WorldWideScience

Sample records for carotid stenting study

  1. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study) : an interim analysis of a randomised controlled trial

    NARCIS (Netherlands)

    Ederle, Joerg; Dobson, Joanna; Featherstone, Roland L.; Bonati, Leo H.; van der Worp, H. Bart; de Borst, Gert J.; Lo, T. Hauw; Gaines, Peter; Dorman, Paul J.; Macdonald, Sumaira; Lyrer, Philippe A.; Hendriks, Johanna M.; McCollum, Charles; Nederkoorn, Paul J.; Brown, Martin M.; Algra, A.; Bamford, J.; Beard, J.; Bland, M.; Bradbury, A. W.; Brown, M. M.; Clifton, A.; Gaines, P.; Hacke, W.; Halliday, A.; Malik, I.; Mas, J. L.; McGuire, A. J.; Sidhu, P.; Venables, G.; Bradbury, A.; Brown, M. M.; Clifton, A.; Gaines, P.; Collins, R.; Molynewc, A.; Naylor, R.; Warlow, C.; Ferro, J. M.; Thomas, D.; Bonati, L. H.; Coward, L.; Dobson, J.; Ederle, J.; Featherstone, R. F.; Tindall, H.; McCabe, D. J. H.; Wallis, A.; Brooks, M.; Chambers, B.; Chan, A.; Chu, P.; Clark, D.; Dewey, H.; Donnan, G.; Fell, G.; Hoare, M.; Molan, M.; Roberts, A.; Roberts, N.; Beiles, B.; Bladin, C.; Clifford, C.; Fell, G.; Grigg, M.; New, G.; Bell, R.; Bower, S.; Chong, W.; Holt, M.; Saunder, A.; Than, P. G.; Gett, S.; Leggett, D.; McGahan, T.; Quinn, J.; Ray, M.; Wong, A.; Woodruff, P.; Foreman, R.; Schultz, D.; Scroop, R.; Stanley, B.; Allard, B.; Atkinson, N.; Cambell, W.; Davies, S.; Field, P.; Milne, P.; Mitchell, P.; Tress, B.; Yan, B.; Beasley, A.; Dunbabin, D.; Stary, D.; Walker, S.; Cras, P.; d'Archambeau, O.; Hendriks, J. M. H.; Van Schil, P.; Bosiers, M.; Deloose, K.; van Buggenhout, E.; De Letter, J.; Devos, V.; Ghekiere, J.; Vanhooren, G.; Astarci, P.; Hammer, F.; Lacroix, V.; Peeters, A.; Verhelst, R.; DeJaegher, L.; Peeters, A.; Verbist, J.; Blair, J-F; Caron, J. L.; Daneault, N.; Giroux, M-F; Guilbert, F.; Lanthier, S.; Lebrun, L-H; Oliva, V.; Raymond, J.; Roy, D.; Soulez, G.; Weill, A.; Hill, M.; Hu, W.; Hudion, M.; Morrish, W.; Sutherland, G.; Wong, J.; Alback, A.; Harno, H.; Ijas, P.; Kaste, M.; Lepantalo, M.; Mustanoja, S.; Paananen, T.; Porras, M.; Putaala, J.; Railo, M.; Sairanen, T.; Soinne, L.; Vehmas, A.; Vikatmaa, P.; Goertler, M.; Halloul, Z.; Skalej, M.; Brennan, P.; Kelly, C.; Leahy, A.; Moroney, J.; Thornton, J.; Koelemay, M. J. W.; Nederkoorn, P. J.; Reekers, J. A. A.; Roos, Y. B. W. E. M.; Hendriks, J. M.; Koudstaal, P. J.; Pattynama, P. M. T.; van der Lugt, A.; van Dijk, L. C.; van Sambeek, M. R. H. M.; van Urk, H.; Verhagen, H. J. M.; Bruininckx, C. M. A.; de Bruijn, S. F.; Keunen, R.; Knippenberg, B.; Mosch, A.; Treurniet, F.; van Dijk, L.; van Overhagen, H.; Wever, J.; de Beer, F. C.; van den Berg, J. S. P.; van Hasselt, B. A. A. M.; Zeilstra, D. J.; Boiten, J.; van Otterloo, J. C. A. de Mol; de Vries, A. C.; Nieholt, G. J. Lycklama A.; van der Kallen, B. F. W.; Blankensteijn, J. D.; De Leeuw, F. E.; Kool, L. J. Schultze; van der Vliet, J. A.; de Borst, G. J.; de Kort, G. A. P.; Kapelle, L. J.; Lo, T. H.; Mali, W. P. Th M.; Moll, F.; van der Worp, H. Bart; Verhagen, H.; Barber, P. A.; Bourchier, R.; Hill, A.; Holden, A.; Stewart, J.; Bakke, S. J.; Krohg-Sorensen, K.; Skjelland, M.; Tennoe, B.; Bialek, P.; Biejat, Z.; Czepiel, W.; Czlonkowska, A.; Dowzenko, A.; Jedrzejewska, J.; Kobayashi, A.; Lelek, M.; Polanski, J.; Kirbis, J.; Milosevic, Z.; Zvan, B.; Blasco, J.; Chamorro, A.; Macho, J.; Obach, V.; Riambau, V.; San Roman, L.; Branera, J.; Canovas, D.; Estela, Jordi; Gimenez Gaibar, A.; Perendreu, J.; Bjorses, K.; Gottsater, A.; Ivancev, K.; Maetzsch, T.; Sonesson, B.; Berg, B.; Delle, M.; Formgren, J.; Gillgren, P.; Kall, T-B; Konrad, P.; Nyman, N.; Takolander, R.; Andersson, T.; Malmstedt, J.; Soderman, M.; Wahlgren, C.; Wahlgren, N.; Binaghi, S.; Hirt, L.; Michel, P.; Ruchat, P.; Bonati, L. H.; Engelter, S. T.; Fluri, F.; Guerke, L.; Jacob, A. L.; Kirsch, E.; Lyrer, P. A.; Radue, E-W; Stierli, P.; Wasner, M.; Wetzel, S.; Bonvin, C.; Kalangos, A.; Lovblad, K.; Murith, N.; Ruefenacht, D.; Sztajzel, R.; Higgins, N.; Kirkpatrick, P. J.; Martin, P.; Adam, D.; Bell, J.; Bradbury, A. W.; Crowe, P.; Gannon, M.; Henderson, M. J.; Sandler, D.; Shinton, R. A.; Scriven, J. M.; Wilmink, T.; D'Souza, S.; Egun, A.; Guta, R.; Punekar, S.; Seriki, D. M.; Thomson, G.; Brennan, A.; Enevoldson, T. P.; Gilling-Smith, G.; Gould, D. A.; Harris, P. L.; McWilliams, R. G.; Nasser, H-C; White, R.; Prakash, K. G.; Serracino-Inglott, F.; Subramanian, G.; Symth, J. V.; Walker, M. G.; Clarke, M.; Davis, M.; Dixit, S. A.; Dolman, P.; Dyker, A.; Ford, G.; Golkar, A.; Jackson, R.; Jayakrishnan, V.; Lambert, D.; Lees, T.; Louw, S.; Macdonald, S.; Mendelow, A. D.; Rodgers, H.; Rose, J.; Stansby, G.; Wyatt, M.; Baker, T.; Baldwin, N.; Jones, L.; Mitchell, D.; Munro, E.; Thornton, M.; Baker, D.; Davis, N.; Hamilton, G.; McCabe, D.; Platts, A.; Tibballs, J.; Beard, J.; Cleveland, T.; Dodd, D.; Gaines, P.; Lonsdale, R.; Nair, R.; Nassef, A.; Nawaz, S.; Venables, G.; Belli, A.; Clifton, A.; Cloud, G.; Halliday, A.; Markus, H.; McFarland, R.; Morgan, R.; Pereira, A.; Thompson, A.; Chataway, J.; Cheshire, N.; Gibbs, R.; Hammady, M.; Jenkins, M.; Malik, I.; Wolfe, J.; Adiseshiah, M.; Bishop, C.; Brew, S.; Brookes, J.; Brown, M. M.; Jaeger, R.; Kitchen, N.; Ashleigh, R.; Butterfield, S.; Gamble, G. E.; McCollum, C.; Nasim, A.; O'Neill, P.; Wong, J.; Edwards, R. D.; Lees, K. R.; MacKay, A. J.; Moss, J.; Rogers, P.

    2010-01-01

    Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid

  2. Carotid stenting

    International Nuclear Information System (INIS)

    Full text: The annual incidence of stroke is estimated around 2 cases per 1000 in the general population and 80% of strokes are ischemic. [1] Atherosclerotic disease resulting in stenosis of common and/or internal carotid arteries is an established risk factor for acute cerebrovascular events. [2] In the majority of the cases ischemic stroke is caused by atherosclerotic plaque rupture and subsequent thrombus formation resulting in carotid occlusion or/and distal thromboembolization. Today, two invasive methods are available in order to reduce the risk of severe ischemic events: surgical carotid artery endarterectomy (CEA) and percutaneous carotid artery stenting (CAS). More recently amassed high-level scientific data coming from randomized controlled trials (RCTs) and meta-analysis comparing CAS with CEA have emerged. [3] Initial RTCs included the French EVA 3S, which investigated 527 symptomatic patients in 30 different centers, the German SPACE investigating 1.200 patients and the International ICSS which randomized 1710 patients. In EVA 3S the 30-day rate of any stroke death was significantly lower in the CEA group (3.9 vs. 9.6%, HR: 2.5). However the trial was prematurely stopped and severely criticized. [4] The SPACE trial resulted in a similar rate of ipsilateral stroke or death at 30-days and 2 years follow-up (6.8% CAS vs. 6.3% CEA), while in the ICSS trial the primary endpoint of all strokes, death and myocardial infarction (MI) was significantly lower in the CAS group (5.2% vs. 8.5%). Finally, the most recent CREST (Carotid Revascularization Endarterectomy vs. Stenting) trial randomized 2.502 patients (1.321 symptomatic). The composite primary endpoint of any stroke, death and MI was similar between the two methods (CAS: 7.2% vs. CEA: 6.8%; HR=1.11), while both methods demonstrated similar short- and longer-term outcomes. However significant differences between the components were detected (stroke 4.1% vs. 2.3%, P=0.012; and MI 1.1% vs. 2.3%, p=0.032, CAS

  3. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial.

    LENUS (Irish Health Repository)

    Ederle, Jörg

    2010-03-20

    Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy.

  4. Carotid artery stenting

    International Nuclear Information System (INIS)

    An ipsilateral stenosis of the internal carotid artery is found in 10 - 15 % of all ischemic strokes and indicates an increased risk of a second stroke. Carotid artery stenting (CAS) is a therapy that is established for many years. CAS reveals complication rates and long-term efficacy comparable to carotid endarterectomy (TEA). Especially younger patients seem to benefit from CAS. Abilities and experiences of the therapist and the choice of the techniques used are critical for patient safety. The efficacy of CAS for treatment of asymptomatic carotid stenosis is probable but still unproven in prospective-randomized trial. (orig.)

  5. Carotid artery stenting; Karotisangioplastie

    Energy Technology Data Exchange (ETDEWEB)

    Fiehler, Jens [Universitaetsklinikum Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum

    2009-09-15

    An ipsilateral stenosis of the internal carotid artery is found in 10 - 15 % of all ischemic strokes and indicates an increased risk of a second stroke. Carotid artery stenting (CAS) is a therapy that is established for many years. CAS reveals complication rates and long-term efficacy comparable to carotid endarterectomy (TEA). Especially younger patients seem to benefit from CAS. Abilities and experiences of the therapist and the choice of the techniques used are critical for patient safety. The efficacy of CAS for treatment of asymptomatic carotid stenosis is probable but still unproven in prospective-randomized trial. (orig.)

  6. Carotid stenting and endarterectomy.

    Science.gov (United States)

    Yip, Hon-Kan; Sung, Pei-Hsun; Wu, Chiung-Jen; Yu, Cheuk-Man

    2016-07-01

    Stroke, either ischemic or hemorrhagic, remains the second commonest cause of death worldwide in the last decade. Etiologies for ischemic stroke (IS) vary widely. Atherothrombotic occlusion is an essential cause to which carotid artery stenosis (CAS) is a major contributor. Administration of anti-platelet agent to patients with CAS has been shown to reduce incidence of long-term IS. In additional, in patients with symptomatic CAS, clinical trials have demonstrated that carotid endarterectomy (CEA) is superior to medical therapy for prevention of future CAS-related IS. However, CEA is not suitable for CAS post-radiotherapy or those located at higher level of the internal carotid artery; and major complications of this procedure including cranial nerve injuries have stimulated the interest of using percutaneous transfemoral carotid stenting as an alternative approach. Although transfemoral arterial approach of carotid stenting is not inferior to CEA in improving clinical outcomes, it has been reported to be associated with vascular complication and has its limitations in patients with athero-occlusive disease of abdominal aorta or bilateral iliac arteries, level II or III aortic arch, or bovine type carotid arterial anatomy. Therefore, transradial/transbrachial arterial approach has emerged as a novel method for carotid stenting. This article provides a critical review on interventional approaches for the treatment of CAS. PMID:27061654

  7. Flow Velocities After Carotid Artery Stenting: Impact of Stent Design. A Fluid Dynamics Study in a Carotid Artery Model with Laser Doppler Anemometry

    International Nuclear Information System (INIS)

    Purpose. To study the influence of a newly developed membrane stent design on flow patterns in a physiologic carotid artery model. Methods. Three different stents were positioned in silicone models of the carotid artery: a stainless steel stent (Wall-stent), a nitinol stent (SelfX), and a nitinol stent with a semipermeable membrane (MembraX). To increase the contact area of the membrane with the vessel wall, another MembranX model was modified at the outflow tract. The membrane consists of a biocompatible silicone-polyurethane copolymer (Elast-Eon) with a pore size of 100 μm. All stents were deployed across the bifurcation and the external carotid artery origin. Flow velocity measurements were performed with laser Doppler anemometry (LDA), using pulsatile flow conditions (Re = 220; flow 0.39 l/min; flow rate ratio ICA:ECA = 70:30) in hemodynamically relevant cross-sections. The hemodynamic changes were analyzed by comparing velocity fluctuations of corresponding flow profiles. Results. The flow rate ratio ICA:ECA shifted significantly from 70/30 to 73.9/26.1 in the MembraX and remained nearly unchanged in the SelfX and Wallstent. There were no changes in the flow patterns at the inflow proximal to the stents. In the stent no relevant changes were found in the SelfX. In the Wallstent the separation zone shifted from the orifice of the ICA to the distal end of the stent. Four millimeters distal to the SelfX and the Wallstent the flow profile returned to normal. In the MembraX an increase in the central slipstreams was found with creation of a flow separation distal to the stent. With a modification of the membrane this flow separation vanished. In the ECA flow disturbances were seen at the inner wall distal to the stent struts in the SelfX and the Wallstent. With the MembraX a calming of flow could be observed in the ECA with a slight loss of flow volume. Conclusions. Stent placement across the carotid artery bifurcation induces alterations of the physiologic flow

  8. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... important thing also is that with the current role of using carotid stent angioplasty, we can get ... study results are pending, which will determine the role of carotid stenting in the healthier patients, the ...

