MedWorm: Carotid Angioplasty

Long‐term results of cephalad arteries percutanoeus transluminal angioplasty with stent implantation (The CAPTAS registry)

Catheterization and Cardiovascular Interventions — Mon, 06 Feb 2012 05:00:00 +0100

Conclusions: CAS is safe and successful procedure with low early and long‐term adverse events. Special attention should be put on patients with bilateral and left ICA stenoses. If possible, longer stents should be applied. © 2011 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)

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Fibromuscular dysplasia: a differential diagnosis of vasculitis

Revista Brasileira de Reumatologia — Fri, 03 Feb 2012 10:19:07 +0100

A displasia fibromuscular (DFM) envolve artérias de pequeno e médio calibre e é uma causa bem conhecida de hipertensão em mulheres jovens caucasianas, quando envolve as artérias renais. A etiologia da DFM permanece desconhecida, a despeito de inúmeras teorias. Há suspeita de um componente genético, já que a doença atinge primariamente caucasianos. Também é descrita associação entre DFM e antígeno de histocompatibilidade HlA-DRw6. Os principais sítios acometidos são as artérias renais, cerebrais, carótidas, viscerais, ilíacas, subclávias, braquiais e poplíteas. As manifestações clínicas correlacionam-se com o sítio acometido, e a hipertensão arterial sistêmica é um sintoma frequente pelo acometimento das artérias renais em 60%-75% dos casos. O diagnóstico da D...

The Results of a Needs Assessment to Guide a Vascular Surgery Skills Simulation Curriculum

Annals of Vascular Surgery — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: Our needs assessment identified vascular procedures where simulation may be beneficial to improve the skill level of vascular trainees in Southern California. With economic and logistical constraints for simulation at each individual training facility, a potential approach to this educational challenge is a regional Southern California vascular surgery skills simulation center. (Source: Annals of Vascular Surgery)

Cilostazol suppression of arterial intimal hyperplasia is associated with decreased expression of sialyl Lewis X homing receptors on mononuclear cells and E-selectin in endothelial cells

Journal of Vascular Surgery — Fri, 27 Jan 2012 11:25:14 +0100

Conclusions: These results demonstrate that the protective effect of cilostazol against neointimal hyperplasia may be mediated by its anti-inflammatory actions of mononuclear cells homing to endothelial cells by decreasing SLX and E-selectin expression. Clinical Relevance: It is reported that cilostazol inhibits neointimal hyperplasia by decreasing the expression of some cell-adhesion molecules. We evaluated the effects of cilostazol for the expression of sialyl Lewis X (SLX) on mononuclear cells and E-selectin on endothelial cells, which interaction is the first step of inflammation action. Cilostazol was thought to show the anti-inflammatory actions by decreasing SLX and E-selectin expression in addition to decreasing the expression of some cell-adhesion molecules. (Source: Journal of...

[Composed angioplasty of the multilevel right common and internal carotid artery stenoses with implantation stents with used of proximal and distal protection system.]

Kardiologia Polska — Wed, 25 Jan 2012 06:54:02 +0100

We present a case of a 73 year-old man with, long-segment thigh stenosis in the right common and internal carotid artery with occlusion left common carotid artery. Complex angioplasty with modification proximal and distal system protection was successful performed. There were no procedure-related complications. We concluded that in very complex, multilevel lesions in carotid artery, there is a place for safe double system protection. This maneuver can increase safe of the carotid artery stenting and minimise potential complications. Kardiol Pol 2012; 70, 1: 88-90. PMID: 22267437 [PubMed - as supplied by publisher] (Source: Kardiologia Polska)

Why the United States Center for Medicare and Medicaid Services should not extend reimbursement indications for carotid artery angioplasty/stenting.

Vascular — Mon, 23 Jan 2012 05:00:00 +0100

Authors: Abbott AL, Adelman MA, Alexandrov AV, Barnett HJ, Beard J, Bell P, Björck M, Blacker D, Buckley CJ, Cambria RP, Comerota AJ, Connolly ES, Davies AH, Eckstein HH, Faruqi R, Fraedrich G, Gloviczki P, Hankey GJ, Harbaugh RE, Heldenberg E, Kittner SJ, Kleinig TJ, Mikhailidis DP, Moore WS, Naylor R, Nicolaides A, Paraskevas KI, Pelz DM, Prichard JW, Purdie G, Ricco JB, Riles T, Rothwell P, Sandercock P, Sillesen H, Spence JD, Spinelli F, Tan A, Thapar A, Veith FJ, Zhou W PMID: 22271806 [PubMed - as supplied by publisher] (Source: Vascular)

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Carotid stenting versus endarterectomy.

Annual Review of Medicine — Fri, 20 Jan 2012 09:00:58 +0100

Authors: Doig D, Brown MM Abstract Since the landmark NASCET and ECST trials demonstrated the superiority of carotid endarterectomy over medical therapy in the prevention of stroke for patients with symptomatic carotid artery stenosis, surgical intervention as a part of secondary prevention of stroke has become widespread. However, the newer technology of carotid artery angioplasty and stenting challenges this mode of intervention, promising the benefits of a procedure under local anesthesia and potentially avoiding the surgical complications of cranial nerve palsy and hematoma. Pooled evidence from randomized controlled trials of endarterectomy versus stenting shows a higher rate of stroke or death in the stenting groups-but this finding is mitigated to an extent by the lower inci...

Protein Kinase C Delta Promotes Adventitial Cell Migration to Neointima by Upregulation of Monocyte Chemoattractant Protein-1 in Smooth Muscle Cells

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:19 +0100

Introduction: Accumulating evidence suggests that adventitial cells directly contribute to neointima formation by migrating into the intima. We have previously reported that gene transfer of Protein kinase C delta(PKC δ) attenuates intimal hyperplasia by inducing apoptosis of smooth muscle cells (SMCs). More recently, we showed that PKCδ mediates expression of monocyte chemoattractant protein-1(MCP-1). in the current study, we tested the hypothesis that PKCδ promotes adventitial cell migration by stimulating SMCs to produce chemokines such as MCP-1. Methods: In vitro migration of isolated adventitial cells was evaluated by chemotaxis assay. Gene transfer to SMCs was achieved by intraluminal perfusion with adenoviruses expressing PKCδ(AdPKCδ) or empty vector (AdNull) following rat caro...

[Endovascular treatment of carotid stenosis: an experience in the Hospital Universitario Central de Asturias].

Revista de Neurologia — Fri, 13 Jan 2012 18:28:21 +0100

CONCLUSIONS. In our hospital CAS is considered an effective and safe technique, with a rate of complications that is within the parameters that justify its indication. PMID: 22234567 [PubMed - in process] (Source: Revista de Neurologia)

Why the United States Center for Medicare and Medicaid Services (CMS) Should not Extend Reimbursement Indications for Carotid Artery Angioplasty/Stenting.

PubMed: Eur J Vasc Endovasc ... — Thu, 05 Jan 2012 05:00:00 +0100

Authors: Abbott AL, Adelman MA, Alexandrov AV, Barnett HJ, Beard J, Bell P, Björck M, Blacker D, Buckley CJ, Cambria RP, Connolly ES, Comerota AJ, Davies AH, Eckstein HH, Faruqi R, Fraedrich G, Gloviczki P, Hankey GJ, Harbaugh RE, Heldenberg E, Kittner SJ, Kleinig TJ, Mikhailidis DP, Moore WS, Naylor R, Nicolaides A, Paraskevas KI, Pelz DM, Prichard JW, Purdie G, Ricco JB, Riles T, Rothwell P, Sandercock P, Sillesen H, Spence JD, Spinelli F, Tan A, Thapar A, Veith FJ, Zhou W PMID: 22226698 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Advances in the Management of Carotid Artery Disease: Focus on Recent Evidence and Guidelines

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

Recent landmark randomized trials and society guidelines have significantly revised the management of carotid artery disease. Duplex ultrasonography is the recommended initial diagnostic test for the assessment of extracranial carotid artery stenosis. Carotid artery imaging is reasonable in select patients scheduled for coronary artery bypass graft (CABG) surgery. Carotid revascularization can be achieved safely and effectively with carotid endarterectomy or carotid artery stenting. Because each procedure has a different risk/benefit profile, the optimal approach is to match the particular patient to the intervention that maximizes outcome benefit. Carotid revascularization is recommended in patients scheduled for CABG surgery when the carotid artery stenosis is symptomatic and/or bilatera...

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Intracranial Angioplasty and Stent Placement After Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) Trial: Present State and Future Considerations⋆

Journal of Neuroimaging — Sun, 01 Jan 2012 05:00:00 +0100

CONCLUSIONThe need for developing new and effective treatments for patients with symptomatic intracranial stenosis cannot be undermined. The data support modification but not discontinuation of our approach to intracranial angioplasty and/or stent placement for intracranial stenosis. There are potential patients in whom angioplasty and/or stent placement might be the best approach, and a new trial with appropriate modifications in patient selection and design may be warranted. (Source: Journal of Neuroimaging)

Stenting Versus Surgery in Patients With Carotid Stenosis After Previous Cervical Radiation Therapy: Systematic Review and Meta-Analysis.

Stroke — Thu, 29 Dec 2011 05:00:00 +0100

CONCLUSIONS: Both CAS and CEA proved to be feasible revascularization techniques with low risk for CVE. Although patients undergoing CEA had more temporary CNI, higher rates of late CVE and restenosis were identified after CAS. PMID: 22207504 [PubMed - as supplied by publisher] (Source: Stroke)

Sex-Related Differences in Embolic Potential During Carotid Angioplasty and Stenting

Annals of Vascular Surgery — Fri, 16 Dec 2011 23:24:35 +0100

Conclusions: Preoperative cerebrovascular symptoms are associated with a greater mean particle size in symptomatic women compared with asymptomatic women. This difference in mean particle size was not observed in men. These results provide evidence that may help in better selection of CAS patients, but the impact of an increased mean particle size in symptomatic women during carotid stenting requires further investigation. (Source: Annals of Vascular Surgery)

Results of Staged Carotid Endarterectomy and Coronary Artery Bypass Graft in Patients With Severe Carotid and Coronary Disease

Annals of Vascular Surgery — Fri, 16 Dec 2011 23:24:35 +0100

Conclusions: Staging of CEA followed by CABG in the immediate perioperative period may be an acceptable approach to patients with severe carotid and coronary disease. Despite the presence of known severe coronary disease, the performance of CEA under general anesthesia as the initial procedure was well tolerated. We propose that this strategy may be a possible option for patients who present with severe disease in both coronary and carotid distributions. The results of our study, though based on a limited cohort, suggest that this approach of staged CEA–CABG within the perioperative period (Source: Annals of Vascular Surgery)

Angioplasty and Stenting of a Jugular‐Carotid Fistula Resulting from the Inadvertent Placement of a Hemodialysis Catheter: Case Report and Review of Literature

Seminars In Dialysis — Fri, 09 Dec 2011 05:00:00 +0100

AbstractHemodialysis catheterization through the right internal jugular vein (IJV) is widely used for mid‐ to long‐term hemodialysis for patients with renal failure. The purpose of this report is to address a serious complication in conjunction with this procedure. This is a case report of an iatrogenic jugular‐carotid fistula (JCF) and a method for rectifying such a vascular conundrum, using endovascular techniques. We describe the technique used to achieve closure of the fistula as well a review of the literature. An 82‐year‐old woman with history of congestive heart failure, chronic renal failure, and diabetes mellitus developed an iatrogenic arteriovenous fistula, following an attempt of canalizing the right IJV. The patient was treated using three different stents, which ach...

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Angioplasty and Stenting of a Jugular-Carotid Fistula Resulting from the Inadvertent Placement of a Hemodialysis Catheter: Case Report and Review of Literature.

