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https://www.readbyqxmd.com/read/28539213/medical-management-of-asymptomatic-carotid-artery-stenosis
#1
REVIEW
Aaron W Aday, Joshua A Beckman
Carotid artery atherosclerosis is a major risk factor for both stroke and cardiovascular disease. Appropriate management of asymptomatic patients with carotid artery stenosis (CAS) remains unclear. Although several randomized clinical trials support revascularization in asymptomatic patients with severe CAS to reduce stroke risk, the participants in these trials did not receive optimal medical therapy (OMT) by today's standards. For many individuals, medical therapy may provide excellent risk reduction without the periprocedural risk of endarterectomy or stenting...
May 21, 2017: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/28535731/transcervical-carotid-stent-placement-in-the-setting-of-a-hostile-neck-and-a-type-iii-aortic-arch
#2
Lauren A Huntress, Naiem Nassiri, Randy Shafritz, Saum A Rahimi
Previous radical neck dissection and neck irradiation pose considerable operative risks in patients requiring carotid endarterectomy for symptomatic carotid disease. Carotid stenting is an acceptable alternative for these patients but carries a higher risk of cerebrovascular accidents especially in patients with type III aortic arch anatomy. Herein, we present a technically challenging case of a patient with an irradiated neck and a history of radical neck dissection who presented with a symptomatic high-grade left internal carotid artery stenosis in the setting of a type III aortic arch...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28533078/simulation-of-carotid-artery-stenting-reduces-training-procedure-and-fluoroscopy-times
#3
Andre F Gosling, Daniel E Kendrick, Ann H Kim, Anil Nagavalli, Ethan S Kimball, Nathaniel T Liu, Vikram S Kashyap, John C Wang
OBJECTIVE: Outcomes from carotid artery stenting (CAS) are related to experience and technical expertise of the operator. Simulation of CAS may enhance clinical proficiency. We interrogated the impact of endovascular simulation of CAS procedures in operators who are at various stages of training. METHODS: Twelve trainees (students [n = 4]; junior surgery residents, postgraduate year [PGY] 1-3 [n = 4]; and senior surgery residents or fellows, PGY 4-7 [n = 4]) were apprised of characteristics of an endovascular simulator and CAS procedures...
May 19, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28530160/eagle-syndrome-a-case-report-of-stylocarotid-syndrome-with-internal-carotid-artery-dissection
#4
Travis W Smoot, Ammar Taha, Nicholas Tarlov, Blake Riebe
Eagle syndrome is defined by an elongated styloid process or a calcified stylohyoid ligament that impinges on surrounding structures and causes a variety of symptoms. Classically, Eagle syndrome presents as neck, throat, or ear pain. The vascular variant, stylocarotid syndrome, can present as headache, transient ischemic attack, or stroke. Carotid artery dissection is a rare complication of stylocarotid syndrome. We report a case of stylocarotid syndrome in a 60-year-old man who presented with a right internal carotid artery (ICA) dissection and focal neurological deficits...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28528662/carotid-stenting-in-patients-with-high-risk-versus-standard-risk-for-open-carotid-endarterectomy-real-1-trial
#5
Joaquin De Haro, Ignacio Michel, Silvia Bleda, Cristina Cañibano, Francisco Acin
Carotid stenting (CAS) has been mainly offered to those patients considered at "high risk" for open carotid endarterectomy based on available data from large randomized clinical trials. However, several recent studies have called medical "high risk" into question for CAS indication. The REAL-1 trial evaluated the safety and perioperative and long-term effectiveness in patients with significant carotid artery stenosis with "high-risk" criteria treated with CAS and proximal protection device (MOMA) compared with those with standard surgical-risk features...
April 26, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28527925/carotid-artery-stenting-should-remain-an-alternative-to-endarterectomy-in-selected-patients
#6
EDITORIAL
Peter A Schneider
No abstract text is available yet for this article.
June 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28527924/who-benefits-from-carotid-artery-stenting
#7
EDITORIAL
Kosmas I Paraskevas, Frank J Veith
No abstract text is available yet for this article.
June 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28516094/combined-transapical-transcatheter-aortic-valve-replacement-and-thoracic-endovascular-aortic-repair-for-severe-aortic-stenosis-and-arch-aneurysm
#8
Yuanjia Zhu, Eric E Roselli, Jay J Idrees, Samir Kapadia, Lars G Svensson
An 83-year-old male with multiple comorbidities presented with critical aortic stenosis and a saccular aortic arch aneurysm. Through a mini thoracotomy, a balloon expandable transcatheter aortic valve was delivered transapically. A thoracic stent graft was then delivered through the prosthetic valve and deployed in the arch, while a covered stent was deployed in the left common carotid artery. Three-year postoperative computed tomography showed a thrombosed arch aneurysm with decreased size. This case demonstrates the feasibility of using combined transapical transcatheter technologies to treat multicomponent disease in a high-risk patient during a single operation...
