed because of the innovations in the catheter-based technology and therapies. Since the adaptation of endovascular abdominal aortic surgery, first introduced by Parodi in 1995, aortic operations are performed more and more commonly using the endovascular techniques. The adaptation of this has led to a significant decrease in the number of open aneurysm cases performed by the graduating vascular surgery fellows...

Current Concepts in the Management of Carotid Stenosis

Medscape Neurology & Neurosurgery Headlines — Wed, 25 Mar 2009 20:06:20 +0100

Endarterectomy or angioplasty? What's the latest evidence on managing carotid stenosis? Faculty of 1000 Medicine (Source: Medscape Neurology & Neurosurgery Headlines)

The proven non-inferiority of carotid angioplasty and stent placement (CAS) versus carotid endarterectomy (CEA)

PharmacoEconomics and Outcomes News — Thu, 12 Mar 2009 18:04:10 +0100

(Source: PharmacoEconomics and Outcomes News)

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[INTERVENTIONAL] Volume and Composition of Emboli in Neuroprotected Stenting of the Carotid Artery

American Journal of Neuroradiology — Wed, 11 Mar 2009 04:00:00 +0100

CONCLUSIONS: Vessel wall and atheromatous plaques are the main source of microemboli during CAS. Embolization is mainly related to the number of balloon dilations during CAS. Planning a proper and individualized strategy for the procedure in each patient is essential to minimize the potential effects of manipulation during CAS. (Source: American Journal of Neuroradiology)

The proven non-inferiority of carotid angioplasty and stent placement (CAS) versus carotid endarterectomy (CEA).

PharmacoEconomics & Outcomes News — Sat, 07 Mar 2009 03:20:21 +0100

Page: 9 (Source: PharmacoEconomics & Outcomes News)

Intracranial angioplasty and stent placement for direct cerebral revascularization of nonacute intracranial occlusions and near occlusions.

Neurosurgical Focus — Thu, 05 Mar 2009 09:26:05 +0100

Conclusions Combined intracranial angioplasty and stent placement is a potential treatment option in selected patients for the direct revascularization of nonacute intracranial occlusions and near occlusions. Whether this represents a substantial risk reduction compared with the best medical therapy or a long-lasting treatment option is unknown. PMID: 19249959 [PubMed - in process] (Source: Neurosurgical Focus)

Hemodynamic instability during carotid artery stenting: the relative contribution of stent deployment versus balloon dilation.

Journal of Neurosurgery — Fri, 20 Feb 2009 05:00:00 +0100

Conclusions Hemodynamic instability during and after carotid artery stenting was observed more frequently when balloon angioplasty was required than when stent placement was performed without concurrent balloon angioplasty. PMID: 19231933 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery)

Radiographic Evidence of Cerebral Hyperperfusion and Reversal Following Angioplasty and Stenting of Intracranial Carotid and Middle Cerebral Artery Stenosis: Case report and review of the literature

Journal of Neuroimaging — Tue, 17 Feb 2009 05:00:00 +0100

Hyperperfusion is a rare but serious complication following cerebrovascular angioplasty and stent placement. Radiographically identifying hyperperfusion before the development of severe sequelae is difficult, as few diagnostic criteria have been established. A 50-year-old woman, initially presenting with 6 weeks of right-sided hemiparesis and dysarthria, was treated for severe stenosis of the left internal carotid and middle cerebral arteries with intracranial angioplasty and placement of a balloon mounted Wingspan Stent (Boston Scientific, Fremont, CA). Continuous transcranial Doppler monitoring after stent placement indicated developing cerebral hyperperfusion. Concurrent angiography revealed markings consistent with dilatations of small arteries in the vascular territory of the stented ...

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[Renal artery stenosis : atheromatous disease and fibromuscular dysplasia.]

Presse Medicale — Thu, 12 Feb 2009 05:00:00 +0100

Authors: Halimi JM Renal artery stenosis may be due to atheromatous disease or renal fibromuscular dysplasia (FMD). Management of both diseases requires treatment of hypertension usually observed in such patients; however, clinical presentation, mechanism and treatment of these 2 diseases are usually different. Renal FMD is now considered as a systemic disease, the cause of which may be genetic (although the exact cause is still elusive). Renal arteries are the most frequent localizations of FMD, but extra renal arteries may also be involved (usually carotid arteries). Risk factors of hypertension-induced renal FMD include estrogen treatment and smoking. Renal FMD are mostly found in young women and in children who present with recent severe and/or refractory symptomatic hypertension. ...