Seminars in Dialysis — Fri, 09 Dec 2011 05:00:00 +0100

Authors: Wadhwa R, Toms J, Nanda A, Abreo K, Cuellar H Abstract Hemodialysis catheterization through the right internal jugular vein (IJV) is widely used for mid- to long-term hemodialysis for patients with renal failure. The purpose of this report is to address a serious complication in conjunction with this procedure. This is a case report of an iatrogenic jugular-carotid fistula (JCF) and a method for rectifying such a vascular conundrum, using endovascular techniques. We describe the technique used to achieve closure of the fistula as well a review of the literature. An 82-year-old woman with history of congestive heart failure, chronic renal failure, and diabetes mellitus developed an iatrogenic arteriovenous fistula, following an attempt of canalizing the right IJV. The patie...

Hydrogen-rich saline prevents neointima formation after carotid balloon injury by suppressing ROS and the TNF-α/NF-κB pathway

Atherosclerosis — Wed, 07 Dec 2011 05:00:00 +0100

Conclusion: HRSS may have a protective role in the prevention of neointima hyperplasia and restenosis after angioplasty. HRSS may partially exert its role by neutralizing the local ROS and suppressing the TNF-α/NF-κB pathway. (Source: Atherosclerosis)

Spontaneous Expulsion of a Dacron Patch After Carotid Endarterectomy

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

We report a case of a spontaneous Dacron patch expulsion without any stenosis or pseudoaneurysm formation. This is a late complication that has not been previously reported in the literature. (Source: Journal of Vascular Surgery)

Use of CT Angiography and CT Perfusion Imaging in the Selection of Hyperacute Stroke Patients to Undergo Emergent Carotid Endarterectomy Versus Intra-Cranial Thrombectomy

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Patients with acute stroke symptoms due to carotid disease are typically not considered for emergent carotid endarterectomy (CEA) due to the risk of fatal intracranial hemorrhage secondary to reperfusion injury. Past studies have failed to show consistent benefit of early operative intervention, presumably due to a high rate of unrecognized intracranial thromboembolism. The emergence of neuro-endovascular clot retrieval has revolutionized acute stroke treatment since initial device clearance by FDA in 2004. While approximately 1 in 10 patients in the national registry undergoing emergent intracranial embolectomy required simultaneous carotid revascularization (typically angioplasty), this ratio increased to approximately 1 in 3 for patients in the southern Stroke Belt. In this setting, a s...

Clinical considerations in the management of asymptomatic carotid artery stenosis.

Neurosurgical Focus — Thu, 01 Dec 2011 05:00:00 +0100

Authors: Taussky P, Hanel RA, Meyer FB Abstract Incidental findings pose considerable management dilemmas for the treating physician and psychological burden for the respective patient. With an aging population, more patients will be diagnosed with asymptomatic internal carotid artery stenosis. Patients will have to be counseled with regard to treatment options according to their individual risk profile and according to professionals' knowledge of evidence-based data derived from large randomized control trials. Treatment consensus has long been lacking for patients with asymptomatic carotid artery stenosis prior to any randomized controlled trials. Additionally, an individual's risk profile may be hard to assess according to knowledge gained from randomized controlled trials. More...

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Strategies for asymptomatic carotid artery stenosis.

Neurosurgical Focus — Thu, 01 Dec 2011 05:00:00 +0100

Authors: Doe C, Jethwa PR, Gandhi CD, Prestigiacomo CJ Abstract The treatment of asymptomatic carotid artery stenosis (ACAS) has continued to evolve for the past 3 decades. With rapidly advancing technology, the results of old trials have become obsolete. While there has been little change in the efficacy of carotid endarterectomy, there have been vast improvements in both medical management and carotid angioplasty with stenting. Finding the best therapy for a given patient can therefore be difficult. In this article, the authors review the current literature regarding treatment options for ACAS and the methods available for stratifying patients who would benefit from surgical versus medical treatment. PMID: 22133168 [PubMed - in process] (Source: Neurosurgical Focus)

Magnoliae Cortex inhibits intimal thickening of carotid artery through modulation of proliferation and migration of vascular smooth muscle cells.

Food and Chemical Toxicology — Mon, 28 Nov 2011 05:00:00 +0100

The objective of this study was to examine the effect of Magnoliae Cortex extract (MOE) on intimal thickening of rat carotid artery injured by balloon endothelial denudation. MOE was administered orally using gastric sonde at three different doses MOE200 (200mg/kg), MOE400 (400mg/kg), and MOE800 (800mg/kg) for 14days from the day of balloon injury. Also, in vitro assays of proliferation, migration and expression of matrix metalloproteinase-2 (MMP-2) in human aortic smooth muscle cells (HASMCs) were carried out using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, transwell boyden chamber method and gelatin zymography, respectively. Oral administration of MOE400 and MOE800 for 14days significantly inhibited intimal area, intimal/medial ratio (I/M), stenosis rate, e...

A novel approach to the treatment of recurrent non‐atherosclerotic carotid stenosis in a patient with takayasu arteritis

Catheterization and Cardiovascular Interventions — Fri, 25 Nov 2011 05:00:00 +0100

AbstractTakayasu arteritis is a chronic inflammatory autoimmune disease of medium and large sized arteries which frequently affects the major supra‐aortic vessels. Morbidity and mortality with both medical and surgical treatments for this disease are high. In the past decade, angioplasty and stenting has emerged as a reasonable alternative to treatment of stenoses in these patients. Restenosis rates of percutaneously treated Takayasu lesions have been higher than with non‐inflammatory lesions. Novel approaches are being sought to treat restenoses in these patients, such as the use of a stent grafts. Such a case is described in this report. © 2011 Wiley‐Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

Cell-specific effects of miR-221/222 in vessels: Molecular mechanism and therapeutic application

Journal of Molecular and Cellular Cardiology — Wed, 23 Nov 2011 05:00:00 +0100

Abstract: MicroRNAs (miRNAs) are noncoding RNAs that impact almost every aspect of biology and disease. Until now, the cell-specific effects of miRNAs in cardiovascular system have not been established. In the current study, the cellular functions of miR-221 and miR-222 (miR-221/222) in vascular smooth muscle cells (VSMCs) and vascular endothelial cells (ECs) were compared. In cultured cells, we identified that the effects of miR-221/222 on proliferation, migration, and apoptosis are opposite between VSMCs and ECs. In VSMCs, miR-221/222 had effects of pro-proliferation, pro-migration, and anti-apoptosis. In contrast, miR-221/222 had effects of anti-proliferation, anti-migration, and pro-apoptosis in ECs. The different expression profiles of their target genes, p27(Kip1), p57(kip2), and c-k...

Intracranial Angioplasty and Stenting Through Direct Carotid Puncture

Journal of Neuroimaging — Mon, 14 Nov 2011 05:00:00 +0100

CONCLUSIONAccess of the intracranial circulation through direct CCA puncture may be a feasible alternative when the transfemoral access is not possible. The transcervical approach may be safe even with the use of antiplatelet medications and anticoagulation. J Neuroimaging 2011;XX:1–4. (Source: Journal of Neuroimaging)

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Carotid Artery Pseudoaneurysm after Carotid Endarterectomy and Bovine Pericardial Patch Angioplasty: Case Report

EJVES Extra — Mon, 14 Nov 2011 05:00:00 +0100

We describe a case of bovine patch infection with Serratia marcescens with acute pseudoaneurysm formation following CEA. Successful interposition vein graft was performed. (Source: EJVES Extra)

Age differential between outcomes of carotid angioplasty and stent placement and carotid endarterectomy in general practice

Journal of Vascular Surgery — Thu, 10 Nov 2011 05:00:00 +0100

Background: Data derived from prospective randomized clinical trials suggest differential comparative benefit between carotid angioplasty and stent (CAS) placement and carotid endarterectomy (CEA) in various age strata. We sought to investigate the impact of age on outcomes of CAS and CEA in general practice. Methods: We analyzed the data from the Nationwide Inpatient Sample (NIS), which is representative of all admissions in the United States from 2005 to 2008. The primary end point was occurrence of stroke, cardiac complications, or death during the postprocedural period. Outcomes of interest were compared between patients aged ≥70 years and (Source: Journal of Vascular Surgery)

Hypercholesterolemia and oxidative stress inhibit endothelial cell healing after arterial injury

Journal of Vascular Surgery — Thu, 03 Nov 2011 04:00:00 +0100

Conclusion: Re-endothelialization of arterial injuries is reduced in hypercholesterolemic mice and is inversely correlated with oxidative stress. An oral antioxidant decreases oxidative stress and improves EC healing. Clinical Relevance: Vascular injury following cardiovascular intervention, including cardiac and peripheral arterial angioplasty and stenting, is associated with inflammation and oxidative stress. Hypercholesterolemia is also associated with increased oxidative stress. Oxidative stress, regardless of the source, induces cellular dysfunction in endothelial and smooth muscle cells that reduce healing after arterial injury. Decreasing oxidative stress with an exogenously administered antioxidant can improve endothelial cell healing, and this is important to control intimal hy...

Multidisciplinary approach to carotid stenting

Internal Medicine Journal — Tue, 01 Nov 2011 04:00:00 +0100

Conclusion: A multidisciplinary approach is a useful strategy for initiating and sustaining a CAS programme. (Source: Internal Medicine Journal)

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An analysis of vascular surgery in elderly patients to determine whether age affects treatment strategy

Irish Journal of Medical Science — Sat, 29 Oct 2011 05:47:55 +0100

Conclusion A paradigm shift has occurred towards endovascular management of aortic, iliac and femoral arterial disease. Whilst patient age >75 significantly impacts on complication rates from index open vascular procedures, age does not impact upon complication rates of corresponding endovascular procedures. We, therefore, recommend an endovascular approach be adopted as first line for all patients, regardless of patient age. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s11845-011-0779-0Authors G. O’Brien, St. James Hospital, Dublin, IrelandZ. Martin, St. James Hospital, Dublin, IrelandN. Haider, St. James Hospital, Dublin, IrelandM. Colgan, St. James Hospital, Dublin, IrelandS. O’Neill, St. James Hospital, Dublin, IrelandD. Moor...

Do Patients With Hostile Necks Have an Increased Rate of Restenosis After CAS?

Journal of Vascular Surgery — Thu, 27 Oct 2011 11:45:46 +0100

Objectives: The purpose of this study is to review a single institution's experience of carotid artery angioplasty and stenting (CAS) and re-intervention rates. Methods: A retrospective analysis of patients that underwent CAS at a university medical center was performed over an 8-year period from August 2003 to August 2011. Data analysis included patient demographics, operative details, radiological information and postoperative outcomes. (Source: Journal of Vascular Surgery)

[Percutaneous, endovascular treatment of innominate artery lesions is a safe and effective procedure].

Orvosi Hetilap — Sun, 23 Oct 2011 04:00:00 +0100

Authors: Paukovits TM, Nemes B, Hüttl K, Bérczi V Abstract Percutaneous endovascular treatment (transluminar balloon angioplasty with or without stent implantation) of innominate artery lesions has become the treatment of choice prior to surgery in the past decades. Authors present the diagnostics, treatment and follow-up of two patients as examples from their largest series in the literature. A 74-year-old male patient with a history of hyperlipidemia, hypertension, nicotine abuse and lower limb claudication was admitted because of acute upper limb claudication and dizziness. Physical examination revealed blood pressure difference of 30 mmHg between his arms, and poststenotic flow pattern in the common carotid artery with retrograde flow in the vertebral artery on carotid duplex...

[Long-term development of carotid stenosis treated by endovascular means: a prospective study in a neurovascular unit].