  9. Morphological and hemodynamic patterns of carotid stenosis treated by endarterectomy with patch closure versus stenting: a duplex ultrasound study

    Directory of Open Access Journals (Sweden)

    Marcia Maria Morales

    2010-01-01

    Full Text Available OBJECTIVES: A duplex ultrasound study was performed to investigate morphological and hemodynamic patterns of carotid stenoses treated by endarterectomy with patch closure versus stenting. MATERIALS AND METHOD: Twenty-nine carotid stenoses were treated with stenting and 65 with patch closure. Duplex ultrasound parameters (luminal diameter, mm; peak systolic velocity and end-diastolic velocity, cm/s were measured 24 hours after the procedures and also at 12 months post-procedure. Residual stenoses (immediately postprocedure and restenoses (within 12 months of procedure were defined as narrowings of >50% on duplex ultrasound examination. RESULTS: In stented patients, the luminal diameter of the proximal internal carotid artery increased in the interval between the 24-hour and 12-month post-procedure studies, while in the patch closure patients, the diameter decreased. Carotid hemodynamics normalized immediately after both patching and stenting and remained relatively stable thereafter up to 12 months. No statistically elevated flow velocities (in the absence of residual stenosis or restenosis were observed in the patched or stented carotid arteries. No significant differences in residual stenosis rates were observed between the stenting group (3 cases, 10.34% and the patch closure group (1 case, 1.53%, P = 0.08. At 12 months, 2 stenting patients (6.88% and 2 patch closure patients (3.07% had $50% restenosis (P = 0.58. One case of late stroke due to restenosis was observed in the stenting group; the patient died 12 months postoperatively, before receiving new intervention. CONCLUSION: Measurements over time in luminal diameter signalized differences in arterial remodeling mechanisms between patched and stented carotids. Both stenting and patch closure were associated with carotid patency and flow restoration. This study does not support a general approach to new velocity criteria indiscriminately applied to stented or patched carotids.

  10. Morphological and hemodynamic patterns of carotid stenosis treated by endarterectomy with patch closure versus stenting: a duplex ultrasound study

    Science.gov (United States)

    Morales, Marcia Maria; Anacleto, Alexandre; Buchdid, Marcello Azem; Simeoni, Paulo Ricardo Baggio; Ledesma, Sérgio; Cêntola, Crescêncio; Anacleto, João Carlos; Aldrovani, Marcela; Piccinato, Carlos Eli

    2010-01-01

    OBJECTIVES: A duplex ultrasound study was performed to investigate morphological and hemodynamic patterns of carotid stenoses treated by endarterectomy with patch closure versus stenting. MATERIALS AND METHOD: Twenty‐nine carotid stenoses were treated with stenting and 65 with patch closure. Duplex ultrasound parameters (luminal diameter, mm; peak systolic velocity and end‐diastolic velocity, cm/s) were measured 24 hours after the procedures and also at 12 months post‐procedure. Residual stenoses (immediately post‐procedure) and restenoses (within 12 months of procedure) were defined as narrowings of ≥50% on duplex ultrasound examination. RESULTS: In stented patients, the luminal diameter of the proximal internal carotid artery increased in the interval between the 24‐hour and 12‐month post‐procedure studies, while in the patch closure patients, the diameter decreased. Carotid hemodynamics normalized immediately after both patching and stenting and remained relatively stable thereafter up to 12 months. No statistically elevated flow velocities (in the absence of residual stenosis or restenosis) were observed in the patched or stented carotid arteries. No significant differences in residual stenosis rates were observed between the stenting group (3 cases, 10.34%) and the patch closure group (1 case, 1.53%, P  =  0.08). At 12 months, 2 stenting patients (6.88%) and 2 patch closure patients (3.07%) had ≥50% restenosis (P  =  0.58). One case of late stroke due to restenosis was observed in the stenting group; the patient died 12 months postoperatively, before receiving new intervention. CONCLUSION: Measurements over time in luminal diameter signalized differences in arterial remodeling mechanisms between patched and stented carotids. Both stenting and patch closure were associated with carotid patency and flow restoration. This study does not support a general approach to new velocity criteria indiscriminately applied to stented or

  11. Carotid stenting versus carotid endarterectomy : Evidence basis and cost implications

    NARCIS (Netherlands)

    Janssen, M. P.; de Borst, G. J.; Mali, W. P. Th. M.; Kappelle, L. J.; Moll, F. L.; Ackerstaff, R. G. A.; Rothwell, P. M.; Brown, M. M.; van Sambeek, M. R.; Buskens, E.

    2008-01-01

    Objective: Carotid Angioplasty combined with Stenting (CAS) is increasingly performed because of its presumed benefits. A study was performed to identify key factors that determine the cost-effectiveness as compared to conventional carotid endarterectomy (CEA). Methods: The incremental cost-effectiv

  12. Efficiency of ultrasonography and CT angiography in follow-up studies of carotid stent and percutaneous transluminal angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Chang Woo; Lee, Byung Hee; Chung, Bong Sub; Ahn, Jung Yong; Heo, Kyung; Kho, Young Sik [Pundang CHA General Hospital, Pochon CHA Univ. College of Medicine, Pochon (Korea, Republic of)

    1999-12-01

    The aim of this study was to determine a more appropriate method for follow-up of carotid stenting by comparing the efficiency of US and CT angiography. Eleven carotid arteries of seven patients(men:5, women:2, mean age:56.4years) who underwent stent placement and percutaneous transluminal angioplasty(PTA) because of carotid stenosis were studied. The follow-up periods ranged from three to eleven (mean, five) months, and US and CT angiography were performed in one day. Color duplex sonography was performed with a 10 MHz linear array transducer. After spiral CT scan were obtained, MPR images were reconstructed on a workstation. Retrospective imaging analysis specifically focused on [1] stent configuration, [2] the accuracy of internal diameter measurement, [3] the detection of blood flow and the measurement of blood flow velocity, [4] the presence of atheroma and intraluminal thrombi, [5] the measurement of stent location, and [6] artifacts. US was more accurate than CT angiography for measuring internal diameter. In all cases, US and CT angiography were able to detect the blood flow at carotid artery, and utilizing the Doppler spectrum, flow velocity was measured. US showed atheromas in all cases but CT angiography demonstrated calcified atheromas in three cases only. In six cases, US failed to determine stent location, though in this respect CT angiography was successful in all cases. Artifacts of US were small reverberation artifact(11/11) of the stent and a defective color Doppler signal caused by acoustic shadowing of atheroma calcification(3/11). Artifacts of CT angiogrpahy were hardbeam artifact of the stent(11/11) and motion artifact(3/11). US was superior to CT angiography in accuracy of measuring stent diameter, hemodynamic assessment, high-resolution views of the luminal state of the stent and minimal artifacts for the non-invasive follow-up studies of carotid stenting.

  13. Efficiency of ultrasonography and CT angiography in follow-up studies of carotid stent and percutaneous transluminal angioplasty

    International Nuclear Information System (INIS)

    The aim of this study was to determine a more appropriate method for follow-up of carotid stenting by comparing the efficiency of US and CT angiography. Eleven carotid arteries of seven patients(men:5, women:2, mean age:56.4years) who underwent stent placement and percutaneous transluminal angioplasty(PTA) because of carotid stenosis were studied. The follow-up periods ranged from three to eleven (mean, five) months, and US and CT angiography were performed in one day. Color duplex sonography was performed with a 10 MHz linear array transducer. After spiral CT scan were obtained, MPR images were reconstructed on a workstation. Retrospective imaging analysis specifically focused on [1] stent configuration, [2] the accuracy of internal diameter measurement, [3] the detection of blood flow and the measurement of blood flow velocity, [4] the presence of atheroma and intraluminal thrombi, [5] the measurement of stent location, and [6] artifacts. US was more accurate than CT angiography for measuring internal diameter. In all cases, US and CT angiography were able to detect the blood flow at carotid artery, and utilizing the Doppler spectrum, flow velocity was measured. US showed atheromas in all cases but CT angiography demonstrated calcified atheromas in three cases only. In six cases, US failed to determine stent location, though in this respect CT angiography was successful in all cases. Artifacts of US were small reverberation artifact(11/11) of the stent and a defective color Doppler signal caused by acoustic shadowing of atheroma calcification(3/11). Artifacts of CT angiogrpahy were hardbeam artifact of the stent(11/11) and motion artifact(3/11). US was superior to CT angiography in accuracy of measuring stent diameter, hemodynamic assessment, high-resolution views of the luminal state of the stent and minimal artifacts for the non-invasive follow-up studies of carotid stenting

  14. Cervical carotid pseudoaneurysm: A carotid artery stenting complication

    OpenAIRE

    Raso, Jair; Darwich, Rogerio; Ornellas, Carlos; Cariri, Gustavo

    2011-01-01

    Background: As carotid artery stenting becomes increasingly used, more complications are likely to occur. We present a case of Staphylococcus septicemia and pseudoaneurysm arising in the neck portion of the carotid artery after stenting. Case Description: A 51-year-old man was admitted with mild left hemiparesis. CT and MRI showed right hemisphere ischemia. Duplex Scan and MRA showed bilateral severe stenosis of the carotid arteries in the neck. A percutaneous angioplasty with stenting of the...

  15. Treatment of distal internal carotid artery aneurysm with the willis covered stent: a prospective pilot study

    International Nuclear Information System (INIS)

    Objective: To evaluate the flexibility and efficacy of the Willis covered stent in the treatment of distal internal carotid artery (DICA) aneurysms. Methods: The study was approved by the authors' institutional review board, and the research was conducted by the authors' institution and the MicroPort Medical Company (Shanghai, China). Thirty-one patients with 33 DICA aneurysms were considered for treatment with a Willis covered stent. The angiographic assessments were categorized as complete or incomplete occlusion. The data on technical success, initial and final angiographic results, mortality, morbidity, and final clinical outcome were collected, and follow-up was performed at 1, 3, 6, and 12 months and yearly after the procedures. Results: Navigation and deployment of the covered stents were successful in 97.6% (41 of 42; 95% confidence interval [CI]: 93%, 102%) of the attempted stent placement procedures. The initial angiographic results showed a complete occlusion in 23 patients with 25 aneurysms (of 32 aneurysms, 78.1% [95% CI: 63%, 93%]) and an incomplete occlusion in seven patients with seven aneurysms (21.9%). The angiographic follow-up (mean, 14 months [95% CI: 12, 15 months]) findings exhibited a complete occlusion in 27 patients with 29 aneurysms (of 31 aneurysms, 93.5% [95% CI: 84%, 103%]) and an incomplete occlusion in two aneurysms (6.5%), with a mild in-stent stenosis in two patients.The clinical follow-up (mean, 27 months [95% CI: 23, 30 months]) demonstrated that 15 patients experienced a full recovery and 14 patients improved. Conclusion: The preliminary results demonstrate good flexibility and efficacy of the Willis covered stent in the treatment of DICA aneurysms in selected patients; longer follow-up and expanded clinical trials are needed. (authors)

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

    LENUS (Irish Health Repository)

    Ederle, Jörg

    2009-10-01

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

  17. Hyperperfusion syndrome after carotid stent angioplasty

    International Nuclear Information System (INIS)

    This study assesses the incidence and causes of hyperperfusion syndrome occurring after carotid artery stenting (CAS). We retrospectively reviewed the clinical database of 417 consecutive patients who were treated with CAS in our department to identify patients who developed hyperperfusion syndrome and/or intracranial hemorrhage. Magnetic resonance imaging (MRI) including fluid-attenuated inversion recovery and diffusion-weighted imaging was performed before and after CAS in 269 cases. A Spearman's rho nonparametric correlation was performed to determine whether there was a correlation between the occurrence/development of hyperperfusion syndrome and the patient's age, degree of stenosis on the stented and contralateral side, risk factors such as diabetes, smoking, hypertension, adiposity, gender and fluoroscopy time, and mean area of postprocedural lesions as well as preexisting lesions. Significance was established at p < 0.05. Of the 417 carotid arteries stented and where MRI was also completed, we found hyperperfusion syndrome in 2.4% (ten cases). Patients who had preexisting brain lesions (previous or acute stroke) were at a higher risk of developing hyperperfusion syndrome (p = 0.022; Spearman's rho test). We could not validate any correlation with the other patient characteristics. Extensive microvascular disease may be a predictor of hyperperfusion syndrome after carotid stent placement. We believe that further studies are warranted to predict more accurately which patients are at greater risk of developing this often fatal complication. (orig.)

  18. Hyperperfusion syndrome after carotid stent angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Grunwald, I.Q.; Politi, M.; Reith, W.; Krick, C.; Karp, K.; Zimmer, A.; Struffert, T.; Kuehn, A.L.; Papanagiotou, P. [University of the Saarland, Department for Interventional and Diagnostic Neuroradiology, Homburg (Germany); Roth, C.; Haass, A. [University of the Saarland, Clinic for Neurology, Homburg (Germany)

    2009-03-15

    This study assesses the incidence and causes of hyperperfusion syndrome occurring after carotid artery stenting (CAS). We retrospectively reviewed the clinical database of 417 consecutive patients who were treated with CAS in our department to identify patients who developed hyperperfusion syndrome and/or intracranial hemorrhage. Magnetic resonance imaging (MRI) including fluid-attenuated inversion recovery and diffusion-weighted imaging was performed before and after CAS in 269 cases. A Spearman's rho nonparametric correlation was performed to determine whether there was a correlation between the occurrence/development of hyperperfusion syndrome and the patient's age, degree of stenosis on the stented and contralateral side, risk factors such as diabetes, smoking, hypertension, adiposity, gender and fluoroscopy time, and mean area of postprocedural lesions as well as preexisting lesions. Significance was established at p < 0.05. Of the 417 carotid arteries stented and where MRI was also completed, we found hyperperfusion syndrome in 2.4% (ten cases). Patients who had preexisting brain lesions (previous or acute stroke) were at a higher risk of developing hyperperfusion syndrome (p = 0.022; Spearman's rho test). We could not validate any correlation with the other patient characteristics. Extensive microvascular disease may be a predictor of hyperperfusion syndrome after carotid stent placement. We believe that further studies are warranted to predict more accurately which patients are at greater risk of developing this often fatal complication. (orig.)