Lesion load in unprotected carotid artery stenting

Neuroradiology — Sat, 07 Feb 2009 10:08:29 +0100

Conclusion In our series of unprotected carotid angioplasty with stent, we found new DWI lesions in 34% of the patients. Further studies should now show in how far protection devices can reduce these lesions. Content Type Journal ArticleCategory Interventional NeuroradiologyDOI 10.1007/s00234-008-0491-6Authors I. Q. Grunwald, University of the Saarland Department for Diagnostic and Interventional Neuroradiology 66424 Homburg GermanyP. Papanagiotou, University of the Saarland Department for Diagnostic and Interventional Neuroradiology 66424 Homburg GermanyC. Roth, University of the Saarland Department for Diagnostic and Interventional Neuroradiology 66424 Homburg GermanyK. Fassbender, University of the Saarland Division of Neurology Homburg GermanyK. Karp, University of...

Does the risk of post-CABG stroke merit staged or synchronous reconstruction in patients with symptomatic or asymptomatic carotid disease?

The Journal of Cardiovascular Surgery — Sun, 01 Feb 2009 05:00:00 +0100

Authors: Naylor AR The management of patients undergoing coronary artery bypass grafting (CABG) who are found to have co-existent carotid artery disease remains controversial. Management options include performing an isolated CABG, synchronous carotid endarterectomy (CEA) plus CABG, staged CEA-CABG, reverse staged CABG-CEA, synchronous CEA+CABG off bypass (OFFCAB) and staged carotid angioplasty with stenting (CAS) followed by CABG. For any of these combined or staged interventions to be clinically effective, the following conditions must be met; (1) CABG must be a proven intervention for ischaemic heart disease, (2) stroke must be an important cause of peri-operative morbidity and mortality, (3) the incidence of post-CABG stroke must be high enough to justify a programme of prevention,...

Revascularization strategy in patients with severe concurrent severe carotid and coronary artery disease: ''Failure to move forward is reason to regress''.

The Journal of Cardiovascular Surgery — Sun, 01 Feb 2009 05:00:00 +0100

Authors: Van Der Heyden J, Suttorp MJ, Schepens MA In the absence of randomized trials, the optimal management of patients with concomitant carotid and coronary artery disease remains disputable. The initial studies of combined or staged carotid endarterectomy in these patients were conceived in an attempt to reduce perioperative mortality. Although encouraging results have been reported with combined carotid endarterectomy and cardiac surgery, this combination requires long operative times and remains a surgical challenge. Recent studies have shown that carotid angioplasty and stenting prior to cardiac surgery is a feasible and effective minimal invasive technique. However, the effect of carotid stenting on the incidence of death and stroke after cardiac surgery is indistinct. Carotid...

Carotid artery stenosis: what is left to surgery.

The Journal of Cardiovascular Surgery — Sun, 01 Feb 2009 05:00:00 +0100

Authors: Chaer RA, Makaroun MS While carotid angioplasty and stenting has been clearly established as a minimally invasive alternative to endarterectomy for patients with carotid occlusive disease, its indications continue to evolve, being refined as more controlled data of large studies are being accumulated. The purpose of this article is to review the current evidence supporting the application of either technique in certain subsets of patients, and the relative contraindications for their use. PMID: 19179989 [PubMed - in process] (Source: The Journal of Cardiovascular Surgery)

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Report Compares California Hospital Mortality Rates

kaisernetwork.org: Health Policy Daily Report — Fri, 23 Jan 2009 05:00:00 +0100

Twenty five California hospitals in 2007 had death rates that were significantly lower than the state average on at least one of eight conditions or procedures, down from 33 hospitals that performed better than the state average in 2006, according to a report released on Thursday by the Office of Statewide Health Planning and Development, the San Francisco Chronicle reports. For the report, researchers examined all 384 acute-care hospitals in California (Colliver, San Francisco Chronicle, 1/22). Joe Parker, director of OSHPD's health care outcomes center, said the state "risk-adjusted" the data to account for differences in hospitals' caseloads (Peyton Dahlberg, Sacramento Bee, 1/22). Hospitals received copies of the report in 2008 and were given one month to respond to it (Hines, Riversid...