Revista de Neurologia — Fri, 21 Oct 2011 12:11:11 +0100

CONCLUSIONS. Carotid angioplasty is an effective, safe technique in the hands of an experienced professional; our findings are good, both in the short and the long term, with a low rate of restenosis. If this latter condition occurs, vascular intervention techniques are safe and efficient. PMID: 22012817 [PubMed - in process] (Source: Revista de Neurologia)

Krüppel‐like Factor 4 is Induced by Rapamycin and Mediates the Anti‐proliferative Effect of Rapamycin in Balloon‐injured Rat Carotid Arteries

British Journal of Pharmacology — Thu, 20 Oct 2011 04:00:00 +0100

Conclusions and Implications: KLF4 plays an important role in mediating the anti‐proliferative effect of rapamycin in VSMCs and balloon‐injured arteries. Thus, it is a potential target for the treatment of proliferative vascular disorders such as restenosis after angioplasty. (Source: British Journal of Pharmacology)

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A Novel Carotid Device for Embolic Diversion: Lessons Learned from a “First in Man” Trial in Patients with Atrial Fibrillation

CardioVascular and Interventional Radiology — Wed, 19 Oct 2011 05:50:53 +0100

Conclusions Implantation of a novel device intended to divert emboli away from the internal carotid artery was feasible, but resulted in occlusive neointimal proliferation in two of three patients. These results demonstrate a discrepancy from the findings of preclinical animal studies and human investigation. Content Type Journal ArticleCategory Technical NotePages 1-7DOI 10.1007/s00270-011-0290-zAuthors Horst Sievert, CardioVascular Center Frankfurt, Seckbacher Landstrasse 65, 60389 Frankfurt, GermanyJennifer Franke, CardioVascular Center Frankfurt, Seckbacher Landstrasse 65, 60389 Frankfurt, GermanyYgael Grad, Faculty of Engineering, Tel-Aviv University, Ramat-Aviv, 69978 Tel-Aviv, IsraelBoaz Nishri, Faculty of Engineering, Tel-Aviv University, Ramat-Aviv, 69978 T...

Influence of Chronic Renal Insufficiency on Outcomes Following Carotid Revascularization [Original Article]

Archives of Surgery — Mon, 17 Oct 2011 04:00:00 +0100

Conclusions Chronic kidney disease is prevalent among patients undergoing carotid revascularization. Overall, patients with moderate renal function have similar outcomes. However, those with severe renal insufficiency have significantly higher 30-day mortality when undergoing carotid revascularization. (Source: Archives of Surgery)

Carotid Artery Revascularisation Following Neck Irradiation: Immediate and Long-Term Results

European Journal of Vascular and Endovascular Surgery — Mon, 17 Oct 2011 04:00:00 +0100

Conclusion: Despite no comparative study as evidence, we think that the perioperative risk of stroke is at least comparable with the risk encountered for angioplasty procedures. (Source: European Journal of Vascular and Endovascular Surgery)

Carotid Surgery or Stenting Following Neck Irradiation: Time to Address the Assumptions

European Journal of Vascular and Endovascular Surgery — Mon, 17 Oct 2011 04:00:00 +0100

Magne et al. are to be congratulated for reviewing the outcomes of carotid surgery for their 24 patients with prior neck irradiation, adding one of the largest and longest followed case-series reported for such patients. This, and the other 17 case-series quoted by Magne et al. of patients with prior neck irradiation undergoing open carotid surgery or angioplasty/stenting, illustrate how these procedures are technically possible with low 30-day procedural stroke/death rates. Considering all 18 case-series, the peri-procedural 30-day stroke/death rate was 0% in ten (56%). However, among these ten case-series, the average sample size was only 16 patients (range 4–28) with a mean followup of approximately 1.6 years (range 1–37 months). By contrast, in the remaining eight case-series, th...

Carotid Artery Revascularisation Following Neck Irradiation: Immediate and Long-Term Results.

PubMed: Eur J Vasc Endovasc ... — Fri, 14 Oct 2011 04:00:00 +0100

CONCLUSION: Despite no comparative study as evidence, we think that the perioperative risk of stroke is at least comparable with the risk encountered for angioplasty procedures. PMID: 22001147 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

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Idiopathic midaortic syndrome: normalization of blood pressure on medication

Pediatric Nephrology — Tue, 11 Oct 2011 05:51:20 +0100

We report a case of a 13-year-old girl who presented with severe hypertension (200/110 mmHg) associated with renal artery stenosis and normal renal function (creatinine clearance 110 ml/min/1.73m2). Percutaneous angioplasty (PTA) was first performed, but early recurrence of hypertension occurred. Subsequent imaging evaluation demonstrated association of aortic narrowing, proximal stenosis of the left renal artery, and wall thickening of superior mesenteric artery and right common carotid artery. Although previous large-vessel arteritis cannot be absolutely excluded, a diagnosis of idiopathic MAS was made, given the absence of any other clinical signs of inflammation (C-reactive protein <0.5 mg/dl; erythrocyte sedimentation rate 5 mm/h). Medical treatment was undertaken without rep...

A dietary approach to increase in-stent stenosis and face validity of a rat model for arterial angioplasty and stenting

Atherosclerosis — Mon, 10 Oct 2011 04:00:00 +0100

Conclusions: Arterial stenting, in combination with the atherogenic diet, led to exacerbated endothelial dysfunction, inflammation, platelet activation, and vascular remodeling compared with stented rats on normal chow. By reproducing key features of clinical restenosis that are lacking in other rat models, this modified rat model may serve as a valuable screening tool to rapidly evaluate new coatings and devices before moving candidates into expensive, more time-consuming rabbit or porcine models. (Source: Atherosclerosis)

Percutaneous and Open Retrograde Endovascular Stenting of Symptomatic High-Grade Innominate Artery Stenosis: Technique and Follow-Up [INTERVENTIONAL]

American Journal of Neuroradiology — Fri, 07 Oct 2011 04:00:00 +0100

CONCLUSIONS: Percutaneous and open retrograde stenting of high-grade stenosis of the IA is a viable less invasive alternatives to open bypass surgery with good midterm clinical results and patency rates. (Source: American Journal of Neuroradiology)

Carotid Tortuosity in Patients With Prior Cervical Radiation: Increased Technical Challenge During Carotid Stenting

Vascular and Endovascular Surgery — Fri, 07 Oct 2011 04:00:00 +0100

Conclusions: A history of cervical irradiation is associated with increased tortuosity of the IC, leading to potential challenges for filter and stent deployment. However, this increased procedural complexity did not affect technical success rate or device selection in this series. (Source: Vascular and Endovascular Surgery)

Case-matched Comparison of Early and Long-term Outcomes of Everted Cervical Vein and Saphenous Vein Carotid Patch Angioplasty

European Journal of Vascular and Endovascular Surgery — Mon, 26 Sep 2011 04:00:00 +0100

Conclusions: CV is a good alternative to SV patching, particularly when the SV needs to be preserved for further use or is unsuitable. (Source: European Journal of Vascular and Endovascular Surgery)

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Safety of early endovascular catheterization and intervention through extracranial-intracranial bypass grafts.

Journal of Neurosurgery — Fri, 23 Sep 2011 04:00:00 +0100

Conclusions Endovascular catheterization and intervention involving a recent EC-IC bypass is feasible. The main limitation in this series was catheter-induced vasospasm involving the STA. A vein graft may be the more appropriate option in patients with subarachnoid hemorrhage who may require subsequent endovascular intervention for vasospasm. PMID: 21942723 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery)

The results of a simplified technique for safe carotid stenting in the elderly

Journal of Vascular Surgery — Mon, 05 Sep 2011 04:00:00 +0100

Conclusion: The results of this preliminary study indicate that the transcervical approach with flow reversal during the insertion of the protecting filter allows CAS with minimal interruption of cerebral circulation and is simple and safe in patients unsuitable for CEA and transfemoral CAS for anatomic reasons. Further research with randomization and with pre-procedure and post-procedure diffusion-weighted magnetic resonance imaging (DW-MRI) is required in order to expand the indications of this method. (Source: Journal of Vascular Surgery)

Post‐operative risk factor control following internal carotid artery intervention

ANZ Journal of Surgery — Thu, 01 Sep 2011 04:00:00 +0100

Conclusion: Future strategy targeted at achieving optimal post‐CEA and carotid angioplasty with adjuvant stenting risk factor control should consider incorporating themes that increase the level of accurate patient insight into their disease (particularly their post‐operative risk factor control), for instance, patient education and effective doctor–patient communication. (Source: ANZ Journal of Surgery)

Anatomical and Technical factors Associated With Stroke or Death During Carotid Angioplasty and Stenting Results from the Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S) Trial and Systematic Review

Journal of Vascular Surgery — Wed, 31 Aug 2011 23:00:00 +0100

Conclusion: There are technical and anatomic factors, especially extreme angulation of the carotid artery, that impact the risk of carotid artery angioplasty and stenting. Summary: It seems clear, at this point, that large randomized clinical trials of 30-day stroke and death rates favor carotid endarterectomy (CEA) over carotid artery stenting (CAS). However, once the perioperative period has passed, CAS and CEA both appear effective in preventing midterm stroke. The implication is decreasing periprocedural rates of CAS would make the procedure more attractive because long-term stroke prevention after CAS or CEA is more equivalent. The authors sought to assess relationships between anatomic and technical factors and 30-day risk of stroke and death after CAS. The authors included patients...

Embolic Potential During Carotid Angioplasty and Stenting: Comparing Open-Cell and Closed-Cell Stents

Journal of Vascular Surgery — Wed, 31 Aug 2011 23:00:00 +0100

We sought to determine the effects of open-cell and closed-cell stents on the size and number of embolic particles generated during carotid artery stenting (CAS) and assess the effect on outcome. (Source: Journal of Vascular Surgery)

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Stroke Prevention: Carotid Stenting and Carotid Endarterectomy Go Neck and Neck

Journal of Radiology Nursing — Wed, 31 Aug 2011 23:00:00 +0100

This article will compare carotid stenting with CEA as a treatment for stroke prevention. The pre-, intra-, and postmonitoring of the patient undergoing this new neurointerventional procedure will be emphasized. (Source: Journal of Radiology Nursing)

Percutaneous and Open Retrograde Endovascular Stenting of Symptomatic High-Grade Innominate Artery Stenosis: Technique and Follow-Up [INTERVENTIONAL]

American Journal of Neuroradiology — Wed, 17 Aug 2011 23:00:00 +0100

Selected Abstracts from the September Issue of the Journal of Vascular Surgery

European Journal of Vascular and Endovascular Surgery — Wed, 17 Aug 2011 09:11:15 +0100

John J. Ricotta, Ali Aburahma, Enrico Ascher, Mark Eskandari, Peter Faries, Brajesh K. Lal Abstract: Management of carotid bifurcation stenosis is a cornerstone of stroke prevention, and has been the subject of extensive clinical investigation, including multiple controlled randomized trials. The appropriate treatment of patients with carotid bifurcation disease is of major interest to the community of vascular surgeons. In 2008 the Society for Vascular Surgery published guidelines for treatment of carotid artery disease. At the time only one randomized trial, comparing carotid endarterectomy and carotid stenting had been published. Since that publication, 4 major randomized trials comparing carotid endarterectomy and carotid stenting have been published, and the role of medical managemen...

Total sleep deprivation augments balloon angioplasty‐induced neointimal hyperplasia in rats

Experimental Physiology — Tue, 16 Aug 2011 04:00:00 +0100

Sleep deprivation has been shown to be associated with an increase in inflammation that is also involved in the development of neointimal hyperplasia (or restenosis). The purpose of this study was to investigate whether total sleep deprivation (TSD) would worsen neointimal formation by balloon injury. Sixteen rats were randomly allocated into the following four groups: group 1, balloon angioplasty alone; group 2, TSD prior to angioplasty; group 3, angioplasty before TSD; and group 4, TSD before and after angioplasty. Total sleep deprivation was induced by the disc‐over‐water method, and balloon angioplasty was performed in the carotid artery. Histopathological analysis and assay of cytokines were applied to evaluate the effects of TSD in this study. Total sleep deprivation significantl...