  19. Carotid artery stenting versus endarterectomy: a systematic review.

    Science.gov (United States)

    Gahremanpour, Amir; Perin, Emerson C; Silva, Guilherme

    2012-01-01

    For about 2 decades, investigators have been comparing carotid endarterectomy with carotid artery stenting in regard to their effectiveness and safety in treating carotid artery stenosis. We conducted a systematic review to summarize and appraise the available evidence provided by randomized trials, meta-analyses, and registries comparing the clinical outcomes of the 2 procedures. We searched the MEDLINE, SciVerse Scopus, and Cochrane databases and the bibliographies of pertinent textbooks and articles to identify these studies. The results of clinical trials and, consequently, the meta-analyses of those trials produced conflicting results regarding the comparative effectiveness and safety of carotid endarterectomy and carotid stenting. These conflicting results arose because of differences in patient population, trial design, outcome measures, and variability among centers in the endovascular devices used and in operator skills. Careful appraisal of the trials and meta-analyses, particularly the most recent and largest National Institutes of Health-sponsored trial (the Carotid Revascularization Endarterectomy vs Stenting Trial [CREST]), showed that carotid stenting and endarterectomy were associated with similar rates of death and disabling stroke. Within the 30-day periprocedural period, carotid stenting was associated with higher risks of stroke, especially for patients aged >70 years, whereas carotid endarterectomy was associated with a higher risk of myocardial infarction. The slightly higher cost of stenting compared with endarterectomy was within an acceptable range by cost-effectiveness standards. We conclude that carotid artery stenting is an equivalent alternative to carotid endarterectomy when patient age and anatomy, surgical risk, and operator experience are considered in the choice of treatment approach. PMID:22949763

  20. Carotid intervention: stent or surgery? A prospective audit

    OpenAIRE

    Robbs, JV; Mulaudzi, T; Paruk, N; Pillay, B; Rajaruthnam, P

    2009-01-01

    Summary This study represents a prospective audit comparing carotid artery stenting (CAS) with carotid endarterectomy (CEA), performed by a single surgical team. Between January 2005 and December 2008, 440 patients were referred; 177 had CAS and 263 CEA. Selection of procedure was individualised and contra-indications for CAS included internal carotid artery (ICA) stenosis > 85–90%, intraluminal thrombus, ICA tortuosity, gross surface ulceration of plaque and excessive calcification. Type III...

  1. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available INNOVATIONS IN STROKE PREVENTION: AN UPDATE ON CAROTID STENTING NEW YORK-PRESBYTERIAN HOSPITAL NEW YORK, NY July ... MD: Good evening. Welcome to our webcast on innovations in stroke prevention: an update on carotid stenting. ...

  2. The use of covered stents for the endovascular treatment of extracranial internal carotid artery stenosis: a prospective study with a 5-year follow-up

    International Nuclear Information System (INIS)

    To evaluate the safety and feasibility of the use of covered stents for the treatment of extracranial carotid artery stenosis caused by highly embologenic plaques, and to study the long-term outcome of patients receiving such covered stents. Between 2002 and 2007, 46 patients (63% symptomatic, 78.3% male, 67 ± 8.6 years old) with internal carotid artery stenosis caused by embologenic plaques or restenosis were treated with self-expanding covered stents (Symbiot, Boston Scientific). Pre-dilatation or protecting devices were not used. Post-dilatation was applied in every patient. Each patient was followed long-term. The outcome measures were the occurrence of neurological events, and the development of in-stent restenosis, as detected by clinical examination and duplex ultrasound. The technical success rate of stenting was 100%. There were no neurological complications in the peri-procedural period. The mean follow-up period was 34.3 ± 27.7 months (the rate of patients lost to follow-up was 15.2%) during which no stroke or stroke-related deaths occurred. Restenosis was detected in 3 patients (6.5%). Covered stents provide efficient peri- and post-procedural protection against neurological complications due to embolisation from high-risk plaques during carotid artery stenting. Restenosis of covered stents appears to be infrequent during long-term follow-up. (orig.)

  3. Cognitive changes after carotid artery stenting

    Energy Technology Data Exchange (ETDEWEB)

    Grunwald, I.Q.; Politi, M.; Struffert, T.; Krick, C.; Backens, M. [University of the Saarland, Department for Diagnostic and Interventional Neuroradiology, Homburg (Germany); Supprian, T.; Falkai, P.; Reith, W. [University of the Saarland, Clinic for Psychiatry and Psychotherapy, Homburg (Germany)

    2006-05-15

    We aimed to test changes in cognitive performance after carotid artery stenting (CAS). Ten patients were neuropsychologically tested at least 24 h before and 48 h after CAS. To diminish thromboembolic events, we used a proximal protection device. The following neuropsychological tests were selected: The Mini Mental State Examination (MMSE), symbol digit test and subtests of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery (verbal fluency, constructional practice, word list memory and delayed recall). Affective state was determined by the Beck Depression Score (BDS). No patient suffered from depression (BDS <1) or dementia (MMSE 29.9{+-}1.5). Nine of the ten patients (P=0.12) showed increased speed in the Number Connection Test (NCT) (corresponding to trail making test). Most patients showed better or similar results concerning delayed recall (P=0.31). No change was observed in the symbol digit test, word list memory, verbal fluency or constructional practice. Better results concerning NCT and delayed recall after carotid stenting might be due to improved brain perfusion. After CAS, cognitive and memory performance seem to improve. Further studies with different time intervals and more refined testing, as well as perfusion-weighted imaging, are needed. (orig.)

  4. Cognitive changes after carotid artery stenting

    International Nuclear Information System (INIS)

    We aimed to test changes in cognitive performance after carotid artery stenting (CAS). Ten patients were neuropsychologically tested at least 24 h before and 48 h after CAS. To diminish thromboembolic events, we used a proximal protection device. The following neuropsychological tests were selected: The Mini Mental State Examination (MMSE), symbol digit test and subtests of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery (verbal fluency, constructional practice, word list memory and delayed recall). Affective state was determined by the Beck Depression Score (BDS). No patient suffered from depression (BDS <1) or dementia (MMSE 29.9±1.5). Nine of the ten patients (P=0.12) showed increased speed in the Number Connection Test (NCT) (corresponding to trail making test). Most patients showed better or similar results concerning delayed recall (P=0.31). No change was observed in the symbol digit test, word list memory, verbal fluency or constructional practice. Better results concerning NCT and delayed recall after carotid stenting might be due to improved brain perfusion. After CAS, cognitive and memory performance seem to improve. Further studies with different time intervals and more refined testing, as well as perfusion-weighted imaging, are needed. (orig.)

  5. Covered Stent Membrane Design for Treatment of Atheroembolic Disease at Carotid Artery Bifurcation and Prevention of Thromboembolic Stroke: An In Vitro Experimental Study.

    Science.gov (United States)

    Kabinejadian, Foad; Nezhadian, Mercedeh Kaabi; Cui, Fangsen; Ho, Pei; Leo, Hwa Liang

    2016-02-01

    In this study, a polymeric membrane has been designed and developed for carotid stents to prevent detachment of emboli from the arterial wall and subsequent stroke, while maintaining side-branch flow. Prototypes of different geometrical design parameters have been fabricated and their performance has been evaluated in vitro under physiological pulsatile flow condition in a life-size silicone anastomotic model of carotid artery bifurcation. These evaluations include both quantitative and qualitative experimental (in vitro) assessments of emboli prevention capability, side-branch flow preservation, and flow visualization. The covered stents with the novel membrane demonstrated significantly higher emboli prevention capability than the corresponding bare nitinol stent as well as some earlier related designs, while preserving more than 93% of the original flow of the external carotid artery (ECA). Flow in the ECA through these covered stents was uniform without evidence of undesirable flow recirculation or retrograde flow that might predispose the vessel wall to intimal thickening and atherosclerotic plaque formation. This study demonstrated the potential of these novel covered stent designs for the treatment of carotid atherosclerotic stenosis and prevention of late embolic stroke. However, further in vivo investigations of biological effects and mechanical performance of this covered stent design (e.g., its thrombogenicity potential and biocompatibility) are warranted. PMID:26147531

  6. Percutaneous transluminal angioplasty and stenting of carotid arteries: Early results

    Directory of Open Access Journals (Sweden)

    Čolić Momčilo

    2008-01-01

    Full Text Available INTRODUCTION Treatment of carotid stenosis could be surgical: eversion endarterectomy, conventional endarterectomy and patch-plasty, resection with graft interposition and bypass procedure or, in the past few years, carotid artery angioplasty (PTA with stent implantation. OBJECTIVE The aim of this study is to present early results of carotid artery angioplasty and stenting, as well as to identify indications for this procedure. METHOD Twenty-three patients with stenosis of internal carotid artery were included in the prospective study which was performed in the period from July 2006 to July 2007. For PTA and stenting of the carotid artery we used Balloon dilatation catheter Ultra-softTM SV and Carotid WallstentTM MonorailTM. During the procedure, brain protection by embolic protection system Filter Wire EZ was essentially performed. Descriptive statistical methods were performed to present and describe the patient characteristics, risk factors and results. RESULTS 23 patients were examined. In four (17.39% cases there was asymptomatic, while in 19 (82.61% there was symptomatic homodynamic significant stenosis of the internal carotid artery. Four of these 19 patients (17.39% had late restenosis following carotid endarterectomy, four (17.39% important respiratory failure, and 11 (47.83% important heart disease. Patients were followed up for the first 30 postopertive days. In that period, there were no mortality and no needs for surgical conversions. In one case (4.35%, residual stenosis of 30% remained. Two patients (8.70% had TIA and one (4.35% had CVI. CONCLUSION Main indications for PTA and stenting of carotid arteries are: surgically inaccessible lesions (at or above C2; or subclavial; radiation-induced carotid stenosis; prior ispilateral radical neck dissection; prior carotid endarterectomy (restenosis, severe cardiac and pulmonary conditions. Limitations and contraindications to carotid angioplasty and stentning include: significant

  7. Recent concepts in the management of extracranial carotid stenosis: Carotid endarterectomy versus carotid artery stenting

    Directory of Open Access Journals (Sweden)

    Jeyaraj D Pandian

    2011-01-01

    Full Text Available Carotid stenosis is seen in 10% of patients with ischemic stroke, and carotid endarterectomy (CEA and carotid artery stenting (CAS are the two invasive treatments options available. Pooled analysis of the three largest randomized trials of CEA involving more than 3000 symptomatic patients estimated 30-day stroke and death rate at 7.1% after CEA. Some subgroups among the symptomatic patients appeared to have more benefit from CEA. These include patients aged 75 years or more, patients with ulcerated plaques, and patients with recent transient ischemic attacks within 2 weeks of randomization. Selection of asymptomatic patients for carotid revascularization should be guided by an assessment of comorbid conditions, life expectancy, and other individual factors, and should include a thorough discussion of the risks and benefits of the procedure with an understanding of patient preferences. The recent trials comparing CEA with CAS has not established its superiority over CEA. The carotid revascularization endarterectomy versus stenting (CREST study showed that CAS is still associated with a higher periprocedural risk of stroke or death than CEA. In patients over 70 years of age, CEA is clearly superior to CAS. The increased risk of nonfatal myocardial infarction in the CREST group subjected to CEA clearly suggests that patients being considered for CEA or CAS require a careful preliminary cardiac evaluation. CAS can be justified for patients whose medical comorbidities or cervical anatomy make them questionable candidates for CEA. The benefit of revascularization by either method versus modern aggressive medical therapy has not been established for patients with asymptomatic carotid stenosis.

  8. Management of Vascular Risk Factors in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST)

    OpenAIRE

    Meschia, James F; Voeks, Jenifer H.; Leimgruber, Pierre P.; Mantese, Vito A.; Timaran, Carlos H; Chiu, David; Bart M. Demaerschalk; Howard, Virginia J; Hughes, Susan E.; Longbottom, Mary; Howard, Annie Green; Brott, Thomas G

    2014-01-01

    Background The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) is a multicenter randomized trial of stenting versus endarterectomy in patients with symptomatic and asymptomatic carotid disease. This study assesses management of vascular risk factors. Methods and Results Management was provided by the patient's physician, with biannual monitoring results collected by the local site. Therapeutic targets were low‐density lipoprotein, cholesterol

  9. Clinical results of carotid artery stenting with a nitinol self-expanding stent (SMART stent)

    Energy Technology Data Exchange (ETDEWEB)

    Drescher, Robert; Mathias, Klaus D.; Jaeger, Horst J.; Bockisch, Georg; Demirel, Eren; Gissler, Martin H.; Hauth, Elke [Department of Radiology, Staedtische Kliniken Dortmund, Beurhausstrasse 40, 44139 Dortmund (Germany); Department of Radiology and Microtherapy, University Witten/Herdecke (Germany)

    2002-10-01

    Our objective was to assess the technical feasibility and the clinical results of internal carotid artery (ICA) stenting using a nitinol self-expanding stent (SMART stent). In 13 patients 13 high-grade stenoses of the internal carotid artery were treated via an implantation of a SMART stent. In all cases a predilation of the stenosis and a postdilation within the stent were performed. Follow-up examinations were carried out in all patients after a period of 6 months. In each case the implantation of the stent was performed without technical complications. In 12 of 13 cases the stent was placed in the patients' internal carotid artery, in 1 case from the internal to the common carotid artery (CCA). The average degree of stenosis of 78% (70-95%) was reduced to an average of 2.8% (0-21%). The 6-month follow-up angiography showed an average degree of restenosis of 11.8% (0-29%) in 8 of 13 patients. Duplex sonography in the remaining 5 patients demonstrated patent stents. One patient showed brief neurological symptoms during the intervention. No further complications occurred during follow-up time. Treatment of internal carotid artery stenosis with the SMART stent seems technically feasible, safe, and promises long-term patency. (orig.)

  10. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... could be a loss of speech or the ability to name objects, especially the -- in the left ... an external carotid artery does not negate your ability to do carotid stent angioplasty. 00:37:59 ...

  11. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... a minimally invasive approach in which we will access from the groin and treat the carotid artery ... carotid stent angioplasty is multifactorial. First is the access is generally done, performed, from a groin access, ...

  12. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... with a five-millimeter balloon typically? 00:48:40 Y. PIERRE GOBIN, MD: I will -- before placing ... patients, carotid artery stenting versus carotid endarterectomy in 40 centers. And the trial was stopped early for ...

  13. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... called a sheath, we can then place a filter, or cerebral protection device, to prevent any small ... very stable environment to pass balloon stents and filters during the carotid stent angioplasty. The cerebral protection ...

  14. Carotid anatomy does not predict the risk of new ischaemic brain lesions on diffusion-weighted imaging after carotid artery stenting in the ICSS-MRI substudy

    OpenAIRE

    Doig, D; Hobson, B. M.; Müller, M; Jäger, H R; Featherstone, R. L.; Brown, M M; Bonati, L.H.; Richards, T.