High-Resolution CT and Angiographic Evaluation of NexStent Wall Adaptation

CardioVascular and Interventional Radiology — Thu, 22 Jan 2009 09:27:20 +0100

We examined the wall adaptability of a new closed-cell carotid stent (NexStent), which has a unique rolled sheet design. Forty-one patients had 42 carotid arteries treated with angioplasty and stenting for internal carotid artery stenosis. The mean patient age was 65 ± 10 years. All patients underwent high-resolution computed tomographic angiography after the stent implantation. Data analysis included pre- and postprocedural stenosis, procedure complications, plaque calcification, and stent apposition. We reviewed the angiographic and computed tomographic images for plaque coverage and stent expansion. All procedures were technically successful. Mean stenosis was reduced from 84 ± 8% before the procedure to 15.7 ± 7% after stenting. Two patients ...

Leukotriene Receptor Antagonism and the Prevention of Extracellular Matrix Degradation During Atherosclerosis and In-Stent Stenosis.

Arteriosclerosis, Thrombosis and Vascular Biology — Thu, 22 Jan 2009 05:00:00 +0100

CONCLUSIONS: These results suggest a key role of LT signaling in the extracellular matrix degradation associated with hyperlipidemia and in-stent stenosis. In conclusion, targeting LT receptors may represent a therapeutic strategy in atherosclerosis and interventional cardiology. PMID: 19164806 [PubMed - as supplied by publisher] (Source: Arteriosclerosis, Thrombosis and Vascular Biology)

Stent Implantation of Multichanneled Pseudoocclusion of the Internal Carotid Artery.

Journal of Vascular and Interventional Radiology : JVIR — Wed, 21 Jan 2009 05:00:00 +0100

This report describes successful carotid stent implantation in five patients with MCPO of the internal carotid artery. Probing of the micro-guide wire through the channel with support of the microcatheter made subsequent angioplasty and stent placement possible without procedure-related complications. There was neither additional stroke nor restenosis during a follow-up period of 6-54 months. PMID: 19167242 [PubMed - as supplied by publisher] (Source: Journal of Vascular and Interventional Radiology : JVIR)

Protection or Nonprotection in Carotid Stent Angioplasty. The Influence of Interventional Techniques on Outcome Data From the SPACE Trial.

Stroke — Thu, 15 Jan 2009 05:00:00 +0100

CONCLUSIONS: This secondary analysis of data from the SPACE trial does not support the need for a PD in CAS. Stent design seems to have an impact on the OE rate. Our analysis demonstrates that the choice of the interventional material may have an impact on the periprocedural complication rate in CAS and that the development of more specific stent systems for the treatment of carotid stenosis may reduce the complication rate significantly. PMID: 19150863 [PubMed - as supplied by publisher] (Source: Stroke)

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A Necessary Role of miR-221 and miR-222 in Vascular Smooth Muscle Cell Proliferation and Neointimal Hyperplasia.

Circulation Research — Thu, 15 Jan 2009 05:00:00 +0100

Authors: Liu X, Cheng Y, Zhang S, Lin Y, Yang J, Zhang C MicroRNAs (miRNAs) comprise a novel class of endogenous, small, noncoding RNAs that negatively regulate gene expression. Functionally, an individual miRNA is as important as a transcription factor because it is able to regulate the expression of its multiple target genes. Recently, miR-221 and miR-222 have been found to play a critical role in cancer cell proliferation. However, their roles in vascular smooth muscle cell (VSMC) biology are currently unknown. In the present study, the time course changes and cellular distribution of miR-221 and miR-222 expression were identified in rat carotid arteries after angioplasty, in which their expression was upregulated and localized in VSMCs in the injured vascular walls. In cultured VSM...

[ESCVS article - Carotid and imaging] Carotid endarterectomy in high-risk Arab patients

Interactive CardioVascular and Thoracic Surgery — Fri, 02 Jan 2009 05:00:00 +0100

Conclusion: This short report showed that CE can be performed safely in high-risk Arab patients. (Source: Interactive CardioVascular and Thoracic Surgery)

Middle cerebral artery flow after angioplasty and stenting of symptomatic internal carotid artery stenosis.