Total sleep deprivation augments balloon angioplasty‐induced neointimal hyperplasia in rat

Experimental Physiology — Mon, 15 Aug 2011 23:00:00 +0100

Abstract Sleep deprivation has been shown to be associated with an increase in inflammation that also involved in the development of neointimal hyperplasia (or restenosis). The purpose of this study was to investigate whether total sleep deprivation (TSD) will worsen neointimal formation by balloon injury. Sixteen rats were randomly allocated into four groups: Group 1, balloon angioplasty alone; Group 2, TSD prior to angioplasty; Group 3, angioplasty before TSD; Group 4, TSD before and after angioplasty. TSD was induced by the disc‐on‐water method, and balloon angioplasty was performed in rat carotid artery. The histopathological analysis and cytokines assay were applied to evaluate the effects of TSD in this study. TSD significantly increased the ratio of post‐injury neointima‐...

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Carotid Endarterectomy is Superior to Carotid Angioplasty and Stenting for Perioperative and Long-Term Results

Vascular and Endovascular Surgery — Thu, 11 Aug 2011 23:00:00 +0100

Conclusion: The 30-day RR of stroke, stroke/death, long-term risk of stroke, and risk of restenosis are consistently higher for carotid artery stenting (CAS). (Source: Vascular and Endovascular Surgery)

Intracranial Hemorrhage Is Much More Common After Carotid Stenting Than After Endarterectomy: Evidence From the National Inpatient Sample.

Stroke — Wed, 10 Aug 2011 23:00:00 +0100

CONCLUSIONS: CAS procedures are associated with elevated adverse outcomes, including ICH, in-hospital death, and unfavorable discharges, especially among symptomatic presentations. PMID: 21836092 [PubMed - as supplied by publisher] (Source: Stroke)

Durability and Stroke-Free Survival after Carotid Stenting: Long-Term Follow-up in a Community Setting

Journal of Vascular Surgery — Sun, 31 Jul 2011 23:00:00 +0100

The purpose of carotid angioplasty and stent (CAS) is stroke prevention. Large trials have been conducted or are underway to understand the results of CAS. However, two significant questions remain: (1) What are the long-term results, beyond the reports of 2 to 4 years? (2) Do the results of major trials correlate with similar results in the community at large? The purpose of this study is twofold: to evaluate the long-term results of CAS with respect to stroke-free survival, re-stenosis, and reintervention; and, to assess the overall result of CAS in a community setting. (Source: Journal of Vascular Surgery)

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

The Journal of Cardiovascular Surgery — Sun, 31 Jul 2011 23:00:00 +0100

This study evaluated the feasibility and safety of angioplasty and stenting for the treatment of carotid stenoses combined with cardiac operations in order to reduce the risk of perioperative stroke. PMID: 21792161 [PubMed - in process] (Source: The Journal of Cardiovascular Surgery)

Unequal Blood Pressures: A Manifestation of Subclavian Steal

The American Journal of Medicine — Tue, 26 Jul 2011 21:04:24 +0100

A 75-year-old African American man with a history of renal cell carcinoma, atrial flutter status post-radiofrequency catheter ablation, abdominal aortic aneurysm, hyperlipidemia, hypertension, and tobacco dependence presented for routine care. The patient reported frequent episodes of lightheadedness lasting several seconds, associated with blurry vision, shortness of breath, and nausea. Symptoms initially began several years ago with 2 episodes of true syncope, although he denied loss of consciousness with the current events. His symptoms were provoked by driving with his left arm and exacerbated by neck extension. He denied arm pain or weakness. Medications included a statin, an angiotensin-receptor blocker, a beta-blocker, and an aspirin. Physical examination was notable for a blood pre...

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Carotid atherosclerotic disease and cognitive function: mechanisms identifying new therapeutic targets

International Journal of Stroke — Wed, 13 Jul 2011 20:14:33 +0100

The treatment of carotid atherosclerotic disease lies primarily in decreasing the risk of stroke. Many investigations have suggested carotid atherosclerotic disease as being independently associated with cognitive dysfunction, also supporting the notion that in sub‐clinical stages, carotid atherosclerotic disease may not be truly silent. An improvement in cognitive function following revascularization approaches may be expected from the reduced embolism and the improved hemodynamics achieved. However, there are no strong data indicating a cognitive change after carotid angioplasty and stenting or carotid endarterectomy in patients who do not experience stroke complications and there is no evidence to support the performance of prophylactic revascularization procedures with the aim of pre...

Evidence-Based Treatment of Carotid Artery StenosisEvidence-Based Treatment of Carotid Artery Stenosis

Medscape Today Headlines — Fri, 24 Jun 2011 11:04:18 +0100

Carotid angioplasty and stent placement has emerged as an alternative to carotid endarterectomy--but medical management must also be considered. What should influence treatment decisions? Neurosurgical Focus (Source: Medscape Today Headlines)

Influence of Chronic Renal Insufficiency on Outcomes Following Carotid Revascularization [Original Article]

Archives of Surgery — Sun, 19 Jun 2011 23:00:00 +0100

A meta-analysis of combined endarterectomy and proximal balloon angioplasty for tandem disease of the arch vessels and carotid bifurcation

Journal of Vascular Surgery — Sun, 19 Jun 2011 23:00:00 +0100

Conclusions: This meta-analysis reports the largest collection of patients having undergone hybrid treatment of tandem disease of the arch vessels and carotid bifurcation. Results from this study show that the combined stroke and death rate with this approach is equal to or better than that for isolated endarterectomy. When possible, balloon angioplasty with stenting of the proximal component of this disease should be pursued to avoid restenosis. (Source: Journal of Vascular Surgery)

Leptin: The missing link between obesity and heart disease?

Atherosclerosis — Sun, 12 Jun 2011 23:00:00 +0100

Two papers in this issue of Atherosclerosis explore different aspects of the role of leptin in cardiovascular disease, and here we review each paper in turn. Leptin plays a key role in the regulation of body weight and inflammatory responses, and its role in atherosclerosis has been described in several studies . Elevated plasma concentrations of leptin are independently associated with the intima-media thickness of the common carotid artery, and with the degree of coronary artery calcification in patients with type 2 diabetes mellitus, after controlling for adiposity and CRP. Hyperleptinemia is also involved in the increased risk of post-angioplasty restenosis. Obesity and the co-existing metabolic syndrome eventually lead to leptin resistance with attenuation of leptin signalling at a ce...

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Carotid endarterectomy for treatment of in-stent restenosis

Journal of Vascular Surgery — Fri, 10 Jun 2011 04:00:00 +0100

In-stent restenosis (ISR) after carotid angioplasty and stenting is becoming evident as more patients undergo carotid stenting and duplex scan surveillance. While redo endovascular therapy has been immediately successful, recurrent stenosis remains a problem. The ideal management of ISR has not been determined. Three cases of symptomatic ISR that were successfully treated by standard carotid endarterectomy (CEA) with removal of the stent are reported herein. Current options for management of ISR are reviewed from the literature. (Source: Journal of Vascular Surgery)

Carotid Artery Interventions For Cerebrovascular Disease Compared

Health News from Medical News Today — Mon, 06 Jun 2011 17:00:00 +0100

New data in the June 2011 issue of the Journal of Vascular Surgery®, the official publication of the Society for Vascular Surgery®, reveals that carotid endarterectomy (CEA) may be the preferred treatment for women who require intervention for cerebrovascular disease. The study notes that the results of cartoid angioplasty and stenting (CAS) have not been extensively analyzed in female patients. According to Caron B... (Source: Health News from Medical News Today)

Response Gene to Complement 32 Promotes Vascular Lesion Formation Through Stimulation of Smooth Muscle Cell Proliferation and Migration.

Arteriosclerosis, Thrombosis and Vascular Biology — Wed, 01 Jun 2011 23:00:00 +0100

CONCLUSIONS: RGC-32 plays an important role in vascular lesion formation following vascular injury. Increased RGC-32 expression in vascular injury appears to be a novel mechanism underlying the migration and proliferation of vascular smooth muscle cells. Therefore, targeting RGC-32 is a potential therapeutic strategy for the prevention of vascular remodeling in proliferative vascular diseases. PMID: 21636805 [PubMed - as supplied by publisher] (Source: Arteriosclerosis, Thrombosis and Vascular Biology)

Evidence-based treatment of carotid artery stenosis.

Neurosurgical Focus — Tue, 31 May 2011 23:00:00 +0100

Authors: Young KC, Jain A, Jain M, Replogle RE, Benesch CG, Jahromi BS Carotid atheromatous disease is an important cause of stroke. Carotid endarterectomy (CEA) is a well-established option for reducing the risk of subsequent stroke due to symptomatic stenosis (> 50%). With adequately low perioperative risk (< 3%) and sufficient life expectancy, CEA may be used for asymptomatic stenosis (> 60%). Recently, carotid angioplasty and stent placement (CAS) has emerged as an alternative revascularization technique. Trial design considerations are discussed in relation to trial results to provide an understanding of why some trials were considered positive whereas others were not. This review then addresses both the original randomized studies showing that CEA is superior to best med...

Endovascular recanalization of symptomatic flow-limiting cervical carotid dissection in an isolated hemisphere.

Neurosurgical Focus — Tue, 31 May 2011 23:00:00 +0100

Conclusions The treatment of ICAD may be difficult in patients with subacute unstable neurological deficits related to symptomatic hypoperfusion, especially in the setting of a hemodynamically isolated hemisphere. Anticoagulation alone may be insufficient in these patients. Although there is no widely accepted guideline for the treatment of ICAD, the authors recommend stent-mediated endovascular recanalization in cases of symptomatic flow-limiting hemodynamic compromise, especially in cases of an isolated hemisphere lacking sufficient communicating artery compensatory perfusion. PMID: 21631217 [PubMed - in process] (Source: Neurosurgical Focus)

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Endovascular stroke therapy: a single-center retrospective review.

Neurosurgical Focus — Tue, 31 May 2011 23:00:00 +0100

Conclusions The authors' institution performs endovascular stroke treatment with a safety and efficacy profile comparable to those of other major endovascular stroke therapy studies. Recanalization was associated with an improved clinical outcome. Protocols to maximize efficient triage of patients and better documentation of stroke treatments can assist in further studies. PMID: 21631211 [PubMed - in process] (Source: Neurosurgical Focus)

Invited commentary

Journal of Vascular Surgery — Wed, 25 May 2011 20:09:53 +0100

This article describes perioperative stroke and death rates for carotid endarterectomy and coronary angioplasty and stenting derived from 20% of United States inpatient episodes during 2004 and 2005. Some important factors prevent comparisons with longer-term clinical trials or cohort studies. The stroke and death rates quoted here are likely to underestimate outcomes; around one-third of 30-day events occurred after discharge. (Source: Journal of Vascular Surgery)

Endovascular treatment of carotid artery restenosis: short term results

Jornal Vascular Brasileiro — Fri, 20 May 2011 23:48:09 +0100

CONTEXTO: O tratamento cirúrgico da reestenose carotídea apresenta alta taxa de lesão neurológica. Contrariamente, o tratamento endovascular da doença obstrutiva carotídea extracraniana tem se tornado mais factível e gradualmente menores taxas de risco cirúrgico vêm sendo reportadas, tornando-se uma opção em situações especiais, e provavelmente poderá ser considerado o tratamento padrão para reestenose carotídea. OBJETIVOS: Avaliar a aplicabilidade, a segurança e a eficácia da angioplastia com o uso do stent (ACS) no tratamento da reestenose carotídea (REC) no intraoperatório e no pós-operatório recente (

Medtronic Advances Research on Peripheral Devices, Highlights Upcoming Presentations

News from Angioplasty.Org — Mon, 16 May 2011 19:05:00 +0100

Medtronic, Inc. (NYSE: MDT) today announced recent milestones in its clinical program for the IN.PACT drug-eluting balloon (DEB) technology. The company also announced upcoming data presentations at the EuroPCR meeting on its peripheral vascular devices -- specifically, the IN.PACT DEB technology for the treatment of atherosclerosis in leg arteries and the Mo.Ma Ultra proximal cerebral protection device for carotid artery stenting. (Source: News from Angioplasty.Org)

Are Distal Protection Devices 'Protective' During Carotid Angioplasty and Stenting?