    2015-01-01

    INTRODUCTION: The International Carotid Stenting Study (ICSS, ISRCTN25337470) randomized patients with recently symptomatic carotid artery stenosis > 50% to carotid artery stenting (CAS) or endarterectomy. CAS increased the risk of new brain lesions visible on diffusion-weighted magnetic resonance imaging (DWI-MRI) more than endarterectomy in the ICSS-MRI Substudy. The predictors of new post-stenting DWI lesions were assessed in these patients. METHODS: ICSS-MRI Substudy patients allocated to...

  15. Carotid angioplasty and stenting in the elderly

    International Nuclear Information System (INIS)

    To investigate the technical success rate as well as the procedural and mid-term complication rates of carotid angioplasty and stenting in elderly patients, a group excluded from large randomized endarterectomy trials given their perceived high surgical risk. Of 200 consecutive carotid angioplasty and/or stenting procedures performed between March 1996 and March 2005, 21 procedures were performed without cerebral protection devices in 20 patients over the age of 79 years (mean age: 83 years, 12 men, eight women). These patients' medical records were retrospectively reviewed for vascular imaging reports and available clinical follow-up. Procedural and mid-term complication rates were calculated and compared to a previously published cohort of 133 consecutive patients ≤79 years of age who also underwent endovascular treatment at our institution. Carotid stenosis was reduced from a mean of 82% to no significant stenosis in all procedures. The procedural stroke rate was zero of 21 procedures. The procedural transient ischemic attack rate (TIA) was one of 21 procedures (4.8%). Mean follow-up was 24.6 months (range: 1.0-79.5 months) with at least a 30-day follow-up for 20 of the 21 procedures (95.2%). There were no new strokes. There was one recurrent ipsilateral TIA at 1.9 months. In five cases with follow-up carotid ultrasonography, no hemodynamically significant restenosis had occurred. There were three myocardial infarctions (MI) occurring at 0.5, 2.1, and 15.2 months, of which the last MI was fatal. The composite 30-day stroke and death rate was zero of 21 procedures (95% confidence interval: 0-14%). No significant difference was found in the 30-day rate of stroke, TIA, MI, or death between the elderly and younger patients. Carotid angioplasty and stenting in elderly patients can be performed successfully with acceptable procedural and mid-term complication rates comparable to younger patients. (orig.)

  16. Treatment of carotid artery aneurysms with covered stents; Aneurysmabehandlung der Arteria carotis interna mit gecoverten Stents

    Energy Technology Data Exchange (ETDEWEB)

    Rohr, A.; Alfke, K.; Doerner, L.; Jansen, O. [UKSH Kiel (Germany). Neurochirurgie Neuroradiologie; Bartsch, T.; Stingele, R. [UKSH Kiel (Germany). Neurologie

    2007-10-15

    Purpose: Evaluation of the use of covered stents in treating pseudoaneurysms of the cervical and intracranial/extradural carotid artery and determination of the periprocedural and short- to mid-term complication rate. Materials and Methods: 8 patients with 9 spontaneous dissecting aneurysms of the cervical carotid artery - 5 of which were symptomatic - plus one patient with ofthalmoplegia due to an aneurysm of the cavernous carotid artery were studied. While the latter was treated with a PTFE-covered balloon-mounted stainless steel stent (Jostent/Graftmaster), a self-expanding PTFE-covered Nitonol Stent (Symbiot) was used in all other cases. Intervention was performed with local anesthesia. Aspirin and Clopidogrel were both used as antiplatelet drugs. Clinical signs and symptoms and vascular imaging with DS, MR, CT angiography and ultrasound were recorded during patient follow-up, with a mean follow-up period of 14.6 months (4 - 30). Results: We were able to treat 8 out of 10 aneurysms (80 %) using covered stents. The aneurysms were immediately occluded and the associated stenoses of the parent vessel were eliminated. No clinically relevant complications occurred during the procedure or in the follow-up interval. In two cases, elongation of the carotid artery prevented the stent from being positioned over the aneurysm neck. These cases were shown to be stable with the use of antiplatelet drugs. Conclusion: Covered stents can be used in the treatment of pseudoaneurysms of the carotid artery as an alternative to long-term antithrombotic medication or surgery. In our study treatment was effective (80 %) and free of complications in the short- and mid-term follow-up. Possible indications, technique and the use of imaging modalities for patient follow-up are discussed. (orig.)

  17. Usefulness of CT angiography after metallic stent implantation of the internal carotid artery

    International Nuclear Information System (INIS)

    To evaluate the usefulness of CT angiography in patients with implantation of metallic stent for stenosed internal carotid artery. Seven patients with atherosclerotic stenosis of the internal carotid artery underwent metallic stent implantation. All were male and their ages ranged from 36 to 69 years. A total of seven stents were placed in the internal carotid artery in five patients and in the carotid bifurcation in two. Spiral CT scans were obtained and CT angiographic images were reconstructed using MPR or curved MPR techniques at a workstation. The interval between CT and conventional angiography did not exceed six days except in one patient, in whom it was 61days. CT and conventional angiography were compared for stent position with respect to the carotid bifurcation, stent deformation, intraluminal filling defect, and luminal caliber and outflow. Luminal patency of the implanted stent was measured according to NASCET(North American Symptomatic Carotid Endarterectomy Trial) criteria, and statistically processed (p>.05). The presence or absence of intrastent thrombus and vascular wall calcification was determined using axial source images. In all patients, CT angiographic findings matched those obtained by conventional angiography. Complications such as migration or deformation of an implanted stent, intraluminal filling defect, change of luminal caliber or outflow of implanted stent were not observed in any patient. In two studies in which Wilcoxon signed rank test was used, degree of stent expansion correlated closely(p=0.237). Axial source images showed that in no patient was an intrastent thrombus present, though in five, vascular wall calcification of internal carotid arteries outside the stent was noted. CT angiography is useful for the assessment of positional change, occlusion, and luminal patency of a stent-implanted internal carotid artery

  18. Usefulness of CT angiography after metallic stent implantation of the internal carotid artery

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Man Won; Kim, Hyeon Chul; Kim, Jae Kyu; Seo, Jeong Jin; Jeong, Gwang Woo; Kang, Heoung Keun [Chonnam Univ. Hospital, Kwangju (Korea, Republic of)

    1999-11-01

    To evaluate the usefulness of CT angiography in patients with implantation of metallic stent for stenosed internal carotid artery. Seven patients with atherosclerotic stenosis of the internal carotid artery underwent metallic stent implantation. All were male and their ages ranged from 36 to 69 years. A total of seven stents were placed in the internal carotid artery in five patients and in the carotid bifurcation in two. Spiral CT scans were obtained and CT angiographic images were reconstructed using MPR or curved MPR techniques at a workstation. The interval between CT and conventional angiography did not exceed six days except in one patient, in whom it was 61days. CT and conventional angiography were compared for stent position with respect to the carotid bifurcation, stent deformation, intraluminal filling defect, and luminal caliber and outflow. Luminal patency of the implanted stent was measured according to NASCET(North American Symptomatic Carotid Endarterectomy Trial) criteria, and statistically processed (p>.05). The presence or absence of intrastent thrombus and vascular wall calcification was determined using axial source images. In all patients, CT angiographic findings matched those obtained by conventional angiography. Complications such as migration or deformation of an implanted stent, intraluminal filling defect, change of luminal caliber or outflow of implanted stent were not observed in any patient. In two studies in which Wilcoxon signed rank test was used, degree of stent expansion correlated closely(p=0.237). Axial source images showed that in no patient was an intrastent thrombus present, though in five, vascular wall calcification of internal carotid arteries outside the stent was noted. CT angiography is useful for the assessment of positional change, occlusion, and luminal patency of a stent-implanted internal carotid artery.

  19. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available INNOVATIONS IN STROKE PREVENTION: AN UPDATE ON CAROTID STENTING NEW YORK-PRESBYTERIAN HOSPITAL NEW YORK, NY July 15, 2008 00:00: ... evening. Welcome to our webcast on innovations in stroke prevention: an update on carotid stenting. I'm ...

  20. Standardization of the reports for carotid artery stenting

    International Nuclear Information System (INIS)

    Objective: Stroke is one of the leading causes of death. Carotid occlusive disease is responsible for 25% of the ischemic strokes. Surgical carotid endarterectomy has been accepted as the best management for the extracranial caroid occlusive disease. However, in recent years, with the development of the endovascular technology, carotid artery stenting becomes more and more popular accompanied by increase of articles in this field correspondingly. The practical difficulty exists in comparison between the carotid stenting and endarterectomy through randomized controlled trials. Standardized report including trial design, patient selection, outcomes, statistical disposition thus become extremely necessary. This article gives a detailed description concerning about the patient selection, pretreatment evaluation, treatment description, curative effect evaluation and complications of carotid artery stenting. The purpose of this article is to standardize the reports of carotid stenting so that the descriptive and statistical data from different authors and agents can be compared. (authors)

  1. Novel A20-gene-eluting stent inhibits carotid artery restenosis in a porcine model

    Science.gov (United States)

    Zhou, Zhen-hua; Peng, Jing; Meng, Zhao-you; Chen, Lin; Huang, Jia-Lu; Huang, He-qing; Li, Li; Zeng, Wen; Wei, Yong; Zhu, Chu-Hong; Chen, Kang-Ning

    2016-01-01

    Background Carotid artery stenosis is a major risk factor for ischemic stroke. Although carotid angioplasty and stenting using an embolic protection device has been introduced as a less invasive carotid revascularization approach, in-stent restenosis limits its long-term efficacy and safety. The objective of this study was to test the anti-restenosis effects of local stent-mediated delivery of the A20 gene in a porcine carotid artery model. Materials and methods The pCDNA3.1EHA20 was firmly attached onto stents that had been collagen coated and treated with N-succinimidyl-3-(2-pyridyldithiol)propionate solution and anti-DNA immunoglobulin fixation. Anti-restenosis effects of modified vs control (the bare-metal stent and pCDNA3.1 void vector) stents were assessed by Western blot and scanning electron microscopy, as well as by morphological and inflammatory reaction analyses. Results Stent-delivered A20 gene was locally expressed in porcine carotids in association with significantly greater extent of re-endothelialization at day 14 and of neointimal hyperplasia inhibition at 3 months than stenting without A20 gene expression. Conclusion The A20-gene-eluting stent inhibits neointimal hyperplasia while promoting re-endothelialization and therefore constitutes a novel potential alternative to prevent restenosis while minimizing complications. PMID:27540277

  2. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... with stroke per year. Stroke is the third leading cause of death in the U.S.A., and ... carotid stenting in stroke had to have 20 leading cases. Next. And then a patient -- then a ...

  3. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... a failure of your carotid stent if you haven't treated it appropriately. And if you talk ... trials. One of the other issues that we haven't really talked about here but we all ...

  4. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... a surgical incision in the neck and many times general anesthesia. Carotid stent angioplasty is the topic ... reallowing restoration of flow to the brain. Many times during these procedures, there may be signs of ...

  5. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... the contrast load, if your patient is in renal insufficiency. I always image the contralateral side. It will, ... will also eventually develop atherosclerotic disease and potentially cause a failure of your carotid stent if you ...

  6. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... risk of stroke in the high-risk patient population. The most common complication was a neck hematoma ... safer than carotid stenting, at least in this population of patients. And the risk of cerebral vascular -- ...

  7. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... the flow divider. So where the carotid actually splits to go to the brain or go to ... stent deployment. A little more contrast, just to double-check, and then here comes the deployment. It's ...

  8. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... that's important, I think, as we get new technologies having to do with flow reversal or flow ... the common carotid. I think the current stent technology, I prefer a closed-cell technique, but I ...

  9. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... an important thing also is that with the current role of using carotid stent angioplasty, we can ... for us. And the various access techniques. The current access techniques are, as Jim mentioned, usually from ...

  10. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... variety, and then others have an open cell, meaning there's breaks between the connections of the stent ... as Pierre alluded to, but the great vessels, meaning the ones coming to the carotid arteries as ...

  11. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... incision in the neck and many times general anesthesia. Carotid stent angioplasty is the topic of tonight, ... significant coronary artery disease. Again, many times general anesthesia is required, though we can do it under ...

  12. Carotid angioplasty and stent placement for restenosis after endarterectomy

    International Nuclear Information System (INIS)

    Recurrent carotid stenosis following endarterectomy is a common complication, and reoperation may be associated with increased morbidity. The goal of this study was to determine the procedural safety and long-term complication rates of carotid angioplasty and stenting for recurrent stenosis. Of 248 consecutive carotid angioplasty and/or stenting procedures performed at our institution between March 1996 and November 2005, 83 procedures for recurrent stenosis following endarterectomy were performed in 75 patients (mean age 68 years; 43 men, 32 women) without cerebral protection devices. The patients' medical records were retrospectively reviewed for vascular imaging reports and available clinical follow-up. Procedural and long-term complication rates were calculated. Recurrent stenosis was reduced from a mean of 80.6% to no significant stenosis in 82 of 83 procedures. The procedural stroke rate was 3 out of 83 procedures (3.6%). The procedural transient ischemic attack (TIA) rate was 2 out of 83 procedures (2.4%). Mean follow-up was 22.4 months (range 0.1 to 86.7 months) with at least 6 months follow-up for 54 of 83 procedures (65%). There were five TIAs and no strokes on follow-up (new TIAs at 25.5 and 43.4 months; recurrent TIAs at 1, 11.1, and 12 months, all with normal angiograms). The composite 30-day stroke, myocardial infarction, or death rate was 5 of 83 procedures (6.0%). In this series, angioplasty and stenting were effective in relieving stenosis secondary to recurrent carotid disease after endarterectomy, and have low rates of ischemic complications. (orig.)

  13. Delayed cerebral infarction due to stent folding deformation following carotid artery stenting

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Kwon Duk; Lee, Kyung Yul; Suh, Sang Hyun [Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Byung Moon [Dept. of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-12-15

    We report a case of delayed cerebral infarction due to stent longitudinal folding deformation following carotid artery stenting using a self-expandable stent with an open-cell design. The stented segment of the left common carotid artery was divided into two different lumens by this folding deformation, and the separated lumens became restricted with in-stent thrombosis. Although no established method of managing this rare complication exists, a conservative approach was taken with administration of anticoagulant and dual antiplatelet therapy. No neurological symptoms were observed during several months of clinical follow-up after discharge.