Neurologia i Neurochirurgia Polska — Thu, 01 Jan 2009 00:00:00 +0100

CONCLUSIONS: Carotid angioplasty and stenting improves blood flow in both the ipsilateral and contralateral middle cerebral artery in patients with symptomatic carotid artery stenosis. Carotid angioplasty and stenting seems to be more effective in patients with symptomatic carotid artery stenosis combined with contralateral carotid artery occlusion than in individuals with symptomatic carotid artery stenosis alone. PMID: 19353439 [PubMed - indexed for MEDLINE] (Source: Neurologia i Neurochirurgia Polska)

Hyperperfusion syndrome after carotid stent angioplasty

Neuroradiology — Tue, 23 Dec 2008 07:25:59 +0100

Conclusion Extensive microvascular disease may be a predictor of hyperperfusion syndrome after carotid stent placement. We believe that further studies are warranted to predict more accurately which patients are at greater risk of developing this often fatal complication. Content Type Journal ArticleCategory Interventional NeuroradiologyDOI 10.1007/s00234-008-0483-6Authors I. Q. Grunwald, University of the Saarland Department for Interventional and Diagnostic Neuroradiology 66424 Homburg GermanyM. Politi, University of the Saarland Department for Interventional and Diagnostic Neuroradiology 66424 Homburg GermanyW. Reith, University of the Saarland Department for Interventional and Diagnostic Neuroradiology 66424 Homburg GermanyC. Krick, University of the Saarland Depa...

Combined surgical and endovascular approach to treat symptomatic in-stent occlusion of the left common carotid artery origin.

Journal of Neurosurgery — Fri, 12 Dec 2008 05:00:00 +0100

Authors: Shah QA, Memon MZ, Tummala RP, Qureshi AI Symptomatic occlusive lesions at the origins of the supra-aortic vessels pose challenges for treatment. Endovascular angioplasty and stent placement via the transfemoral approach is possible, but obtaining a stable position for the guide catheter via this approach is technically difficult. The authors describe the case of a 56-year-old man presenting with symptomatic occlusion of a previously placed stent at the origin of the left common carotid artery (CCA). An endovascular revascularization of the left CCA was planned. However, the absence of a lumen proximal to the stent prevented stable placement of a guide catheter via the transfemoral route. Consequently, the authors used a combined surgical and endovascular approach to gain acce...

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CONTROVERSIES IN NEUROLOGY: Angioplasty and Stenting of Asymptomatic Carotid Stenosis Before Cardiac Surgery: More Study Is Needed

Archives of Neurology — Mon, 08 Dec 2008 05:00:00 +0100

(Source: Archives of Neurology)

Extracranial Internal Carotid Artery Aneurysms: case report of a saccular wide-necked aneurysm and review of the literature.

Acta Bio-Medica : Atenei Parmensis — Mon, 01 Dec 2008 05:00:00 +0100

CONCLUSIONS: Open surgery remains the gold standard for the treatment of extracranial internal carotid artery aneurysms in terms of patency and reduced risk of adverse complications; endovascular procedures may, in selected cases, provide a valuable additional tool in the armoury of the physician. PMID: 19260382 [PubMed - in process] (Source: Acta Bio-Medica : Atenei Parmensis)

Crossing The Lesion During Angioplasty And Stenting Yields Success In Cases Studied

Health News from Medical News Today — Mon, 24 Nov 2008 16:00:00 +0100

Internal carotid occlusion is the final event in the natural history of carotid stenosis. It may be asymptomatic or cause ischemic stroke with or without permanent neurologic deficit. Carotid stenosis causes microembolization to the brain, and occlusion is usually interpreted as the cessation of the risk of embolic events, thus requiring no surgical treatment. (Source: Health News from Medical News Today)

VAST: Vertebral Artery Stenting Trial. Protocol for a randomised safety and feasibility trial

BioMed Central — Mon, 24 Nov 2008 05:00:00 +0100

DiscussionImprovements both in imaging of the vertebral artery and in endovascular techniques have created new opportunities for the treatment of symptomatic vertebral artery stenosis. This trial will assess the feasibility and safety of stenting for symptomatic vertebral artery stenosis and will provide sufficient data to inform a conclusive randomised trial testing the benefit of this treatment strategy. The VAST is supported by the Netherlands Heart Foundation (2007B045; ISRCTN29597900). (Source: BioMed Central)