October 2016: Aorta (Stamford, Conn.)
https://www.readbyqxmd.com/read/28513115/endarterectomy-or-stenting-in-severe-asymptomatic-carotid-stenosis
#9
Dallit Mannheim, Batla Falah, Ron Karmeli
BACKGROUND: Stroke is a major cause of death in the western world, and carotid endarterectomy has been shown to be effective in treating both symptomatic and asymptomatic carotid stenosis. Carotid stenting is a relatively new form of treatment for carotid stenosis and few studies have looked specifically at asymptomatic patients. OBJECTIVES: To retrospectively examine short- and long-term results in the treatment of asymptomatic carotid artery stenosis with surgery or stenting...
May 2017: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28504557/carotid-angioplasty-assisted-mechanical-thrombectomy-without-urgent-stenting-may-be-a-better-option-in-acute-tandem-occlusions
#10
Cetin K Akpinar, Erdem Gürkaş, Emrah Aytac
Background The aim of the study was to assess the efficacy of balloon angioplasty-assisted mechanical thrombectomy without urgent stenting in the carotid artery as another approach for endovascular treatment of tandem occlusions. Methods Fifteen consecutive cases of tandem occlusions treated with the endovascular approach between January 2014 and May 2016 were reviewed. The study cohort included patients with an etiology of large vessel atherosclerosis. Extracranial carotid stenting was performed in another session if post-thrombectomy mRS modified Rankin Score (mRS) was 0-2...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28502547/carotid-artery-stenting-is-associated-with-a-higher-incidence-of-major-adverse-clinical-events-than-carotid-endarterectomy-in-female-patients
#11
Kyla M Bennett, John E Scarborough
BACKGROUND: The optimal approach to carotid revascularization in female patients with carotid artery stenosis is widely debated. Information available is largely derived from clinical trials that include only highly selected patients. The goal of this study was to compare the early clinical outcomes in women who undergo carotid artery stenting (CAS) vs carotid endarterectomy (CEA). METHODS: Female patients undergoing CAS or CEA between January 1, 2012 and December 31, 2015, and who were included in the Procedure Targeted American College of Surgeons National Surgical Quality Improvement Program were assessed for their incidence of early postoperative complications...
May 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28502544/first-experience-with-the-double-chimney-technique-in-the-treatment-of-aortic-arch-diseases
#12
Tun Wang, Chang Shu, Quan-Ming Li, Ming Li, Xin Li, Hao He, Alan Dardik, Jian Qiu
OBJECTIVE: The objective of this study was to summarize our initial experience using the double chimney technique to treat aortic arch diseases. METHODS: From December 2009 to October 2016, 23 patients with aortic arch diseases, including 20 acute aortic dissections, 2 aortic arch aneurysms, and 1 type I endoleak after thoracic endovascular aortic repair (TEVAR), were treated using a double chimney technique. An emergent operation was performed in only one patient with an acute aortic dissection for severe left lower extremity ischemia...
May 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28502543/the-association-of-carotid-revascularization-endarterectomy-versus-stent-trial-crest-and-centers-for-medicare-and-medicaid-services-carotid-guideline-publication-on-utilization-and-outcomes-of-carotid-stenting-among-high-risk-patients
#13
Gregory G Salzler, Alik Farber, Denis V Rybin, Gheorghe Doros, Jeffrey J Siracuse, Mohammad H Eslami
OBJECTIVE: Since the 2004 approval by the United States Food and Drug Administration of carotid artery stenting (CAS), there have been two seminal publications about CAS reimbursement (Centers for Medicare and Medicaid Services guidelines; 2008) and clinical outcomes (Carotid Revascularization Endarterectomy versus Stent Trial [CREST]; 2010). We explored the association between these publications and national trends in CAS use among high-risk symptomatic patients. METHODS: The most recent congruent data sets of the Nationwide Inpatient Sample (NIS) were queried for patients undergoing carotid revascularization...
May 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28498234/long-term-outcomes-of-carotid-endarterectomy-versus-stenting-in-a-multicenter-population-based-canadian-study
#14
Mohamad A Hussain, Muhammad Mamdani, Jack V Tu, Gustavo Saposnik, Badr Aljabri, Deepak L Bhatt, Subodh Verma, Mohammed Al-Omran
OBJECTIVE: To compare the long-term outcomes of patients treated with carotid endarterectomy and carotid-artery stenting. BACKGROUND: Evidence for the long-term safety and efficacy of carotid-artery stenting compared with endarterectomy is accumulating from randomized trials. However, comparative data on the long-term outcomes of carotid revascularization strategies in real world practice are lacking. METHODS: We conducted a population-based, multicenter, observational cohort study using validated linked databases from Ontario, Canada...
May 11, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28495538/clinical-outcome-of-carotid-artery-stenting-according-to-provider-specialty-and-volume
#15
Ali F AbuRahma, John E Campbell, Nizar Hariri, Joseph AbuRahma, L Scott Dean, Mark C Bates, Aravinda Nanjundappa, Patrick A Stone, Ace O'vil
BACKGROUND: Several studies have demonstrated better outcomes for carotid endarterectomy (CEA) with high-volume hospitals and providers. However, only a few studies have reported on the impact of operator specialty/volume on the perioperative outcome of carotid artery stenting (CAS). This study will analyze the correlation of CAS outcomes and provider specialty and volume. METHODS: Prospectively collected data of CAS procedures done at our institution during a 10-year period were analyzed...