Stroke — Wed, 11 May 2011 23:00:00 +0100

CONCLUSIONS: In accordance with recent literature, this series cast doubts as to the real effectiveness of distal embolic protection devices in reducing periprocedural complications. PMID: 21566230 [PubMed - as supplied by publisher] (Source: Stroke)

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[How can we improve the prognosis of infrapopliteal bypasses?]

Journal des Maladies Vasculaires — Tue, 03 May 2011 23:00:00 +0100

Authors: Fichelle JM Infrapopliteal bypasses are often used for critical ischemia, in patients older than 80, in diabetics patients in 20% of cases, and patients with end-stage renal disease in 10% of cases. The goal of this paper is to analyze the systemic factors, which contribute to the clinical results, the technical aspects, which improve the patency of the bypass, and the role of postoperative follow-up. Postoperative mortality in those patients ranges from 3 to 10%, depending on several factors: age, global cardiovascular diffusion, diabetes mellitus, end-stage renal disease. A complete evaluation of concomitant cardiovascular disease including coronary, renal and carotid disease is necessary to achieve the goal of reducing early and late mortality. Previous treatment of septic ...

Outcomes after carotid angioplasty and stenting in symptomatic octogenarians.

The Canadian Journal of Neurological Sciences — Sat, 30 Apr 2011 23:00:00 +0100

Conclusion: The complications rate observed in octogenarians was not significantly higher than non-octogenarians. Our findings suggest that octogenarians should be included in randomized trials examining CAS to better define the risk-benefit profile of this procedure in the elderly. PMID: 21515504 [PubMed - in process] (Source: The Canadian Journal of Neurological Sciences)

Eversion Carotid Endarterectomy for Recurrent Stenosis After Carotid Angioplasty/Stenting

Annals of Vascular Surgery — Sat, 30 Apr 2011 23:00:00 +0100

This report describes a patient with recurrent stenosis treated with eversion carotid endarterectomy and stent removal. (Source: Annals of Vascular Surgery)

Filter content after carotid angioplasty and stenting: relation to ischemic lesions in diffusion-weighted imaging.

Radiologia — Wed, 27 Apr 2011 23:00:00 +0100

CONCLUSIONS: Ischemia after carotid angioplasty and stenting does not depend solely on the embolic load and its nature. We consider that the lower prevalence of postprocedural lesions in our series compared to others suggests that appropriate patient selection and experience minimize the negative influence of some variables like age in their development. PMID: 21530991 [PubMed - as supplied by publisher] (Source: Radiologia)

Outcome of carotid artery interventions among female patients, 2004 to 2005

Journal of Vascular Surgery — Sun, 24 Apr 2011 23:00:00 +0100

Conclusions: The concern regarding an increased perioperative stroke rate after CEA among asymptomatic women appears to be unfounded. The perioperative stroke rate among symptomatic women was higher than that of symptomatic men, but still well within the acceptable range for symptomatic patients undergoing a cerebrovascular intervention. Nationally, women underwent CAS significantly less frequently than did men. Outcome among women for perioperative stroke favored CEA over CAS, particularly in asymptomatic patients. CEA may be the preferred treatment in women seeking intervention for cerebrovascular disease, unless compelling reasons exist to perform CAS. (Source: Journal of Vascular Surgery)

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A 10-year experience of infection following carotid endarterectomy with patch angioplasty

Journal of Vascular Surgery — Sun, 24 Apr 2011 23:00:00 +0100

Conclusion: Infection following carotid endarterectomy occurs (Source: Journal of Vascular Surgery)

Endovascular Treatment of Tandem Extracranial/Intracranial Anterior Circulation Occlusions: Preliminary Single-Center Experience.

Stroke — Wed, 20 Apr 2011 23:00:00 +0100

CONCLUSIONS: Endovascular therapy of tandem occlusions using extracranial internal carotid artery revascularization as the first step is technically feasible, has a high recanalization rate, and results in an acceptable rate of good clinical outcome. Future randomized, prospective studies should clarify the role of this approach. PMID: 21512175 [PubMed - as supplied by publisher] (Source: Stroke)

Experimental determination of circumferential properties of fresh carotid artery plaques

Journal of Biomechanics — Sun, 17 Apr 2011 23:00:00 +0100

This study analysed atherosclerotic plaque characteristics from 18 patients tested on site, post-surgical revascularisation through endarterectomy, with 4 tissue samples being excluded from tensile testing based on large width–length ratios. According to their mechanical behaviour, atherosclerotic plaques were separated into 3 grades of stiffness. Individual and group material coefficients were then generated analytically using the Yeoh strain energy function. The ultimate tensile strength (UTS) of each sample was also recorded, showing large variation across the 14 atherosclerotic samples tested. Experimental Green strains at rupture varied from 0.299 to 0.588 and the Cauchy stress observed in the experiments was between 0.131 and 0.779MPa. It is expected that this data may be used in f...

Spontaneous peritoneal and retroperitoneal hemorrhage, rare serious complication following carotid angioplasty with stent

Journal of the Neurological Sciences — Sun, 17 Apr 2011 23:00:00 +0100

We report a rare case of 75-year-old male with spontaneous peritoneal and perirenal hemorrhage following carotid angioplasty with stent. Because this intraabdominal hemorrhage can cause delayed diagnosis and treatment due to vague symptoms and the lack of suspicion of the hemorrhage, and can induce fatal condition, physicians should be aware that the abdominal hemorrhage could occur as a rare but serious complication after CAS without puncture site problems or iatrogenic injury. (Source: Journal of the Neurological Sciences)

Takayasu Arteritis with Coronary Aneurysms Causing Acute Myocardial Infarction in a Young Man.

Texas Heart Institute Journal — Sat, 16 Apr 2011 17:45:06 +0100

Authors: Ouali S, Kacem S, Fradj FB, Gribaa R, Naffeti E, Remedi F, Laaoueni C, Boughzela E Takayasu arteritis is an inflammatory condition that involves the large cardiac vessels, predominantly the aorta and its main branches. It typically affects young women (age, ≤40 yr), most often Asians and Latin Americans. Herein, we describe a rare manifestation of Takayasu arteritis in a 19-year-old black Tunisian man who presented with acute inferior myocardial infarction and complete atrioventricular block after occlusion from a giant aneurysm in the right coronary artery. The coronary artery disease was associated with aneurysmal dilations in the carotid, vertebral, and right renal arteries. Medical therapy improved Thrombolysis in Myocardial Infarction flow in the area of the giant aneur...

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[Renal artery fibromuscular dysplasia.]

Presse Medicale — Thu, 14 Apr 2011 23:00:00 +0100

Authors: Amar L, Azarine A, Carreira E, Vidal-Trécan T, Plouin PF Fibromuscular dysplasia (FMD) encompasses a heterogeneous group of idiopathic, segmental, nonatherosclerotic diseases of the musculature of arterial walls, leading to the narrowing of small and medium-sized arteries. The most common locations of FMD are renal arteries and carotid arteries. The diagnosis of FMD is made on the "string of beads" appearance of the arteries. The French Health Authority recommends performing a CT scan or an MRA to assess the diagnosis of FMD. A recent meta-analysis showed the cure rates using current definitions of hypertension cure are only 36% and 54% after angioplasty and surgery, respectively. PMID: 21498033 [PubMed - as supplied by publisher] (Source: Presse Medicale)

Carotid Artery Stenting without Angioplasty and Cerebral Protection: A Single-Center Experience with up to 7 Years' Follow-Up [INTERVENTIONAL]

American Journal of Neuroradiology — Mon, 11 Apr 2011 23:00:00 +0100

CONCLUSIONS: CASWBAP is effective and safe with a low incidence of periprocedural complications, providing satisfactory long-term clinical results. (Source: American Journal of Neuroradiology)

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

Neuroradiology — Fri, 08 Apr 2011 16:58:26 +0100

Conclusion Unprotected carotid stenting appears to accompany with low early and late complications. Cerebral embolization during CAS is not the only cause of these complications and the use of cerebral protection devices may therefore not prevent all major complications including myocardial infarction, hyperperfusion syndrome, and re-stenosis. Content Type Journal ArticlePages 1-6DOI 10.1007/s00234-011-0867-xAuthors Reza Mohammadian, Neuroscience Research Center (NSRC), Tabriz University of Medical Sciences, P.O Box 51665–348, Tabriz, IranBahram Sohrabi, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, IranReza Mansourizadeh, Neurology Department, Aalinasab Hospital, Tabriz, IranFarideh Mohammadian, Neuroscience Research Center (NSRC...

A new idea for a safer approach to the supra-aortic trunks: the PitonTM catheter.

The Journal of Cardiovascular Surgery — Thu, 31 Mar 2011 23:00:00 +0100

Authors: Setacci C, Moratto R, Sirignano P, Setacci F, Silingardi R, Coppi G Carotid artery disease is among the most common causes of stroke, and stroke is the third leading cause of death in industrialized countries. Thus the personal health and socioeconomic burden of carotid artery disease is significant. Carotid artery disease accounts for approximately 5-12% of new strokes in patients amenable to revascularization therapy. Atherosclerosis is the main reason for stroke and accounts for approximately one third of all cases. Carotid stenting is nowadays considered a valid standard alternative to surgical carotid endarterectomy, especially in patients having a high perioperative risk. The first carotid balloon angioplasty was carried out in 1979 and the first carotid balloon-expandab...

Whole body shaking due to intracranial blood flow steal

Journal of the Neurological Sciences — Wed, 23 Mar 2011 00:00:00 +0100

We report a patient with numerous episodes of whole body shaking in the setting of bilateral carotid occlusions as well as vertebral stenoocclusive disease. These episodes of whole body shaking occurred in the presence of bilateral intracranial blood flow steal phenomenon. After angioplasty of the vertebral artery and initiation of aggressive medical therapy and non-invasive ventilatory correction, intracranial blood flow improved and whole body shaking episodes were resolved during 6-months follow-up. (Source: Journal of the Neurological Sciences)

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Magnetic Resonance Angiography in the Evaluation of Carotid Stent Patency

Perspectives in Vascular Surgery and Endovascular Therapy — Wed, 16 Mar 2011 00:00:00 +0100

This report presents a case of MRA and duplex ultrasonography providing drastically different images, presenting the clinician with an opportunity to evaluate the various imaging modalities that are used in evaluating carotid stent patency. (Source: Perspectives in Vascular Surgery and Endovascular Therapy)

Carotid Artery Stenting Shown To Be Cost-Effective Alternative To Endarterectomy

Health News from Medical News Today — Fri, 04 Mar 2011 11:00:00 +0100

Researchers determined that carotid artery stenting (CAS) with embolic protection is an economically attractive alternative to endarterectomy (END) for patients at increased surgical risk. The study, based on data from the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial, found that initial procedural cost was higher with CAS, but post-procedure hospital stay was shorter which significantly offset associated costs compared to END... (Source: Health News from Medical News Today)

Carotid Artery Stenting without Angioplasty and Cerebral Protection: A Single-Center Experience with up to 7 Years' Follow-Up [INTERVENTIONAL]

American Journal of Neuroradiology — Thu, 24 Feb 2011 00:00:00 +0100

CONCLUSIONS: CASWBAP is effective and safe with a low incidence of periprocedural complications, providing satisfactory long-term clinical results. (Source: American Journal of Neuroradiology)

Role of Inflammation and Insulin Resistance in Endothelial Progenitor Cell Dysfunction.