  14. Is Acute Carotid Artery Stent Thrombosis an Avoidable Complication?

    Science.gov (United States)

    Köklü, Erkan; Yüksel, İsa Öner; Bayar, Nermin; Arslan, Şakir

    2015-10-01

    The most serious complication of carotid artery stenting (CAS) is acute carotid artery stent thrombosis (ACAST). ACAST is a very rare complication, but it may lead to dramatic and catastrophic consequences. The most important cause is inadequate or ineffective antiaggregant therapy. It is very important to identify, before CAS, those patients who might be candidates for ACAST and to start antiplatelet therapy for them. Testing patients who are candidates for CAS for acetylsalicylic acid and clopidogrel resistance may prevent this complication. PMID:26303788

  15. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... EVA3S was a trial performed in France randomizing patients, carotid artery stenting versus carotid endarterectomy in 40 centers. And the trial was stopped early for reasons of safety and futility. Next. Because the trial showed that ...

  16. The use of virtual reality for training in carotid artery stenting: a construct validation study

    DEFF Research Database (Denmark)

    Berry, M.; Reznick, R.; Lystig, T.;

    2008-01-01

    difference in video-gaming habits was demonstrated. Conclusion: With the exception of the metrics of performance time and fluoroscopic use, construct validity of the Procedicus-VIST carotid metrics were not confirmed. Virtual reality simulation as a training method was valued more by novices than by...... recorded), tool/vessel ratio, coverage percentage, and placement accuracy or residual stenosis. Contrast measurement metrics were found to be too imprecise for statistical analysis. Experienced and novice opinions differed significantly for six of 10 subjective parameters. No statistically significant...

  17. A meta-analysis of carotid endarterectomy versus stenting in the treatment of symptomatic carotid stenosis

    Institute of Scientific and Technical Information of China (English)

    WANG Liang; LIU Xiao-zhi; LIU Zhen-lin; LAN Feng-ming; SHI Wan-chao; LIU Jun; ZHANG Jian-ning

    2013-01-01

    Background Carotid stenosis is one of the common reasons for patients with ischemic stroke,and the two invasive options carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the most popular treatments.But the relative efficacy and safety of the methods are not clear.Methods About 521 articles related to CAS and CEA for carotid stenosis published in 1995-2011 were retrieved from MEDLINE,Cochrane Library (CL),and China National Knowledge Infrastructure (CNKI) China Journal Full-Test database.Of them,eight articles were chosen.Meta-analysis was used to assess the relative risks.Results The eight studies included 3873 patients with symptomatic carotid artery stenosis,including 1941 cases in the carotid stent angioplasty group,and 1932 cases in the carotid endarterectomy group.Fixed effect model analysis showed that within 30 days of incidence of all types of strokes,surgery was significantly highly preferred in CAS patients (CAS group) than the CEA patients (CEA group),and the difference was statistically significant (relative ratio (RR)=1.80,95% confidence interval (CI):1.380-2.401,P <0.0001).But the incidence of death in the two groups is not showed and is not statistically significant after 30 days (RR=1.52,95% CI:0.82-2.82,P=0.18).The rate of cranial nerve injury in the CAS group is lower than the CEA group (RR=0.14,95% CI:0.05-0.43,P=0.0005).The incidence of CAS patients with myocardial infarction is lower than the CEA group after 30 days,but statistically meaningless (RR=0.22,95% CI:0.05-1.02,P=0.05).The stroke or death in CAS patients were higher than the CEA group after 1 year of treatment (RR=2.58,95% CI:1.03-6.48,P=0.04).Conclusions Compared to CAS,carotid endarterectomy is still the preferred treatment methodology of symptomatic carotid artery stenosis.Future meta-analyses should then be performed in long-term follow-up to support this treatment recommendation.

  18. Stent-assisted angioplasty for atherosclerotic stenosis of the carotid artery. An overview

    International Nuclear Information System (INIS)

    For symptomatic stenosis of the carotid artery the invasive options for treatment (by means of stent or operation) are superior to conservative medical treatment. Recent multi-center randomized controlled trials, which will be presented here, indicate that stenting in the treatment of symptomatic carotid stenosis is neither safer nor more effective than carotid endarterectomy. When carried out by an experienced interventionalist stent-assisted angioplasty (CAS) is an alternative to carotid endarterectomy. Subgroup-analysis indicates that for patients older than 70 years of age invasive techniques should be the method of choice. In the case of contralateral high-grade stenosis or occlusion, CAS is the method of choice. For patients treated by stenting, the periprocedural complication rate is not influenced by the use of protection systems. The present results on symptomatic carotid stenosis should not be transferred to the therapy of asymptomatic carotid stenosis. A 3-armed study (SPACE2) on the comparison of the best medical treatment with the invasive treatment modalities (CAS or CEA) is in preparation and will be started in 2 months. (orig.)

  19. Risk reduction of brain infarction during carotid endarterectomy or stenting using sonolysis - Prospective randomized study pilot data

    Science.gov (United States)

    Kuliha, Martin; Školoudík, David; Martin Roubec, Martin; Herzig, Roman; Procházka, Václav; Jonszta, Tomáš; Krajča, Jan; Czerný, Dan; Hrbáč, Tomáš; Otáhal, David; Langová, Kateřina

    2012-11-01

    Sonolysis is a new therapeutic option for the acceleration of arterial recanalization. The aim of this study was to confirm risk reduction of brain infarction during endarterectomy (CEA) and stenting (CAS) of the internal carotid artery (ICA) using sonolysis with continuous transcranial Doppler (TCD) monitoring by diagnostic 2 MHz probe, additional interest was to assess impact of new brain ischemic lesions on cognitive functions. Methods: All consecutive patients 1/ with ICA stenosis >70%, 2/ indicated to CEA or CAS, 3/ with signed informed consent, were enrolled to the prospective study during 17 months. Patients were randomized into 2 groups: Group 1 with sonolysis during intervention and Group 2 without sonolysis. Neurological examination, assessment of cognitive functions and brain magnetic resonance imaging (MRI) were performed before and 24 hours after intervention in all patients. Occurrence of new brain infarctions (including infarctions >0.5 cm3), and the results of Mini-Mental State Examination, Clock Drawing and Verbal Fluency tests were statistically evaluated using T-test. Results: 97 patients were included into the study. Out of the 47 patients randomized to sonolysis group (Group 1) 25 underwent CEA (Group 1a) and 22 CAS (Group 1b). Out of the 50 patients randomized to control group (Group 2), 22 underwent CEA (Group 2a) and 28 CAS (Group 2b). New ischemic brain infarctions on follow up MRI were found in 14 (29.8%) patients in Group 1-4 (16.0%) in Group 1a and 10 (45.5%) in Group 1b. In Group 2, new ischemic brain infarctions were found in 18 (36.0%) patients-6 (27.3%) in Group 2a and 12 (42.9%) in Group 2b (p>0.05 in all cases). New ischemic brain infarctions >0.5 cm3 were found in 4 (8.5 %) patients in Group 1 and in 11 (22.0 %) patients in Group 2 (p= 0.017). No significant differences were found in cognitive tests results between subgroups (p>0.05 in all tests). Conclusion: Sonolysis seems to be effective in the prevention of large ischemic

  20. Improved circulation in ocular ischemic syndrome after carotid artery stenting

    Institute of Scientific and Technical Information of China (English)

    WANG Yan-ling; ZHAO Lu; LI Ming-ming

    2011-01-01

    Ocular ischemic syndrome is a chronic ischemic eye disease including a series of ischemic ocular and brain syndromes caused by carotid artery occlusion or stenosis.Because of the different degrees of ischemia,clinical manifestations of ocular ischemic syndrome are diverse,and it is difficult to diagnose in the initial stage.The main strategy to treat ocular ischemic syndrome is elimination of carotid stenosis.We presented a patient who recovered dramatically after carotid artery stenting.The pre-stenting arm-retinal circulation time of the patient's left eye was prolonged,and a large amount of microaneurysm appeared at the posterior polar and mid-peripheral aspects of the left retina.The post-stenting arm-retinal circulation time of the left eye decreased to 16.3 seconds,and the microaneurysm almost disappeared.

  1. The 10-year Trend of Periprocedural Complication Following Carotid Artery Stenting; Single Center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Jeong-Ho [Keimyung University Dongsan Medical Center, Department of Neurology (Korea, Republic of); Kang, Jihoon; Yeo, Min-Ju; Kim, Beom Joon; Jang, Min Uk; Bae, Hee-Joon [Seoul National University College of Medicine, Department of Neurology, Stroke Center, Seoul National University Bundang Hospital (Korea, Republic of); Kwon, O-Ki; Hwang, Gyo Jun; Oh, Chang Wan [Seoul National University Bundang Hospital, Department of Neurosurgery (Korea, Republic of); Jung, Cheolkyu [Seoul National University Bundang Hospital, Department of Radiology (Korea, Republic of); Lee, Ji Sung [Soonchunhyang University Medical Center, Biostatistical Consulting Unit (Korea, Republic of); Han, Moon-Ku, E-mail: mkhan@snu.ac.kr [Seoul National University College of Medicine, Department of Neurology, Stroke Center, Seoul National University Bundang Hospital (Korea, Republic of)

    2015-04-15

    PurposeCarotid endarterectomy and stenting are used to treat carotid stenosis, with the volume of carotid artery procedures increasing over the past decade. We investigated the 10-year trend of periprocedural complications with an increasing procedure volume of carotid stenting at a single tertiary hospital.MethodsWe collected 416 consecutive cases (384 patients) of carotid artery stenting performed for either symptomatic (231 cases, 55.5 %) or asymptomatic (185 cases, 44.5 %) internal carotid artery stenosis at a single center. Periprocedural complication was defined as any stroke, myocardial infarction, or death. Procedure-related outcome included any dissection, hemodynamic event, or periprocedural complication.ResultsThe mean age was 68.8 years (82.8 % males; range of 20–89 years); 23.9 % were older than 75 years. Before the procedure, 99.3 and 56.0 % of patients received antiplatelet and lipid-lowering medication, respectively. The overall periprocedural complication rate was 3.6 % (1.6 and 5.2 % in the asymptomatic and symptomatic group, respectively). The composite outcome of any stroke or death was 3.4 %. Periprocedural complication and procedure-related outcome showed a decremental trend with increasing procedure volume, and this trend remained after adjusting for confounders.ConclusionsOur study suggests that carotid stenting at an experienced center might reduce the periprocedural complications. Our periprocedural complication rate of carotid artery stenting may be comparable to, or somewhat lower than, that reported in other clinical trials.

  2. Endovascular self-expandable stent placement of complicated extracranial carotid stenosis with high surgical risk

    International Nuclear Information System (INIS)

    Objective: To study the safety and efficacy of endovascular therapy in the treatment of complicated extracranial carotid stenosis in patients with high surgical risk. Methods: Seven patients with high surgical risk of complicated extracranial carotid stenosis received endovascular stenting. Results: The stents were accurately implanted ,and total disappearance of stenosis was obtained in 4 patients and the degree of stenosis reduced more than 90% in other 3 patients. The clinical symptoms were improved significantly or disappeared after the procedure without any complications. Follow-up from 3 to 23 months, no restenosis and ischemic symptoms were noted in all cases. Conclusions: Endovascular stenting is a safe and valid method of choice for the treatment of complicated extracranial carotid stenosis in high surgical risk patients. (authors)

  3. Comparison of the safety of simultaneous bilateral carotid artery stenting versus unilateral carotid artery stenting: 30-day and6-month results

    Institute of Scientific and Technical Information of China (English)

    DONG Hui; JIANG Xiong-jing; PENG Meng; JI Wei; WU Hai-ying; HUI Ru-tai; XU Bo; YANG Yue-jin; GAO Run-lin

    2012-01-01

    Background Severe bilateral carotid stenosis caused by atherosclerosis has not been unusual in the elderly.Such patients have high stroke risk.Many studies show that carotid artery stenting (CAS) is an alternative to treat unilateral carotid stenosis.However,the optimal procedural strategy of bilateral carotid stenosis remains unclear.The purpose of our study was to evaluate the safety of simultaneous bilateral carotid artery stenting (SBCAS) compared with unilateral carotid artery stenting (UCAS).Methods In this single-center retrospective study,we analyzed 234 consecutive patients who underwent carotid stenting from January 2005 to December 2009.Thirty-nine patients (16.7%) of them underwent SBCAS,and the others (n=195) underwent UCAS.Indication for CAS was defined as carotid artery diameter reduction >60% (symptomatic) or >80% (asymptomatic).Six-month and 30-day hemodynamic depression (HD),hyperperfusion syndrome (HPS),stroke,death and myocardial infarction (MI) after carotid stenting were assessed.Results SBCAS group had no more HD and HPS compared with UCAS group at 30 days (HD:28.2% vs.20.0%,P=0.396; HPS:2.6% vs.2.1%,P=0.262).Moreover,there was no statistically significant difference between SBCAS group and UCAS group in major stroke,death,MI and their combinations within 30 days (major stroke:0 vs.3.6%,P=0.604; death:2.6% vs.1.5%,P=0.520; MI:2.6% vs.0.5%,P=0.306; and their combinations:5.1% vs.4.6%,P=1.000)and 6 months (major stroke:0 vs.3.6%,P=0.604; death:5.1% vs.2.1%,P=0.262; MI:5.1% vs.1.0%,P=0.130 and their combinations:7.7% vs.5.1%,P=0.459).Conclusions The patients undergoing SBCAS had no more events than those undergoing UCAS in 30-day and 6-month follow-up.Our finding suggests that SBCAS appears to be as safe as UCAS.

  4. Ten years experience of carotid stenting

    International Nuclear Information System (INIS)

    Full text: Introduction: A retrospective analysis of our experience with stenting of total and subtotal carotid occlusions, including 18 months follow-up of 51 cases of patients for the period 2006-2010, showing the possibilities of endovascular treatment of this condition. Materials and Methods: Patients were selected according to two criteria - anatomic and clinical. Totally occlusions were 5 (9.8%), the criteria for inclusion in the group are: interruption of the lumen of the ICA, TIMI 0 distal occlusion and collateral filling of established intracranial area of the ipsilateral ICA. Subtotal occlusions were 46 (90.2%). The criteria for this group are: delayed filling of contrast in ICA ipsilateral compared with ECA, a reduced diameter of the ICA as compared to the contralateral ICA and of reduced diameter compared to the ICA in the ipsilateral ECA. Results: In all patients observed preprocedure progression of neurological deficit and ischemic episodes. In 31 patients (60.7%) has a preceding ipsilateral stroke and at 20 (39,3%) - TIA. In 14 patients (28%) were observed contralateral ICA stenosis over 50%. Post-procedure in 50 patients (98%) have achieved successful recanalization, as in 49 of them the distal protection is placed. In one case, the tortuosity of the distal area didn't allow placement of the EPD. Following the procedure in 48 (94 %) of patients developed residual stenosis of less than 20 %. In two of these cases the stenosis was 50-60 % due substantial calcification of artery. In 48 (94%) was recovered TIMI- 3 flow, and in 47 (92 %) to restore the circulation of the ipsilateral hemisphere. One patient was observed complication of ICA ( dissection without clinical significance)

  5. Age-dependent effects of carotid endarterectomy or stenting on cognitive performance

    OpenAIRE

    Wasser, Katrin; Hildebrandt, Helmut; Gröschel, Sonja; Stojanovic, Tomislav; Schmidt, Holger; Gröschel, Klaus; Pilgram-Pastor, Sara M.; Knauth, Michael; Kastrup, Andreas

    2012-01-01

    Although evidence is accumulating that age modifies the risk of carotid angioplasty and stenting (CAS) versus endarterectomy (CEA) for patients with significant carotid stenosis, the impact of age on cognition after either CEA or CAS remains unclear. In this study, we analyzed the effects of age on cognitive performance after either CEA or CAS using a comprehensive neuropsychological test battery with parallel test forms and a control group to exclude a learning effect. The neuropsychological...