May 8, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28495179/impact-of-hypertriglyceridemia-on-carotid-stenosis-progression-under-normal-low-density-lipoprotein-cholesterol-levels
#16
Masayuki Kitagami, Ryuta Yasuda, Naoki Toma, Masato Shiba, Mai Nampei, Yoko Yamamoto, Yoshinari Nakatsuka, Hiroshi Sakaida, Hidenori Suzuki
BACKGROUND: Dyslipidemia is a well-known risk factor for carotid stenosis progression, but triglycerides have attracted little attention. The aim of this study was to assess if serum triglycerides affect progression of carotid stenosis in patients with well-controlled low-density lipoprotein cholesterol (LDL-C) levels. METHODS: This is a retrospective study in a single hospital consisting of 71 Japanese patients with internal carotid artery stenosis greater than or equal to 50% and normal serum LDL-C levels who underwent angiographic examination with or without the resultant carotid artery stenting or endarterectomy from 2007 to 2011, and were subsequently followed up for 4 years...
May 8, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28487806/synchronous-carotid-bifurcation-endarterectomy-and-retrograde-kissing-stenting-of-the-innominate-and-left-common-carotid-artery-in-a-patient-with-a-bovine-aortic-arch
#17
Alessandro Robaldo, Guido Carignano, Alberto Balderi, Claudio Novali
Management of the symptomatic multiple stenosis of supra-aortic vessels (MSSVs) in a "bovine" aortic arch (BAA) configuration is infrequently reported. The optimal treatment choice remains debatable. A successful hybrid treatment for a proximal critical stenosis of the innominate and left common carotid artery was performed in a high-risk patient with a tandem symptomatic lesion in the right carotid bifurcation and a concentric vulnerable plaque in the bovine trunk. This case supports the feasibility, safety, and efficacy of a combined carotid bifurcation endarterectomy and retrograde kissing stenting of common carotid arteries with cerebral protection after evaluation of radiological, anatomical, and clinical parameters...
2017: Case Reports in Surgery
https://www.readbyqxmd.com/read/28485278/30-day-results-from-prospective-multi-specialty-evaluation-of-carotid-artery-stenting-using-the-cguard-micronet-covered-embolic-prevention-stent-system-in-real-world-multicenter-clinical-practice-the-iron-guard-study
#18
Francesco Speziale, Laura Capoccia, Pasqualino Sirignano, Wassim Mansour, Chiara Pranteda, Renato Casana, Carlo Setacci
AIMS: The aim of the present study was to evaluate peri-procedural and 30-day outcomes in a prospective series of patients treated with the CGuard embolic prevention stent system (EPS). METHODS AND RESULTS: From April 2015 to June 2016 a physician-initiated prospective multicenter study was performed in 200 consecutive patients admitted to protected carotid artery stenting (CAS) and treated using CGuard EPS in twelve Vascular Centers. Outcome measures were: technical success, periprocedural (0-24 hours) and post- procedural (24hours-30 days) major and minor strokes, death, acute myocardial infarction (AMI), transient ischemic attack (TIA), and external carotid occlusion...
May 9, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28483628/acute-early-carotid-stent-thrombosis-a-case-series
#19
Konstantinos G Moulakakis, John Kakisis, Georgios Tsivgoulis, Vasilis Zymvragoudakis, Stavros Spiliopoulos, Andreas Lazaris, Giorgos S Sfyroeras, Spyridon N Mylonas, Spyridon N Vasdekis, George Geroulakos, Elias N Brountzos
PURPOSE: Acute early carotid stent thrombosis (AcuteCST) is a rare complication after carotid artery stenting (CAS). Purpose of this retrospective study was to investigate the incidence, causes and optimal management of AcuteCST. METHODS: Medical records of all patients undergoing CAS between 2008 and 2016 were retrospectively reviewed. Time of thrombosis, grade of stenosis, lesion side, pre and post-procedural anticoagulants, causes, symptoms, treatment, recanalization and outcome were reviewed...
May 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28483614/proximal-embolic-protection-devices-in-complicated-carotid-artery-stenting
#20
Andrea Gaggiano, Holta Kasemi, Antonella Laurito, Andrea Monti, Mauro Maselli, Paola Manzo, Simone Quaglino, Francesca Sperti
The most frequent complication during carotid artery stenting (CAS) is intraoperative distal embolization. Three categories of embolic protection devices (EPDs) are routinely used through a transfemoral or transcervical approach: distal occlusion devices, distal EPDs with flow preservation using filters and the proximal occlusive protective systems. We report the case of the internal carotid artery (ICA) plaque rupture during CAS using a proximal embolic protection device (the Mo.Ma system, Invatec), treated with immediate surgery...
May 5, 2017: Annals of Vascular Surgery
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