Diabetes — Wed, 23 Feb 2011 00:00:00 +0100

CONCLUSIONS In conclusion, we have shown that insulin signaling and EPC survival is impaired in Zucker fatty insulin resistant rats. For the first time, we have shown that this defect can be significantly ameliorated by a knockdown of NF-κB and that these EPCs given to Zucker fatty rats decrease neointimal hyperplasia post-carotid angioplasty. PMID: 21346178 [PubMed - as supplied by publisher] (Source: Diabetes)

Angioplasty Associated With Triple Costs And Unclear Safety And Efficacy

Health News from Medical News Today — Mon, 14 Feb 2011 08:00:00 +0100

Angioplasty and stenting of the blood vessels within the skull (intra-cranial vessels) that supply blood to the brain was predominantly performed at urban teaching hospitals and was associated with nearly triple the cost compared to usual care. However, data on the efficacy and safety of these procedures remains uncertain according to late-breaking science reported at the American Stroke Association's International Stroke Conference 2011. Angioplasty and stenting of the carotid arteries in the neck was excluded from this review... (Source: Health News from Medical News Today)

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Carotid Artery Stenting vs Carotid Endarterectomy: Meta-analysis and Diversity-Adjusted Trial Sequential Analysis of Randomized Trials [Original Contribution]

Archives of Neurology — Mon, 14 Feb 2011 00:00:00 +0100

Conclusions In this largest and most comprehensive meta-analysis to date using outcomes that are standard in contemporary studies, CAS was associated with an increased risk of both periprocedural and intermediate to long-term outcomes, but with a reduction in periprocedural MI and cranial nerve injury. Strategies are urgently needed to identify patients who are best served by CAS vs CEA. (Source: Archives of Neurology)

Carotid endarterectomy for treatment of in-stent restenosis after carotid angioplasty and stenting

Journal of Vascular Surgery — Mon, 14 Feb 2011 00:00:00 +0100

Conclusion: CEA with stent explantation for ISR after CAS seems an effective and durable therapeutic option, albeit with potential cerebral and bleeding complications, as in this study. The optimal treatment for carotid ISR, however, has yet to be defined. (Source: Journal of Vascular Surgery)

Carotid Artery Disease and Stenting: Insights From Recent Clinical Trials

Current Treatment Options in Cardiovascular Medicine — Fri, 11 Feb 2011 11:53:41 +0100

Opinion statement Cerebrovascular disease remains a leading cause of morbidity, mortality, and health care expenditure in the United States. Approximately 80% of strokes are ischemic in origin, with 20% to 25% due to atherosclerotic disease of the carotid artery. It is well established that untreated, symptomatic carotid stenosis confers a 25% risk of stroke within 2 years, and that asymptomatic carotid stenosis > 60% is associated with an 11% stroke risk at 5 years. Over the past six decades, surgical revascularization with carotid endarterectomy, when performed by experienced surgeons, has been demonstrated to be effective in reducing stroke risk in patients with severe stenosis. During the same time, medical therapy has improved considerably, and endovascul...

Restenosis Is More Frequent After Carotid Stenting Than After Endarterectomy: The EVA-3S Study.

Stroke — Thu, 10 Feb 2011 00:00:00 +0100

CONCLUSIONS: The short-term rate of carotid restenosis of ≥50% or occlusion is ≈2.5-times more common after CAS than after CEA, a difference accounted for by an excess risk in moderate restenosis. More data with longer follow-up are needed to assess the rates of late severe restenosis and to determine the relation between restenosis and recurrent stroke over time. PMID: 21311065 [PubMed - as supplied by publisher] (Source: Stroke)

Controversies in neurology: asymptomatic carotid stenosis—intervention or just stick to medical therapy. The argument for carotid endarterectomy

Journal of Neural Transmission — Fri, 04 Feb 2011 17:35:37 +0100

Abstract Patients with a significant carotid stenosis are at an increased risk of suffering from a potentially fatal or disabling stroke. The current management strategies available to a patient with an asymptomatic carotid stenosis are either medical therapy alone, or in combination with either carotid endarterectomy, or carotid angioplasty and stenting. Medical therapy alone can reduce the incidence of stroke in general, but whether there is any reduction in stroke attributable to a significant carotid stenosis is less clear. Carotid endarterectomy, on the other hand, has been shown to reduce the incidence of ipsilateral ischaemic stroke in both symptomatic and asymptomatic patients, with the benefits extending into the long-term. Carotid angioplasty and stenting is a ne...

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Rear Polarization of the Microtubule-Organizing Center in Neointimal Smooth Muscle Cells Depends on PKCα, ARPC5, and RHAMM.

The American Journal of Pathology — Tue, 01 Feb 2011 00:00:00 +0100

Authors: Silverman-Gavrila R, Silverman-Gavrila L, Hou G, Zhang M, Charlton M, Bendeck MP Directed migration of smooth muscle cells (SMCs) from the media to the intima in arteries occurs during atherosclerotic plaque formation and during restenosis after angioplasty or stent application. The polarized orientation of the microtubule-organizing center (MTOC) is a key determinant of this process, and we therefore investigated factors that regulate MTOC polarity in vascular SMCs. SMCs migrating in vivo from the medial to the intimal layer of the rat carotid artery following balloon catheter injury were rear polarized, with the MTOC located posterior of the nucleus. In tissue culture, migrating neointimal cells maintained rear polarization, whereas medial cells were front polarized. Using p...

The CREST Results: Another Piece to an Unfinished Puzzle

Annals of Vascular Surgery — Tue, 01 Feb 2011 00:00:00 +0100

The results of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) have been eagerly anticipated for almost a decade. Sponsored by the National Institute of Neurologic Disorders, it is the largest randomized clinical trial comparing percutaneous carotid angioplasty to carotid endarterectomy (CEA) ever conducted, allocating 1321 symptomatic patients with 50-99% carotid stenosis and 1181 asymptomatic patients with 60-99% stenosis to either angioplasty (n=1271) or CEA (n=1251) at 117 centers in the United States and Canada from December 2000 to July 2008. All angioplasty procedures were done using stents and, whenever feasible, cerebral embolic protection devices (Acculink and Accunet systems, Abbott Vascular Solutions, Santa Clara, CA), and the interventionalists were str...

Carotid Artery Stenting

Annals of Vascular Surgery — Tue, 01 Feb 2011 00:00:00 +0100

ALKK, Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärtze Carotid Artery Stent Registry; ARCHeR, ACCULINK for Revascularization of Carotids in High-Risk patients; ARMOUR, Proximal Protection with the MO.MA Device during Carotid Stenting; BEACH, Boston Scientific EPI: A Carotid Stenting Trial for High-Risk Surgical Patients; CABERNET, Carotid Artery Revascularization Using the Boston Scientific FilterWire; EX®/EZ™ and the Endotex™ NexStent®; CARESS, Carotid Revascularization using Endarterectomy or Stenting Systems; CAS, Carotid Artery Stenting; CASES-PMS, CAS with Emboli Protection Surveillance—Post Marketing Study; CAST I, Carotid Artery Stent Trial; CAVATAS, Carotid and Vertebral Transluminal Angioplasty Study; CEA, Carotid Endarterectomy; CREATE, Carotid Revascularizat...

Carotid Surgery Is the Gold Standard for High-Risk (HRP) Carotid Artery Intervention: Five-Year Cost-Effectiveness and Quality Stroke-Free Survival Comparison Between Carotid Endarterectomy (CEA), Carotid Angioplasty, and Stenting Technique (CAST), and Optimal Medical Therapy (OMT)

Journal of Vascular Surgery — Fri, 28 Jan 2011 20:30:45 +0100

Background: Our aim was to conciliate carotid angioplasty and stenting technique (CAST) with CEA and optimal medical therapy (OMT) in high-risk patients. Primary end points were stroke, myocardial infarction, or death. Secondary end points were patency rate, cost-effectiveness, length of hospital stay, reintervention rate, quality of life, Q-TwiST (Quality-Adjusted Time Without Symptoms of Disease or Toxicity of Treatment), and cost per quality-adjusted life-year (QALY). (Source: Journal of Vascular Surgery)

Current Usage and Future Directions for the Bovine Pericardial Patch

Annals of Vascular Surgery — Fri, 28 Jan 2011 00:00:00 +0100

Bovine pericardium (BP) is widely used in surgery and is commonly used as a patch after arteriotomy in cardiovascular surgery. BP patches have several advantages compared with prosthetic patches, including superior biocompatability, easy handling, less suture line bleeding, and possibly reduced rates of infection. These advantages of BP have led to its common use during carotid endarterectomy (CEA). However, long-term clinical results reported after CEA have suggested several issues that may be related to the patch, including restenosis, pseudoaneurysm formation, infection, fibrosis, calcification, and thrombosis. These complications may diminish the long-term efficacy of CEA and suggest potential areas for improvement of surgical patches. Understanding the mechanisms by which BP heals aft...

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Age Modifies the Relative Risk of Stenting versus Endarterectomy for Symptomatic Carotid Stenosis – A Pooled Analysis of EVA-3S, SPACE and ICSS

European Journal of Vascular and Endovascular Surgery — Thu, 27 Jan 2011 00:00:00 +0100

Abstract: Background: Recent randomised controlled trials comparing carotid artery stenting (CAS) with endarterectomy (CEA) for the treatment of symptomatic carotid stenosis were not powered to investigate differences in risks in specific patient subgroups. We therefore performed a pooled analysis of individual patient data from the Symptomatic Severe Carotid Stenosis trial (EVA-3S), the Stent-Protected Angioplasty versus Carotid Endarterectomy trial (SPACE), and the International Carotid Stenting Study (ICSS).Methods: Individual data from all 3433 patients randomised and analysed in these trials were pooled and analysed with fixed-effect binomial regression models adjusted for source trial. The primary outcome event was any stroke or death.Results: In the first 120 days after randomisatio...

FDA Advisory Panel Votes 7-3 to Expand Indications for Carotid Stent

News from Angioplasty.Org — Wed, 26 Jan 2011 17:00:00 +0100

The FDA Circulatory System Devices Panel today voted 7-3 in favor of expanding the indications for carotid artery stenting, specifically for the Abbott Vascular RX Acculink Carotid Stent System. (Source: News from Angioplasty.Org)

Age Modifies the Relative Risk of Stenting versus Endarterectomy for Symptomatic Carotid Stenosis - A Pooled Analysis of EVA-3S, SPACE and ICSS.

PubMed: Eur J Vasc Endovasc ... — Mon, 24 Jan 2011 00:00:00 +0100

Authors: Bonati LH, Fraedrich G, BACKGROUND: Recent randomised controlled trials comparing carotid artery stenting (CAS) with endarterectomy (CEA) for the treatment of symptomatic carotid stenosis were not powered to investigate differences in risks in specific patient subgroups. We therefore performed a pooled analysis of individual patient data from the Symptomatic Severe Carotid Stenosis trial (EVA-3S), the Stent-Protected Angioplasty versus Carotid Endarterectomy trial (SPACE), and the International Carotid Stenting Study (ICSS). METHODS: Individual data from all 3433 patients randomised and analysed in these trials were pooled and analysed with fixed-effect binomial regression models adjusted for source trial. The primary outcome event was any stroke or death. RESULTS: In the fir...