  6. Thrombectomy assisted by carotid stenting in acute ischemic stroke management

    DEFF Research Database (Denmark)

    Steglich-Arnholm, Henrik; Holtmannspötter, Markus; Kondziella, Daniel; Wagner, Aase; Stavngaard, Trine; Cronqvist, Mats E; Hansen, Klaus; Højgaard, J.; Taudorf, Sarah; Krieger, Derk Wolfgang

    2015-01-01

    Extracranial carotid artery occlusion or high-grade stenosis with concomitant intracranial embolism causes severe ischemic stroke and shows poor response rates to intravenous thrombolysis (IVT). Endovascular therapy (EVT) utilizing thrombectomy assisted by carotid stenting was long considered risky......-center analysis of 47 consecutive stroke patients with carotid occlusion or high-grade stenosis and concomitant intracranial embolus treated between September 2011 and December 2014. Benefits included early improvement of stroke severity (NIHSS ≥ 10) or complete remission within 72 h and favorable long...... patient management is central to achieve good clinical outcome....

  7. Carotid angioplasty with stenting for chronic internal carotid artery occlusion: technical note

    International Nuclear Information System (INIS)

    Carotid angioplasty with stenting (CAS) is becoming accepted as an effective and reliable treatment option for severe carotid artery stenosis. However, it is rarely applied for carotid occlusion, especially in its chronic stage. We report our experience of CAS for chronic internal carotid artery occlusion representing compromised cerebral blood flow using various protection methods. A 77-year-old woman, who was already diagnosed with severe left internal carotid artery stenosis, suddenly had right hemiparesis and aphasia. At that time, she was treated conservatively because her neurological status was quite good, in spite of left carotid artery occlusion. Her symptoms improved in the short term, except slight aphasia, but deteriorated again 18 days from the onset, and magnetic resonance imaging (MRI) showed new ischemic lesions. CAS was then performed for the occluded carotid artery on the 23rd day from the first onset. Using the proximal protection technique, the occluded lesion was crossed carefully with a microguidewire. Stents were also placed successfully with the distal protection technique. The occluded carotid artery was completely recanalized without any unfavorable events or neurological deterioration. In this patient, CAS was successfully to treat chronic carotid artery occlusion. These procedures and techniques are reviewed and discussed. (orig.)

  8. Stent implantation for the treatment of wide-necked aneurysms located at internal carotid artery bifurcation

    International Nuclear Information System (INIS)

    Objective: To preliminarily evaluate the feasibility, safety and efficacy of stent placement for the treatment of wide-necked aneurysms located at internal carotid artery bifurcation. Methods: Eleven patients with wide-necked aneurysms located at internal carotid artery bifurcation, who were encountered during the period from Jan. 2004 to Dec. 2010 in hospital, were collected. A total of 16 intracranial aneurysms were detected, of which 11 were wide-necked and were located at internal carotid artery bifurcation. The diameters of the aneurysms ranged from 2.5 mm to 18 mm. Individual stent type and stenting technique was employed for each patient. Follow-up at 1, 3, 6 and 12 months after the procedure was conducted. Results: A total of 11 different stents were successfully deployed in the eleven patients. The stents included balloon expandable stent (n=1) and self-expanding stent (n=10). According to Raymond grading for the immediate occlusion of the aneurysm, grade Ⅰ (complete obliteration) was obtained in 4, grade Ⅱ (residual neck) in 2 and grade Ⅲ (residual aneurysm) in 5 cases. No procedure-related complications occurred. At the time of discharge, the modified Rankin score was 0-1 in the eleven patients. During the follow-up period lasting for 1-108 months, all the patients were in stable condition and no newly-developed neurological dysfunction or bleeding observed. Follow-up examination with angiography (1-48 months) showed that the aneurysms were cured (no visualization) in 4 cases, improved in 2 cases and in stable condition in one case. Conclusion: For the treatment of wide-necked aneurysms located at internal carotid artery bifurcation, stent implantation is clinically feasible, safe and effective. Further studies are required to evaluate its long-term efficacy. (authors)

  9. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... click on the buttons on your screen and open the door to informed medical care. ORLive, the vision of improving health. 00:01:27 JAMES F. McKINSEY, MD: Good evening. Welcome to our webcast on innovations in stroke prevention: an update on carotid stenting. ...

  10. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... stroke was 4.6%. In symptomatic patients, this risk was 6.5%. And we can already identify some subgroup that shows that, as kind of expected, carotid stenting is a little more risky in diabetic patients and it's more risky in older patients. ...

  11. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... patients as I just tell you, their randomization phase is finished. What the leading phase results are telling us is that overall, 30- ... A. GRAY, MD: Yeah, I think the next phase of carotid stenting really is in a couple ...

  12. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... IN STROKE PREVENTION: AN UPDATE ON CAROTID STENTING NEW YORK-PRESBYTERIAN HOSPITAL NEW YORK, NY July 15, 2008 00:00:01 ... single day. 00:00:20 ANNOUNCER: Located in New York City, New York-Presbyterian is ranked among ...

  13. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... informed medical care. ORLive, the vision of improving health. 00:01:27 JAMES F. McKINSEY, MD: Good evening. Welcome to our webcast on innovations in stroke prevention: an update on carotid stenting. I'm Jim ...

  14. Endovascular stenting of carotid stenosis in patients at high surgical risk

    International Nuclear Information System (INIS)

    Objective: To evaluated the safety and complications of endovascular stenting for symptomatic carotid stenosis with surgical high risk. Methods: A series of 11 vessels in 9 patients at surgical high risk were treated by endovascular stenting. The complications during the procedures and postoperative periods were analyzed within one to five months. Results: All of the operations were successfully performed without any serious complications. During the follow-up period (averaging 6 months), there were no complications of TIAs, stokes and re-stenoses. Conclusions: The study suggests that endovascular stenting may be safe and effective for patients as surgical high risk, but further more study is needed

  15. Influence of carotid artery stenting on cognitive function

    Energy Technology Data Exchange (ETDEWEB)

    Quasar Grunwald, Iris [Saarland University Clinic, Department for Diagnostic and Interventional Neuroradiology, Homburg (Germany); Department of Neuroradiology, Homburg (Germany); Papanagiotou, Panagiotis; Backens, Martin; Politi, Maria; Vedder, Verena; Zercher, K. [Saarland University Clinic, Department for Diagnostic and Interventional Neuroradiology, Homburg (Germany); Reith, Wolfgang; Supprian, Tilman; Muscalla, B.; Haass, Anton; Krick, Christoph M. [Saarland University Clinic, Clinic for Neurology, Homburg (Germany); Saarland University Clinic, Clinic for Psychiatry and Psychotherapy, Homburg (Germany)

    2010-01-15

    There have only been a few studies on cognitive changes in patients with carotid occlusive disease, and the results of these show major discrepancies in the extent to which treatment affects neuropsychological function. We sought to clarify these discrepancies by evaluating the effects of carotid artery stenting (CAS) on the cognitive function. Forty-one asymptomatic CAS patients were administered a test battery of neuropsychological tests measuring cognitive speed and memory function before and 3 months after the procedure. A control group was also evaluated. To test for thromboembolic lesions, diffusion-weighted imaging was used. CAS led to a significant increase in cognitive speed (p < 0.001) but did not afford any change in memory function. This was regardless of the degree or side of stenosis or patient age or gender. CAS significantly improved functions that involve cognitive speed. Earlier studies did not differentiate between speed and memory tests and thus might have missed these changes. Further studies correlating changes in brain perfusion with increase in cognitive speed are needed. (orig.)

  16. Influence of carotid artery stenting on cognitive function

    International Nuclear Information System (INIS)

    There have only been a few studies on cognitive changes in patients with carotid occlusive disease, and the results of these show major discrepancies in the extent to which treatment affects neuropsychological function. We sought to clarify these discrepancies by evaluating the effects of carotid artery stenting (CAS) on the cognitive function. Forty-one asymptomatic CAS patients were administered a test battery of neuropsychological tests measuring cognitive speed and memory function before and 3 months after the procedure. A control group was also evaluated. To test for thromboembolic lesions, diffusion-weighted imaging was used. CAS led to a significant increase in cognitive speed (p < 0.001) but did not afford any change in memory function. This was regardless of the degree or side of stenosis or patient age or gender. CAS significantly improved functions that involve cognitive speed. Earlier studies did not differentiate between speed and memory tests and thus might have missed these changes. Further studies correlating changes in brain perfusion with increase in cognitive speed are needed. (orig.)

  17. Acute Carotid Artery Stent Thrombosis Due to Dual Antiplatelet Resistance

    International Nuclear Information System (INIS)

    Carotid artery stenting (CAS) is a revascularization modality that is an alternative to carotid endarterectomy. The efficacy of CAS in primary and secondary prevention from ischemic stroke has been demonstrated in various trials. Acute thrombosis of CAS is a rare complication that can lead to dramatic and catastrophic consequences. We discuss a case of acute CAS thrombosis in a patient who had previously undergone successful CAS. CAS was performed in a 73-year-old man who had had dysarthria lasting 2 weeks with 95 % stenosis in his left internal carotid artery. An acute cerebrovascular event resulting in right-sided hemiplegia developed 24 h after the procedure. Computed tomographic carotid angiography revealed complete occlusion of the stent with thrombus. The cause of stent thrombosis was thought to be antiaggregant resistance to both acetylsalicylic acid and clopidogrel. The most important cause of acute CAS thrombosis is inadequate or ineffective antiaggregant therapy. Evaluating patients who are candidates for CAS for acetylsalicylic acid and clopidogrel resistance may preclude this complication

  18. Acute Carotid Artery Stent Thrombosis Due to Dual Antiplatelet Resistance

    Energy Technology Data Exchange (ETDEWEB)

    Köklü, Erkan, E-mail: drerkankoklu@gmail.com; Arslan, Şakir; Yüksel, İsa Öner; Bayar, Nermin [Antalya Education and Research Hospital, Clinic of Cardiology (Turkey); Koç, Pınar [Antalya Education and Research Hospital, Clinic of Radiology (Turkey)

    2015-08-15

    Carotid artery stenting (CAS) is a revascularization modality that is an alternative to carotid endarterectomy. The efficacy of CAS in primary and secondary prevention from ischemic stroke has been demonstrated in various trials. Acute thrombosis of CAS is a rare complication that can lead to dramatic and catastrophic consequences. We discuss a case of acute CAS thrombosis in a patient who had previously undergone successful CAS. CAS was performed in a 73-year-old man who had had dysarthria lasting 2 weeks with 95 % stenosis in his left internal carotid artery. An acute cerebrovascular event resulting in right-sided hemiplegia developed 24 h after the procedure. Computed tomographic carotid angiography revealed complete occlusion of the stent with thrombus. The cause of stent thrombosis was thought to be antiaggregant resistance to both acetylsalicylic acid and clopidogrel. The most important cause of acute CAS thrombosis is inadequate or ineffective antiaggregant therapy. Evaluating patients who are candidates for CAS for acetylsalicylic acid and clopidogrel resistance may preclude this complication.

  19. A suggested training programme for carotid artery stenting (CAS)

    International Nuclear Information System (INIS)

    Carotid artery stenting as an alternative to traditional carotid endartrectomy is becoming increasingly important in the treatment of transient ischemic attack and stroke. Physicians from several different medical disciplines are interested in treating appropriate patients by this method. Patients are entitled to know what training and experience the surgeon or clinician has before giving consent. This should involve endovascular experience in all systems and experience and knowledge of cerebral angiography and intervention. A multidisciplinary approach and reporting of adverse events is vital for patient safety

  20. A Case of In-Stent Neoatherosclerosis 10 Years after Carotid Artery Stent Implantation: Observation with Optical Coherence Tomography and Plaque Histological Findings

    OpenAIRE

    Matsumoto, Hiroyuki; YAKO, Rie; Masuo, Osamu; HIRAYAMA, Katsuhisa; Uematsu, Yuji; Nakao, Naoyuki

    2013-01-01

    We report a patient's case of slow progressive in-stent restenosis 10 years after bare-metal stent implantation to his carotid artery. We treated the patient with an additional stent placement under a distal filter protection device. Optical coherence tomographic assessment and plaque histology during the carotid artery stenting (CAS) revealed atheromatous change at in-stent neointima, which contained lipid-rich plaque and calcification deposits. These findings suggest that in-stent neoathero...

  1. Reflections by contrarians on the post-CREST evaluation of carotid stenting for stroke prevention.

    Science.gov (United States)

    Barnett, Henry J M; Pelz, David M; Lownie, Stephen P

    2010-12-01

    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 invasive than carotid endarterectomy. The authors argue that the design of Carotid Revascularization Endarterectomy vs. Stenting Trial was flawed by the mixture of two dissimilar patient groups, thus violating the principle of ceteris paribus, essential for the validity of a randomized controlled trials. The evidence for any invasive treatment of asymptomatic carotid disease is weak, with recent data favouring purely medical management. The authors believe that carotid angioplasty and stenting in asymptomatic patients should cease until better evidence is available. PMID:21050401

  2. Carotid Artery Stenting: Retrospective Evaluation of Experience of an Invasive Tertiary Center

    Directory of Open Access Journals (Sweden)

    Faruk Ertaş

    2016-03-01

    Full Text Available Objective: Carotid artery stenting (CAS is being applied more frequently as an alternative mode of treatment to carotid endarterectomy. We aimed to present the short-term clinical outcomes of the patients admitted to our clinic with a diagnosis of carotid artery disease and revas­cularized by CAS. Methods: The study was retrospective and a single-centered study. Between June 2013-January 2016 the patients with an indication for carotid artery intervention and accepted CAS procedure were included in the study. Clinical characteristics and procedural data of the patients were obtained by scanning patient files. After discharge, hospital records were scanned and patients were called to learn whether or not patients were alive and that they have suffered a recent stroke. Results: We included 82 patients that meet the inclusion criteria in the study. 59% of patients were male with a mean age of 68±9 years. 56% of patients were symp­tomatic. In all patients, stents were used. 85% of patients distal embolic protection devices and 15% MOMA were used. 64 right, 18 left, and two bilateral carotid arteries were stented with a total of 82 patient of 84 successful CAS. Due to residual stenosis a second stent was im­planted only in one patient. One patient experienced a partial muscle weakening in upper extremity due to an air embolism and 2 patients received opac material which recovered spontaneously in 24 hours. Conclusion: CAS is being successfully applied with a very low risk of complications in experienced centers. Short-term clinical results of CAS are quite satisfactory.