Characterizing the Unstable Plaque: Grey Scale Median and Microscopic Debris Analysis Predict Greater Embolic Risk In Symptomatic CAS Patients

Journal of Surgical Research — Wed, 19 Jan 2011 20:26:58 +0100

Introduction: Symptomatic patients undergoing carotid angioplasty and stenting (CAS) may be at greater embolic risk than asymptomatic patients. Our goal is to correlate plaque echolucency and microscopic debris characteristics with carotid plaque instability in symptomatic patients undergoing CAS. Methods: 244 CAS procedures were performed between 2003-2010. Plaque echomorphology of 52 consecutive patients was determined by gray scale median (GSM) with image normalization (blood: GSM 0-5, adventitia: GSM 185-195). Echolucent (EL) and echogenic (EG) plaques were defined by GSM (Source: Journal of Surgical Research)

Aged Rats Have Increased Neointimal Thickening And Altered MCP-1/CCR2 Expression After Carotid Angioplasty

Journal of Surgical Research — Wed, 19 Jan 2011 20:25:42 +0100

(Source: Journal of Surgical Research)

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Synchronous carotid artery stenting and open heart surgery

Journal of Vascular Surgery — Wed, 19 Jan 2011 00:00:00 +0100

Conclusions: In our experience, CAS followed immediately by cardiac surgery is safe and represents a reasonable option for selected patients presenting with severe carotid and coronary disease. (Source: Journal of Vascular Surgery)

Diagnosis, management, and future developments of fibromuscular dysplasia

Journal of Vascular Surgery — Fri, 14 Jan 2011 00:00:00 +0100

Fibromuscular dysplasia (FMD) is a nonatherosclerotic noninflammatory vascular disease that primarily affects women from age 20 to 60, but may also occur in infants and children, men, and the elderly. It most commonly affects the renal and carotid arteries but has been observed in almost every artery in the body. FMD has been considered rare and thus is often underdiagnosed and poorly understood by many health care providers. There are, however, data to suggest that FMD is much more common than previously thought, perhaps affecting as many as 4% of adult women. When it affects the renal arteries, the most common presentation is hypertension. When it affects the carotid or vertebral arteries, the patient may present with transient ischemic attack or stroke, or dissection. An increasing numb...

Size and nature of emboli produced during carotid artery angioplasty and stenting: In vivo study

International Journal of Surgery — Mon, 10 Jan 2011 00:00:00 +0100

Conclusions: Filter-type EPDs collect debris of significant quantity and size during the CAS procedure as performed in our institution. The collected material was likely dislocated from the atherosclerotic plaque. CT calcium scoring allows us to predict the nature of material captured by the EPD. These data may allow the clinician to individualise care during CAS and thus reduce peri-operative risk. (Source: International Journal of Surgery)

The distribution and size of ischemic lesions after carotid artery angioplasty and stenting: Evidence for microembolization to terminal arteries

Journal of Vascular Surgery — Mon, 10 Jan 2011 00:00:00 +0100

Background: Much of the brain is perfused by penetrating arteries that are the “single source” of blood to their surrounding tissues. These tissues should be equally vulnerable to ischemia from embolic occlusion, but there are questions about whether emboli have access to the penetrating arteries serving the deep brain tissues. To examine this issue in humans we recorded the number and distribution of new ischemic lesions on diffusion-weighted magnetic resonance imaging (DWMRI) after carotid artery stenting (CAS), a procedure producing showers of numerous small atheroemboli.Methods: Twenty-nine men (aged 62-81) underwent 30 CAS procedures with distal protection in place, and DWMRI 48 hours after the procedure documented new lesions had developed. Thirteen patients were asymptomatic, an...

Internal Carotid Artery Stenosis: Natural History and Management

Seminars in Neurology — Tue, 04 Jan 2011 00:00:00 +0100

Semin Neurol 2010; 30: 518-527DOI: 10.1055/s-0030-1268864ABSTRACTExtracranial internal carotid artery stenosis is an important cause of ipsilateral stroke. The natural history of the disease is related to the presence or absence of ipsilateral hemispheric symptoms and the severity of stenosis. Doppler ultrasound is commonly used as a screening test, with more advanced noninvasive imaging studies such as computerized tomography angiography (CTA) and magnetic resonance angiography (MRA) utilized as confirmatory tests if invasive treatment is contemplated. With less-invasive imaging techniques, traditional catheter angiography is rarely indicated for the diagnosis of carotid stenosis. Medical therapy remains the mainstay of treatment in patients with asymptomatic stenosis. Invasive treatment ...

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Duplex criteria for determining >=50% and >=80% internal carotid artery stenosis following carotid endarterectomy with patch angioplasty.

Vascular — Sat, 01 Jan 2011 00:00:00 +0100

Authors: Aburahma AF The purpose of this study was to determine optimal velocities for detecting ≥50% and ≥80% restenosis prior to considering carotid intervention/carotid artery stenting (CAS) after carotid endarterectomy (CEA) with patching in symptomatic and asymptomatic patients. Two hundred CEA patients with 195 pairs of imaging (duplex ultrasound versus computed tomography angiography [CTA]/carotid arteriography) were analyzed. Peak systolic velocities (PSVs), end diastolic velocity (EDV) and internal carotid artery/common carotid artery (ICA/CCA) ratios were correlated to angiography. Receiver operator characteristic (ROC) curves determined optimal velocity criteria in detecting ≥50% and ≥80% restenosis. The mean PSVs for ≥50% and ≥80% restenosis were 248 and 404 c/s...

Systematic review of randomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy.

Asian Journal of Surgery — Sat, 01 Jan 2011 00:00:00 +0100

Authors: Rerkasem K, Rothwell PM Patch angioplasty during carotid endarterectomy (CEA) can reduce the risk of perioperative stroke or late carotid artery recurrent stenosis and subsequent ischaemic stroke. We aimed to update our previous systematic review of randomized controlled trials (RCTs) of routine or selective carotid patch angioplasty compared with CEA with primary closure, and of different materials used for carotid patch angioplasty. PMID: 21515211 [PubMed - in process] (Source: Asian Journal of Surgery)

Anatomical and Technical Factors Associated With Stroke or Death During Carotid Angioplasty and Stenting: Results From the Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S) Trial and Systematic Review.

Stroke — Thu, 23 Dec 2010 00:00:00 +0100

CONCLUSIONS: Our results strongly suggest that some technical and anatomic factors, especially extreme angulation of the carotid artery, have an impact on the risks of carotid angioplasty and stenting. PMID: 21183750 [PubMed - as supplied by publisher] (Source: Stroke)

Patients’ Radiation Doses During the Implantation of Stents in Carotid, Renal, Iliac, Femoral and Popliteal Arteries

European Journal of Vascular and Endovascular Surgery — Mon, 13 Dec 2010 00:00:00 +0100

Conclusions: In procedures performed on the arteries of the lower limbs, a significantly higher dose was received by patients with TASC II C lesions. With regard to the number of stents implanted, the total DAP value was 50% higher for simultaneous three-stent implantation than for one or two stents. (Source: European Journal of Vascular and Endovascular Surgery)

Patients' Radiation Doses During the Implantation of Stents in Carotid, Renal, Iliac, Femoral and Popliteal Arteries.

PubMed: Eur J Vasc Endovasc ... — Fri, 10 Dec 2010 00:00:00 +0100

CONCLUSIONS: In procedures performed on the arteries of the lower limbs, a significantly higher dose was received by patients with TASC II C lesions. With regard to the number of stents implanted, the total DAP value was 50% higher for simultaneous three-stent implantation than for one or two stents. PMID: 21147004 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

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Cerebrospinal Fluid Enhancement on Fluid Attenuated Inversion Recovery Images After Carotid Artery Stenting with Neuroprotective Balloon Occlusions: Hemodynamic Instability and Blood–Brain Barrier Disruption

CardioVascular and Interventional Radiology — Fri, 03 Dec 2010 06:57:27 +0100

Conclusions Ischemic intolerance for severe carotid artery stenosis and temporary neuroprotective balloon occlusion, causing reperfusion injury, seem to be the main factors that underlie BBB disruption with delayed CSF space enhancement shortly after CAS, rather than sudden poststenting hemodynamic change. Our results suggest that factors related to hemodynamic instability or ischemic intolerance seem to be associated with post-CAS BBB vulnerability. Patients at risk for hemodynamic instability or with ischemic intolerance, which decrease BBB integrity, require careful management to prevent intracranial hemorrhagic and other post-CAS complications. Content Type Journal ArticleDOI 10.1007/s00270-010-0035-4Authors Ryo Ogami, Department of Neurosurgery, Mazda Hospit...

Carotid endarterectomy in the acute phase of crescendo cerebral transient ischemic attacks is safe and effective

Journal of Vascular Surgery — Fri, 03 Dec 2010 00:00:00 +0100

Conclusions: Short delay between symptom onset and neurological assessment, immediate start of secondary stroke prevention, optimal perioperative medical treatment, and standardized operative techniques enabled performance of CEA in the acute phase of CcTIAs with low combined risk of stroke, death, and major cardiac event. (Source: Journal of Vascular Surgery)

Carotid Stenting vs Endarterectomy: New Results in Perspective

Mayo Clinic Proceedings — Wed, 01 Dec 2010 00:00:00 +0100

Carotid artery stenosis is a major risk factor for stroke, and treatments for this condition to decrease the risk of stroke include medical therapy, carotid endarterectomy (CEA), and, more recently, carotid angioplasty and stenting (CAS). Randomized controlled trials comparing the efficacy of CEA vs medical therapy showed a clear benefit for CEA in patients with symptomatic carotid artery stenosis of greater than 70% and a lesser benefit in patients with 50% to 69% stenosis. Treatments have evolved in the ensuing 20 years, and a new method, CAS, has emerged as a possible alternative to CEA. In early results, CAS proved feasible but did not compare favorably with CEA. Later and larger-scale studies comparing CAS to CEA failed to reach conclusions regarding a clear neurologic outcome advanta...

Impact of stent design on the outcome of intervention for carotid bifurcation stenosis.

The Journal of Cardiovascular Surgery — Wed, 01 Dec 2010 00:00:00 +0100

Authors: Hart JP, Bosiers M, Deloose K, Uflacker R, Schönholz CJ Over the past several years, there has been continued significant interest in refinement of patient selection, devices, procedures and protocols in an effort to optimize the outcome of percutaneous intervention for carotid bifurcation stenosis, including: ongoing National Institutes of Health and manufacturer trials and registries; the further refinement of existing devices and emergence of new platforms to attain distal embolic protection; ongoing study of what really constitutes a high-risk carotid surgery or stenting patient; and attention to device characteristics and patient-device matching. Within the latter area, considerable interest has focused on stent characteristics that have the potential to impact short and...

National Utilization and Outcome of Carotid Artery Revascularization in Octogenarians

Journal of Vascular Surgery — Wed, 01 Dec 2010 00:00:00 +0100

The objective of this study was to examine the national utilization and outcome of CEA and CAS in octogenarians. (Source: Journal of Vascular Surgery)

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Carotid Endarterectomy for Treatment of Instent Restenosis

Journal of Vascular Surgery — Wed, 01 Dec 2010 00:00:00 +0100

Carotid stenting is now an established option in the treatment of carotid stenosis. Recurrent stenosis following carotid stenting, however, can be a management challenge. Repeat angioplasty may be ineffective or result in recurrent instent stenosis. Obtaining distal control of the internal carotid artery above the stented segment may be difficult. Instent restenosis was encountered in three patients who underwent successful surgical endarterectomy of the stented segment. (Source: Journal of Vascular Surgery)

Interventional Management of Asymptomatic Extracranial Carotid Stenosis

Current Cardiology Reports — Tue, 23 Nov 2010 18:17:00 +0100

Abstract Carotid artery stenosis is a major risk factor for stroke and transient ischemic attack. Although carotid endarterectomy is the established gold standard for carotid revascularization, carotid artery angioplasty and stenting (CAS)—proven by large randomized clinical trials and rigorous registries and supported by improving stent designs, embolic protection, and increasing neurointerventionalist experience—is developing into a safer and more efficacious method of stroke prevention. Today, protected CAS is approved for symptomatic and asymptomatic patients with severe carotid stenosis with high surgical risk. We reviewed recently published data regarding new developments in the use of protected CAS, particularly in patients with carotid stenosis who are either a...