  3. Thrombectomy assisted by carotid stenting in acute ischemic stroke management: benefits and harms.

    Science.gov (United States)

    Steglich-Arnholm, Henrik; Holtmannspötter, Markus; Kondziella, Daniel; Wagner, Aase; Stavngaard, Trine; Cronqvist, Mats E; Hansen, Klaus; Højgaard, Joan; Taudorf, Sarah; Krieger, Derk Wolfgang

    2015-12-01

    Extracranial carotid artery occlusion or high-grade stenosis with concomitant intracranial embolism causes severe ischemic stroke and shows poor response rates to intravenous thrombolysis (IVT). Endovascular therapy (EVT) utilizing thrombectomy assisted by carotid stenting was long considered risky because of procedural complexities and necessity of potent platelet inhibition-in particular following IVT. This study assesses the benefits and harms of thrombectomy assisted by carotid stenting and identifies factors associated with clinical outcome and procedural complications. Retrospective single-center analysis of 47 consecutive stroke patients with carotid occlusion or high-grade stenosis and concomitant intracranial embolus treated between September 2011 and December 2014. Benefits included early improvement of stroke severity (NIHSS ≥ 10) or complete remission within 72 h and favorable long-term outcome (mRS ≤ 2). Harms included complications during and following EVT. Mean age was 64.3 years (standard deviation ±12.5), 40 (85%) patients received IVT initially. Median NIHSS was 16 (inter-quartile range 14-19). Mean time from stroke onset to recanalization was 311 min (standard deviation ±78.0). Early clinical improvement was detected in 22 (46%) patients. Favorable outcome at 3 months occurred in 32 (68%) patients. Expedited patient management was associated with favorable clinical outcome. Two (4%) patients experienced symptomatic hemorrhage. Eight (17%) patients experienced stent thrombosis. Four (9%) patients died. Thrombectomy assisted by carotid stenting seems beneficial and reasonably safe with a promising rate of favorable outcome. Nevertheless, adverse events and complications call for additional clinical investigations prior to recommendation as clinical standard. Expeditious patient management is central to achieve good clinical outcome. PMID:26345413

  4. Incidence of hemodynamic depression after carotid artery stenting using different self-expandable stent types

    International Nuclear Information System (INIS)

    The rates of hemodynamic depression (HD) and thromboembolism were compared in 95 carotid artery stenting (CAS) procedures performed in 87 patients with severe carotid artery stenosis using self-expandable braided Elgiloy stents (Wallstent) in 52 and slotted-tube Nitinol stents (Precise) in 43 procedures. The blood pressure, pulse rate, and neurological signs were recorded at short intervals during and after CAS. All patients underwent diffusion-weighted magnetic resonance imaging within 5 days after the procedure. The incidences of hypotension, bradycardia, and both were 17.9%, 3.2%, and 11.6%, respectively. The rate of postprocedural HD was 23.1% with Wallstent and 44.2% with Precise; the difference was significant (p=0.025). No patient manifested major cardiovascular disease after CAS. Diffusion-weighted magnetic resonance imaging revealed thromboembolism after 26.9% and 34.9% of Wallstent and Precise stent placement procedures, respectively; the difference was not significant. The type of self-expandable stent placed may affect the risk of procedural HD in patients undergoing CAS. Postprocedural HD was resolved successfully by the administration of vasopressors and by withholding antihypertensive agents. (author)

  5. Surgical management for retained distal embolic protection device and fractured guidewire after carotid artery stenting.

    Science.gov (United States)

    Li, Tongxun; Zha, Yuanting; Bo, Liyang; Wirthlin, Douglas J; Zhang, Qinyi

    2016-01-01

    Entrapment and fracture of carotid angioplasty and stenting hardware is a rare complication of percutaneous stenting procedures. We describe a case of a retained distal filter embolic protection device and guidewire in a 57-year-old male in Beijing, China. After unsuccessful attempts at removal via interventional methods, a second stent was deployed to secure the original hardware in situ, and the patient was discharged. He later experienced guidewire fragmentation in the carotid artery and aortic arch, with subsequent thrombus formation. We report partial removal of the guidewire and stent via carotid artery cutdown and open thoracotomy without complication. When efforts to retrieve stenting hardware are unsuccessful, it is never a suitable choice to leave them within the artery. We advocate for early surgical management of retained materials after unsuccessful carotid artery stenting. Furthermore, improved quality monitoring and assurance programs are needed to prevent such complications in the future. PMID:27316621

  6. Carotid artery stenting by GuardWire and Wallstent RP

    International Nuclear Information System (INIS)

    In our institute, carotid artery stenting (CAS) has been performed using GuardWire and Wallstent RP, regardless of plaque pathology. In this study, we evaluated our results (high-intensity area on diffusion-weighted imaging (DWI), stroke/death/myocardial infarction within 30 days, ipsilateral stroke/neurological death after 31 days, and retreatment after CAS). Between April 2005 and December 2009, 76 CAS procedures were performed on 74 patients. DWI obtained after CAS showed a high-intensity area in 13 of 75 procedures (17.3%). Two patients (2.6%) died of stroke and myocardial infarction within 30 days after CAS. One patient (1.3%) had symptomatic cerebral infarction; the other, intracranial hemorrhage. Ipsilateral stroke and neurological death after 31 days occurred in 1 patient (1.3%), who had ipsilateral cerebral infarction at 24 months. Retreatment after CAS was required in 2 patients (2.6%). CAS performed using GuardWire and Wallstent RP is an effective and safe procedure. It is important to achieve proficiency in the use of technical devices to perform successful CAS. (author)

  7. Contralateral Cerebral Infarction after Stent Placement in Carotid Artery: An Unexpected Complication

    OpenAIRE

    Park, Seong-Ho; Lee, Chang Young

    2008-01-01

    Stenting is a useful alternative treatment modality in carotid artery stenosis patients who are too high-risk to undergo carotid endarterectomy (CEA). We report a case of contralateral cerebral infarction after stenting for extracranial carotid stenosis. A 78-year-old woman was admitted to the hospital with left-sided weakness. Based on magnetic resonance imaging (MRI) of the brain and conventional angiography, she was diagnosed with an acute watershed infarct of the right hemisphere secondar...

  8. Endovascular stenting for high risk patients with high grade internal carotid stenosis combined with occlusion of the contralateral carotid artery

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy and safety of endovascular therapy for high risk patients with high grade internal carotid artery stenosis combined with occlusion of the contralateral internal carotid artery. Methods: From October, 2000 to December, 2001, 8 patients with high grade stenosis of one internal carotid artery combined with occlusion of the other whose conditions were not suitable for carotid endarterectomy, were treated through endovascular approach. The stenotic degree of the lesions before procedures was (85.2±9.4)% (70%-98%). NIHSS was used to evaluate the neurological function before and after endovascular stenting, and modified Rakin scale was used before and 3 months after endovascular stenting. Carotid arterial ultrasound and transcranial Doppler (TCD) examinations were used before and 2 days, 3 months, 6 months, 12 months after procedure. The averaged follow-up duration was 9 months (6 - 14 months). Results: Predilation was made in 3 patients in whom the stenotic degree of the lesions was more than 90 %. Five Smart self-expanding stents and 3 Wallstent were applied in the 8 patients. All the procedures were technologically successful, and the residual stenosis after procedures were (5.3±2.2)% (5% - 9%). The carotid stenosis after procedure was improved significantly compared with that of preoperation (t = 4.79, P 0.05). Results of carotid ultrasound and TCD examinations showed that the stenotic arteries in which stents were placed were patent, the velocity of blood flow after procedures was markedly improved, and the blood perfusion improved not only at the procedure side but also at the carotid occlusive side in some patients. Neither new stroke nor TIA happened during the follow-up period. Conclusion: Endovascular stenting is an effective and safe method for the treatment of high risk internal carotid stenosis combined with occlusion of the contralateral internal carotid artery which is not suitable for carotid endarterectomy

  9. [Features of carotid stenting in elderly: predictors of adverse outcomes (review of literature)].

    Science.gov (United States)

    Smol'nikov, A V; Kozlov, K L; Kachesov, É Iu; Tishko, V V; Oleksiuk, I B

    2014-01-01

    This article presents the review of literature devoted to studying of features of carotid angioplasty and stenting (CAS) in older patients. Age has been shown to be a predictor of neurological complications during CAS. However, it has been demonstrated recently that carotid stenting can be performed safely in patients over 70 and even 80 years. According to researchers, predictors of mortality were remote (≥ 6 months) transient ischemic attack or cerebrovascular accident, smoking history, creatinine clearance and hemoglobin level. Better selection of patients using the predictors of mortality may help to reduce unwarranted procedures and to optimize survival likelihood. Furthermore, CAS could be safely performed in elderly patients if certain anatomical and clinical markers such as excessive vascular tortuosity, heavy concentric calcification of the lesion and decreased cerebral reserve were avoided. However, additional randomized trial data are needed. PMID:25946844

  10. Short- and Long-Term Major Cardiovascular Adverse Events in Carotid Artery Interventions: A Nationwide Population-Based Cohort Study in Taiwan

    OpenAIRE

    Ming-Lung Tsai; Chun-Tai Mao; Dong-Yi Chen; I-Chang Hsieh; Ming-Shien Wen; Tien-Hsing Chen

    2015-01-01

    Introduction Carotid artery stenosis is one of the leading causes of ischemic stroke. Carotid artery stenting has become well-established as an effective treatment option for carotid artery stenosis. For this study, we aimed to determine the efficacy and safety of carotid stenting in a population-based large cohort of patients by analyzing the Taiwan National Healthcare Insurance (NHI) database. Methods 2,849 patients who received carotid artery stents in the NHI database from 2004 to 2010 we...

  11. Fragmentation of calcified plaque after carotid artery stenting in heavily calcified circumferential stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Tsutsumi, Masanori; Kodama, Tomonobu; Aikawa, Hiroshi; Onizuka, Masanari; Iko, Minoru; Nii, Kouhei; Hamaguchi, Shuko; Etou, Housei; Sakamoto, Kimiya; Inoue, Ritsurou; Nakau, Hiroya [Fukuoka University Chikushi Hospital, Department of Neurosurgery and Neuroradiology, Fukuoka (Japan); Kazekawa, Kiyoshi [Fukuoka University Chikushi Hospital, Department of Neurosurgery and Neuroradiology, Fukuoka (Japan); Fukuoka University Chikushi Hospital, Department of Neurosurgery, Fukuoka (Japan)

    2010-09-15

    We assessed the morphological change of calcified plaque after carotid artery stenting (CAS) in vessels with heavily calcified circumferential lesions and discuss the possible mechanisms of stent expansion in these lesions. We performed 18 CAS procedures in 16 patients with severe carotid artery stenosis accompanied by plaque calcification involving more than 75% of the vessel circumference. All patients underwent multidetector-row computed tomography (MDCT) to evaluate lesion calcification before and within 3 months after intervention. The angiographic outcome immediately after CAS and follow-up angiographs obtained 6 months post-CAS were examined. The preoperative mean arc of the calcifications was 320.1 {+-} 24.5 (range 278-360 ). In all lesions, CAS procedures were successfully carried out; excellent dilation with residual stenosis {<=}30% was achieved in all lesions. Post-CAS MDCT demonstrated multiple fragmentations of the calcifications in 17 of 18 lesions (94.4%), but only cracks in the calcified plaque without fragmentation in one (5.6%). Angiographic study performed approximately 6 months post-CAS detected severe restenosis in one lesion (5.6%) without fragmentation of calcified plaque. Excellent stent expansion may be achieved and maintained in heavily calcified circumferential carotid lesions by disruption and fragmentation of the calcified plaques. (orig.)

  12. Fragmentation of calcified plaque after carotid artery stenting in heavily calcified circumferential stenosis

    International Nuclear Information System (INIS)

    We assessed the morphological change of calcified plaque after carotid artery stenting (CAS) in vessels with heavily calcified circumferential lesions and discuss the possible mechanisms of stent expansion in these lesions. We performed 18 CAS procedures in 16 patients with severe carotid artery stenosis accompanied by plaque calcification involving more than 75% of the vessel circumference. All patients underwent multidetector-row computed tomography (MDCT) to evaluate lesion calcification before and within 3 months after intervention. The angiographic outcome immediately after CAS and follow-up angiographs obtained 6 months post-CAS were examined. The preoperative mean arc of the calcifications was 320.1 ± 24.5 (range 278-360 ). In all lesions, CAS procedures were successfully carried out; excellent dilation with residual stenosis ≤30% was achieved in all lesions. Post-CAS MDCT demonstrated multiple fragmentations of the calcifications in 17 of 18 lesions (94.4%), but only cracks in the calcified plaque without fragmentation in one (5.6%). Angiographic study performed approximately 6 months post-CAS detected severe restenosis in one lesion (5.6%) without fragmentation of calcified plaque. Excellent stent expansion may be achieved and maintained in heavily calcified circumferential carotid lesions by disruption and fragmentation of the calcified plaques. (orig.)