FGF-23 and future cardiovascular events in patients with chronic kidney disease before initiation of dialysis treatment

Nephrology Dialysis Transplantation — Mon, 22 Nov 2010 00:00:00 +0100

Conclusions. Elevated FGF-23 plasma levels predict cardiovascular events in CKD patients not on dialysis therapy. This finding complements two recent cohort studies in which incident and prevalent haemodialysis patients with highest FGF-23 levels had worst survival. Lowering FGF-23 levels (e.g. by oral phosphate binder medication) could emerge as a promising new therapeutic option to reduce cardiovascular morbidity in CKD patients. (Source: Nephrology Dialysis Transplantation)

Improved Hemodynamic Outcomes With Glycopyrrolate Over Atropine in Carotid Angioplasty and Stenting

Perspectives in Vascular Surgery and Endovascular Therapy — Mon, 22 Nov 2010 00:00:00 +0100

Conclusions: Prophylactic glycopyrrolate, compared with atropine, reduces hemodynamic instability during CAS. The authors recommend glycopyrrolate use to prevent CAS-induced bradycardia and hypotension. (Source: Perspectives in Vascular Surgery and Endovascular Therapy)

Beyond The CREST Researchers Call For New Trials To Resolve Issues Surrounding Surgical Intervention For Carotid Artery Stenosis

Health News from Medical News Today — Fri, 19 Nov 2010 08:00:00 +0100

As the debate continues to swirl around the preliminary findings of the CREST (Carotid Revascularization Endartarectomy versus Stent Trial), with proponents of carotid endarterectomy (CEA) and those favoring carotid angioplasty and stenting (CAS) both claiming superiority for their preferred intervention, Wesley S. Moore, M.D... (Source: Health News from Medical News Today)

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National trends in utilization and postprocedure outcomes for carotid artery revascularization 2005 to 2007

Journal of Vascular Surgery — Fri, 19 Nov 2010 00:00:00 +0100

Conclusion: Utilization of CAS has increased from the years 2005 to 2007 with some improvements in the outcome. Despite improvements in outcome, resource utilization remains significantly higher for CAS than CEA. (Source: Journal of Vascular Surgery)

Divergent roles of NF-κB and Egr-1 in flow-dependent restenosis after angioplasty and stenting

Atherosclerosis — Mon, 15 Nov 2010 00:00:00 +0100

Conclusions: We conclude that Egr-1 plays a pivotal role in intima formation under all flow conditions and that NF-κB plays a key role in flow-sensitive remodelling after angioplasty and that NF-κB inhibition likely accounts for a significant part of the morphological effects of PDTC after vessel injury. (Source: Atherosclerosis)

Carotid stenting in acute ischemic stroke patients with intraluminal thrombus

Neuroradiology — Thu, 04 Nov 2010 17:46:27 +0100

Conclusions Stent assisted angioplasty is a feasible treatment option for acute ischemic stroke patients caused by carotid stenosis with intraluminal thrombus and may be effective in preventing early recurrent stroke. Content Type Journal ArticleDOI 10.1007/s00234-010-0788-0Authors Tai Hyung Kwon, Department of Radiology, Yonsei University College of Medicine, 250 Seongsanno, Seoul, 120-752 South KoreaByung Moon Kim, Department of Radiology, Yonsei University College of Medicine, 250 Seongsanno, Seoul, 120-752 South KoreaHyo Suk Nam, Department of Neurology, Yonsei University College of Medicine, Seoul, South KoreaYoung Dae Kim, Department of Neurology, Yonsei University College of Medicine, Seoul, South KoreaJi Hoe Heo, Department of Neurology, Yonsei University Col...

Reflections by contrarians on the post‐CREST evaluation of carotid stenting for stroke prevention

International Journal of Stroke — Wed, 03 Nov 2010 22:03:28 +0100

Carotid angioplasty and stenting has become a popular alternative to carotid endarterectomy for the treatment of carotid stenosis in stroke. Evidence from early randomized controlled trials comparing these interventions revealed mixed results. The largest such trial, the Carotid Revascularization Endarterectomy vs. Stenting Trial recently showed equivalence of the procedures in a mixed cohort of both symptomatic and asymptomatic patients. These results have been heralded in North America as definitively demonstrating the safety and efficacy of carotid angioplasty and stenting, making it an attractive alternative to carotid endarterectomy. It is therefore probable that many more asymptomatic patients will be subjected to Carotid angioplasty and stenting, perceived by many to be less invasiv...

Essential role of ER-{alpha}-dependent NO production in resveratrol-mediated inhibition of restenosis

AJP: Heart and Circulatory Physiology — Fri, 29 Oct 2010 00:00:00 +0100

Resveratrol (Resv), a red wine polyphenol, is known to exhibit vascular protective effects and reduce vascular smooth muscle cell mitogenesis. Vascular smooth muscle cell proliferation is a critical factor in the pathogenesis of restenosis, the renarrowing of vessels that often occurs after angioplasty and/or stent implantation. Although Resv has been shown to be an estrogen receptor (ER) modulator, the role of the ER in Resv-mediated protection against restenosis has not yet been elucidated in vivo. Therefore, with the use of a mouse carotid artery injury model, our objective was to determine the role of ER in modulating Resv-mediated effects on neointimal hyperplasia. Female wild-type and ER-–/– mice were administered a high-fat diet ± Resv for 2 wk. A carotid artery e...

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Treating Metabolic Syndrome, Undergoing Carotid Angioplasty Recommended In Revised Recurrent Stroke Prevention Guidelines

Health News from Medical News Today — Fri, 22 Oct 2010 13:00:00 +0100

Treating metabolic syndrome and undergoing carotid angioplasty may prevent recurrent stroke or transient ischemic attack (TIA), according to revised American Heart Association/American Stroke Association guidelines. Last updated in 2006, the evidence-based guidelines for doctors will be published in Stroke: Journal of the American Heart Association. "Patients who've had a stroke or TIA are at highest risk for having another event," said Karen Furie, M.D., M.P.H., writing committee chair and stroke neurologist... (Source: Health News from Medical News Today)

Treating Metabolic Syndrome, Undergoing Carotid Angioplasty Recommended in Revised Recurrent Stroke Prevention Guidelines

MedlinePlus Health News — Fri, 22 Oct 2010 05:32:50 +0100

Source: American Heart Association Related MedlinePlus Pages: Angioplasty, Metabolic Syndrome, Stroke (Source: MedlinePlus Health News)

Effects of statins on early and late results of carotid stenting

Journal of Vascular Surgery — Thu, 21 Oct 2010 00:00:00 +0100

Conclusions: These data suggest that statins use is associated with decreased perioperative and late ischemic strokes risk and reduced mortality rates in patients undergoing CAS. Statins therapy should be considered part of the best medical treatment in current CAS practice. (Source: Journal of Vascular Surgery)

Discussion

Journal of Vascular Surgery — Thu, 21 Oct 2010 00:00:00 +0100

Dr Peter Henke (Ann Arbor, Mich). What is the duration of statins that you recommend prior to the carotid angioplasty and stenting? In other words, how many of these patients had been on a statin a week before, had been on for 6 months, or a year before? Whether you can add these medications acutely, just prior to a procedure, is an important question. Do you have any information on that? (Source: Journal of Vascular Surgery)

Treatment of Carotid Artery Disease: Endarterectomy or Angioplasty?

Current Neurology and Neuroscience Reports — Wed, 20 Oct 2010 00:47:26 +0100

Abstract The management of carotid stenosis has enjoyed renewed interest in the neurological community in recent years due to the advent of endovascular approaches. In concert, progress in medical treatment of these patients has rekindled the debate regarding the best management of carotid stenosis overall, both for symptomatic and asymptomatic disease. For symptomatic carotid stenosis, the major decision required is choosing the type of intervention best suited for individual patients: carotid endarterectomy versus carotid artery stenting. For patients with asymptomatic carotid stenosis, intensive medical management has evolved significantly over the past decade to decrease the risk of ischemic stroke to match surgical intervention under most circumstances. This review wi...

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Carotid Artery Stenting vs Carotid Endarterectomy: Meta-analysis and Diversity-Adjusted Trial Sequential Analysis of Randomized Trials [Original Contribution]

Archives of Neurology — Mon, 11 Oct 2010 19:42:53 +0100

The I{kappa}B Kinase Inhibitor Nuclear Factor-{kappa}B Essential Modulator-Binding Domain Peptide for Inhibition of Balloon Injury-Induced Neointimal Formation.

Arteriosclerosis, Thrombosis and Vascular Biology — Wed, 06 Oct 2010 23:00:00 +0100

CONCLUSIONS: The NBD peptide reduces neointimal formation and smooth muscle cell proliferation/migration, both effects associated with the inhibition of NF-κB activation. PMID: 20930169 [PubMed - as supplied by publisher] (Source: Arteriosclerosis, Thrombosis and Vascular Biology)

Early outcomes after carotid angioplasty with stenting performed by neurologists

Annals of Indian Academy of Neurology — Wed, 06 Oct 2010 15:47:19 +0100

Conclusions: We conclude that neurologists, with adequate training, can develop and add this technical skill to the existing cognitive skill of vascular neurology and safely perform stenting. (Source: Annals of Indian Academy of Neurology)

Symptomatic Vertebral Artery Stent Fracture: A Case Report

Journal of Vascular and Interventional Radiology : JVIR — Tue, 28 Sep 2010 23:00:00 +0100

Percutaneous transluminal angioplasty (PTA) with stent placement is the preferred treatment modality at present for atherosclerotic stenotic lesions of vertebral artery origin. A complication of stent placement in the vertebral artery origin that has received little attention is the risk of stent fracture. A case with four-vessel pathology treated with PTA and stent placement in the left vertebral artery origin is presented. Symptoms recurred 4 months after stent placement, and arteriogram revealed a fractured stent, which was treated surgically with stent removal and vertebral artery–common carotid artery reimplantation. (Source: Journal of Vascular and Interventional Radiology : JVIR)

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New brain lesions after carotid revascularization are not associated with cognitive performance

Journal of Vascular Surgery — Mon, 27 Sep 2010 00:00:00 +0100

Conclusions: The findings support the assumption that new brain lesions, as detected with DWI after CAS or CEA, do not affect cognitive performance in a manner that is long-lasting or clinically relevant. Despite the higher embolic load detected by DWI, CAS is not associated with a greater cognitive decline than CEA. (Source: Journal of Vascular Surgery)

[Comment] Lessons from carotid endarterectomy and stenting trials

LANCET — Thu, 23 Sep 2010 23:00:00 +0100

In trial after trial, carotid stenting (CAS) does not replace carotid endarterectomy (CEA) for symptomatic carotid stenosis revascularisation. In The Lancet today, a meta-analysis of pooled individual patient data from the Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial, the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) trial, and the International Carotid Stenting Study (ICSS) confirms the higher periprocedural risk of stroke or death rate with CAS than with CEA (8·9% vs 5·8%). However, the investigators found heterogeneity between different age-groups, with a significant difference recorded only between CAS and CEA in patients older than 70 years (12·0% vs 5·9%, risk ratio 2·04, 95% CI 1·48–2·82, interacti...

[Articles] Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patient data

LANCET — Thu, 23 Sep 2010 23:00:00 +0100

In patients with recently symptomatic carotid stenosis, carotid endarterectomy reduces the risk of further stroke. In the past few years, endovascular treatment with placement of a stent has emerged as an alternative to carotid endarterectomy. Outcomes after stenting were not worse than those after endarterectomy in the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial, in which the two procedures were compared in patients with increased surgical risk, who also mostly had asymptomatic carotid stenosis. By contrast, results from several large trials in patients with symptomatic carotid stenosis who were judged to be at standard surgical risk—the Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3...

Trials in Progress

Perspectives in Vascular Surgery and Endovascular Therapy — Tue, 21 Sep 2010 05:19:02 +0100

Nine completed randomized clinical trials (RCTs) failed to show any advantage of carotid angioplasty and stenting (CAS) over carotid surgery, whereas a number of larger trials were recently developed and are still ongoing or have just released interim data analysis. These new RCTs, giving emphasis to CAS carried out with appropriate credentialing and updated technology should be appropriately powered. According to last published data, carotid revascularization performed by highly qualified surgeons and interventionalists might be safe and effective; nevertheless, stroke is more likely after carotid stenting, whereas myocardial infarction is more likely after surgery, and the 2 risks need to be balanced in selecting the indication for treatment in specific patients. It is hoped that ongoing...