  13. Initial experience with the inspire MD C-Guard stent in the treatment of carotid artery disease.

    Science.gov (United States)

    Mazzaccaro, Daniela; Occhiuto, Maria T; Righini, Paolo; Malacrida, Giovanni; Nano, Giovanni

    2016-06-01

    One of the main issue concerning the treatment of carotid artery stenosis is about the use of stents which could offer the best navigability through the lesion and the smallest "maximum unprotected circular area", ensuring the lowest risk of neurological complication both intraprocedurally and in the long term. Recently, Inspire MD (Tel Aviv, Israel) presented the new stent Inspire MD C-Guard™, a bare-metal stent covered by a micron level mesh (MicroNet). We report our experience about the use of this novel stent in the endovascular treatment of carotid artery stenosis, with some technical considerations. Data about patients in whom the Inspire MD C-Guard was used for the treatment of carotid artery diseases were retrospectively collected and analyzed. The procedure was completed in all patients without any intraoperative complications. Postoperative course was uneventful in all cases and no complications have been recorded till now. In our limited experience, the Inspire MD C-Guard has proven to be a safe stent for the treatment of carotid artery diseases. However large studies are needed to better explain strengths and weaknesses of this device. PMID:27094426

  14. Prediction of Prolonged Hemodynamic Instability During Carotid Angioplasty and Stenting

    Science.gov (United States)

    Rhim, Jong Kook; Park, Jeong Jin; Choi, Hyuk Jai; Cho, Young Dae; Sheen, Seung Hun; Jang, Kyung-Sool

    2016-01-01

    Purpose The aim of this study was to assess the risk factors of prolonged hemodynamic instability (HDI) after carotid angioplasty and stenting (CAS). Herein, a simplified predictive scoring system for prolonged HDI is proposed. Materials and Methods Sixty-six patients who had CAS from 2011 to 2016 at a single institution were evaluated. Prolonged HDI was defined as systolic blood pressure >160 mm Hg or <90 mm Hg or heart rate <50 beats/min, lasting over 30 minutes despite medical treatments. For the study, clinical data and radiologic data, including plaque morphology and stenosis were analyzed. Results Prolonged HDI was observed in 21 patients (31.8%). Multivariable analysis revealed that calcification (OR, 6.726; p=0.006), eccentric stenosis (OR, 3.645; p=0.047) and extensive plaque distribution (OR, 7.169; p=0.006) were related to prolonged HDI. According to these results, a simplified scoring scale was proposed based on the summation of points: 2 points for calcified plaque, 2 points for extensive plaque distribution, and 1 point for eccentric stenosis. The percentages of prolonged HDI according to the total score were as follows: score 0, 8.7%; score 1, 20.0%; score 2, 38.5%; score 3, 72.7%; score 4, 66.7%; score 5, 100%. From the analysis, the total score in patients with prolonged HDI was significantly higher than those without prolonged HDI (p<0.001). Conclusion Prolonged HDI can be associated with calcification of plaque, eccentric stenosis and extensive plaque distribution, and a simplified scoring system enables prediction of prolonged HDI according to our cohort.

  15. Impact of baseline characteristics on outcomes of carotid artery stenting in acute ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Yu CS

    2016-03-01

    Full Text Available Cheng-Sheng Yu,1,* Chih-Ming Lin,2,3,* Chi-Kuang Liu,4 Henry Horng-Shing Lu1 1Institute of Statistics and Big Data Research Center, National Chiao Tung University, Hsinchu, 2Stroke Centre and Department of Neurology, Chunghua Christian Hospital, Chunghua, 3Graduate Institute of Biological Science and Technology, National Chiao Tung University, Hsinchu, 4Department of Medical Imaging, Chunghua Christian Hospital, Chunghua, Taiwan, Republic of China *These authors contributed equally to this work Abstract: Carotid artery stenting is an effective treatment for ischemic stroke patients with moderate-to-severe carotid artery stenosis. However, the midterm outcome for patients undergoing this procedure varies considerably with baseline characteristics. To determine the impact of baseline characteristics on outcomes following carotid artery stenting, data from 107 eligible patients with a first episode of ischemic stroke were collected by retrospective chart review. A modified Rankin Scale (mRS was used to divide patients into two baseline groups, mRS ≤2 and mRS >2. A three-step decision-tree statistical analysis was conducted. After weighting the decision-tree parameters, the following impact hierarchy was obtained: admission low-density lipoprotein, gouty arthritis, chronic kidney disease, ipsilateral common carotid artery resistance index, contralateral ophthalmic artery resistance index, sex, and dyslipidemia. The finite-state machine model demonstrated that, in patients with baseline mRS ≤2, 46% had an improved mRS score at follow-up, whereas 54% had a stable mRS score. In patients with baseline mRS >2, a stable mRS score was observed in 75%, improved score in 23%, and a poorer score in 2%. Admission low-density lipoprotein was the strongest predictive factor influencing poststenting outcome. In addition, our study provides further evidence that carotid artery stenting can be of benefit in first-time ischemic stroke patients with baseline m

  16. Cognitive Performance following Carotid Endarterectomy or Stenting in Asymptomatic Patients with Severe ICA Stenosis

    Directory of Open Access Journals (Sweden)

    Livio Picchetto

    2013-01-01

    Full Text Available Background. Endarterectomy (CEA or stenting (CAS of a stenotic carotid artery is currently undertaken to reduce stroke risk. In addition removal of the arterial narrowing has been hypothesized to improve cerebral hemodynamics and provide benefits in cognitive functions, by supposedly resolving a “hypoperfusion” condition. Methods. In this study we sought to test whether resolution of a carotid stenosis is followed by measurable changes in cognitive functions in 22 subjects with “asymptomatic” stenosis. Results. A main finding of the study was the statistically significant pre-post difference observed in the performance of phonological verbal fluency and Rey’s 15-word immediate recall. Remarkably, there was a significant interaction between phonological verbal fluency performance and side of the carotid intervention, as the improvement in the verbal performance, a typical “lateralized” skill, was associated with resolution of the left carotid stenosis. Conclusion. The results reflect a substantial equivalence of the overall performance at the before- and after- CEA or CAS tests. In two domains, however, the postintervention performance resulted improved. The findings support the hypothesis that recanalization of a stenotic carotid could improve brain functions by resolving hypothetical “hypoperfusion” states, associated with the narrowing of the vessels.

  17. An experimental study on Hanaro self-expanding metallic stent in porcine carodid arteries

    International Nuclear Information System (INIS)

    To evaluate the patency of the Hanaro self-expanding stainless steel stent in the common carotid artery of the pig. Sixteen stents(6mm in diameter/3.5mm in length) were inserted in one or both common carotid arteries of none pigs. Carotid angiography was performed before and after stent insertion, and at the end of the follow-up period(which ranged from 4 to 13 weeks), to evaluate stent patency and change of stent location. Histopathologic study was carried out to assess the endothelial proliferation. Of nine pigs with 16 successfully-inserted stents, follow-up angiography was obtained in seven pigs with 3 stents. The stents inserted were patent in 12 cases and occluded in one. Stenosis was noted in nine of the 12 stents. In three stents, there was angiographic evidence of recanalization such as non-filling or collateral filling of the rate. In no case was there any change of stent location. Endothelial proliferation was more severe in two of four occluded stents(mean thickness : 0.43 mm) than in the other 11 stents(mean thickness : 0.08 mm). Because the Hanaro stent was successfully inserted in porcine carotid arteries and showed a rather good patency(92%), the stent can be used in the small arteries. However, before it is used clinically, further study and development appear to be necessary

  18. An experimental study on Hanaro self-expanding metallic stent in porcine carodid arteries

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Dae Chul; Yoon, Kwon Ha; Song, Ho Young; Sung, Kyu Bo; Lee, Ho Kyu; Choi, Choong Gon; Auh, Yong Ho [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of); Choe, Ghee Young [Seoul City Boramae Hospital, Seoul (Korea, Republic of)

    1996-06-01

    To evaluate the patency of the Hanaro self-expanding stainless steel stent in the common carotid artery of the pig. Sixteen stents(6mm in diameter/3.5mm in length) were inserted in one or both common carotid arteries of none pigs. Carotid angiography was performed before and after stent insertion, and at the end of the follow-up period(which ranged from 4 to 13 weeks), to evaluate stent patency and change of stent location. Histopathologic study was carried out to assess the endothelial proliferation. Of nine pigs with 16 successfully-inserted stents, follow-up angiography was obtained in seven pigs with 3 stents. The stents inserted were patent in 12 cases and occluded in one. Stenosis was noted in nine of the 12 stents. In three stents, there was angiographic evidence of recanalization such as non-filling or collateral filling of the rate. In no case was there any change of stent location. Endothelial proliferation was more severe in two of four occluded stents(mean thickness : 0.43 mm) than in the other 11 stents(mean thickness : 0.08 mm). Because the Hanaro stent was successfully inserted in porcine carotid arteries and showed a rather good patency(92%), the stent can be used in the small arteries. However, before it is used clinically, further study and development appear to be necessary.

  19. Accidental Removal of a Carotid Endovascular Stent during Oropharyngeal Mass Biopsy

    OpenAIRE

    Charbel Rameh; Arnaud Deveze; Jean-Pierre Lavieille; Jacques Magnan; Melanie Sanjuan

    2010-01-01

    A 54-year-old male patient, with a history of a right mandibular adenocarcinoma, previously excised, and treated with post operative chemo- and radio-therapy, presented with a right oropharyngeal necrotic mass of several months duration. His history is pertinent for a right internal carotid endovascular stenting 2 years prior to presentation. During biopsy of his oropharyngeal lesion, a specimen of tissue was retrieved, with the carotid stent within. There was no bleeding. To the best of our ...

  20. Routine Use of Cerebral Protection (Filter Wire During Carotid Artery Stenting: Results of a Single Center Registry of 37 Patients

    Directory of Open Access Journals (Sweden)

    A.M. Haji Zeinali

    2006-05-01

    Full Text Available Objective/Background: To evaluate the short-term outcome of patients who underwent carotid stenting with the routine use of cerebral protection devices. Patients and methods: In our center, 36 successful carotid stenting procedures (of 38 at-tempted were performed in 37 patients (23 men; aged 667 years. Cerebral protection in-volved distal filter devices (n= 36 of which 12 were Accunet and 24 were EZ filter wires. Results: The protection devices were positioned successfully in 36 of the 38 attempted vessels. The 30-day incidence of stroke and neurological death was three. Neurological complications included one major stroke, and one minor stroke. There was also one (sudden cardiac death on the first day. The proportion of stroke or death was two for symptomatic lesions and one for asymptomatic lesions, and two in patients aged <80 years and one in those aged 80 years. Protection device-related vascular complications included mild spasm, which occurred after three procedures (8%, none of which led to neurological symptoms. There were another four cardiogenic deaths in 30-day follow-up. Conclusion: In this uncontrolled study, routine cerebral protection during carotid artery stenting was technically feasible and clinically safe. The incidence of major neurological complications in this study was lower than in previous reports of carotid artery stenting without cerebral protection.

  1. Association between carotid plaque composition assessed by multidetector computed tomography and cerebral embolism after carotid stenting

    Energy Technology Data Exchange (ETDEWEB)

    Uchiyama, Naoyuki [Kanazawa University, Department of Neurosurgery and Radiology, Graduate School of Medical Science, Kanazawa (Japan); Kanazawa University, Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa, Ishikawa (Japan); Misaki, Kouichi; Mohri, Masanao; Watanabe, Takuya; Hirota, Yuichi; Nakada, Mitsutoshi; Hayashi, Yutaka; Ueda, Fumiaki; Hamada, Jun-ichiro [Kanazawa University, Department of Neurosurgery and Radiology, Graduate School of Medical Science, Kanazawa (Japan)

    2012-05-15

    We aimed to assess the relationship between atherosclerotic carotid plaque composition analyzed using multidetector computed tomography (MDCT) and the appearance of new ischemic lesions detected by diffusion-weighted images (DWI) after carotid artery stenting (CAS). We quantitatively and qualitatively analyzed plaque characteristics in carotid arteries using MDCT before CAS in 19 patients. Carotid plaques were expediently subdivided into four components with Hounsfield unit (HU) values of <0, 0-60, 60-130, and >600. The incidence of distal embolism was evaluated with DWI. Pearson's correlation analyses were used to assess the association between plaque composition and the incidence of cerebral embolization. Fifteen patients (79%) demonstrated new DWI lesions after CAS. High-signal DWIs were noted as follows: one in six patients, 2{proportional_to}5 in five patients, 6{proportional_to}10 in two patients, and >10 in two patients. The mean volumes of the plaque components for HU < 0, 0-60, 60-130, and >600 were 5.4, 200, 260, and 59 mm{sup 3}, respectively. There was a strong correlation between the number of high-signal DWI lesions in the ipsilateral side and the plaque volume of HU < 0 (r = 0.927; P < 0.0001). There was a moderate correlation between the number of high-signal DWI lesions and the plaque volume of HU 0-60 (r = 0.568; P = 0.0099) and the sum total of HU < 0 and HU 0-60 (r = 0.609; P = 0.0047). Quantitative and qualitative tissue characterization of carotid plaques using MDCT might be a useful predictor for silent ischemic lesions after CAS. (orig.)

  2. Carotid Stenting with Distal Protection in High-Surgical-Risk Patients: One-Year Results of the ASTI Trial

    Energy Technology Data Exchange (ETDEWEB)

    Bosiers, Marc, E-mail: marc.bosiers@telenet.be [A.Z. Sint-Blasius, Department of Vascular Surgery (Belgium); Scheinert, Dierk, E-mail: dierk.scheinert@gmx.de [Park Hospital, Center for Vascular Medicine-Angiology and Vascular Surgery (Germany); Mathias, Klaus, E-mail: k.mathias@asklepios.com [Klinikum Dortmund GmbH (Germany); Langhoff, Ralf, E-mail: ralf.langhoff@sankt-gertrauden.de [Sankt Gertrauden-Krankenhaus (Germany); Mudra, Harald, E-mail: haraldmudra@aol.com [Klinikum Neuperlach (Germany); Diaz-Cartelle, Juan, E-mail: juan.diazcartelle@bostonscientific.com [One Boston Scientific Place, Boston Scientific Corporation (United States)

    2015-04-15

    PurposeThis prospective, multicenter, nonrandomized study evaluated the periprocedural and 1-year outcomes in high-surgical-risk patients with carotid artery stenosis treated with the Adapt Carotid Stent plus FilterWire EZ distal protection catheter (Boston Scientific Corporation, Natick, MA).Materials and MethodsThe study enrolled 100 patients (32 symptomatic, 63 asymptomatic, 5 unknown) at high risk for carotid endarterectomy due to prespecified anatomical criteria and/or medical comorbidities. Thirty-day and 1-year follow-up included clinical evaluation, carotid duplex ultrasound, and independent neurologic and NIH stroke scale assessments. One-year endpoints included the composite rate of major adverse events (MAE), defined as death, stroke, and myocardial infarction (MI) and the rates of late ipsilateral stroke (31–365 days), target lesion revascularization, and in-stent restenosis.ResultsOf the 100 enrolled patients, technical success was achieved in 90.9 % (90/99). The 30-day MAE rate (5.1 %) consisted of major stroke (2.0 %) and minor stroke (3.1 %); no deaths or MIs occurred. The 1-year MAE rate (12.2 %) consisted of death, MI, and stroke rates of 4.4, 3.3, and 8.9 %, respectively. Late ipsilateral stroke (31–365 days) rate was 1.1 %. Symptomatic patients had higher rates of death (11.1 vs. 1.7 %) and MI (7.4 vs. 1.7 %), but lower rates of major (7.4 vs. 10.0 %) and minor stroke (0.0 vs. 6.7 %), compared with asymptomatic patients.ConclusionResults through 1 year postprocedure demonstrated that carotid artery stenting with Adapt Carotid Stent and FilterWire EZ is safe and effective in high-risk-surgical patients.

  3. Carotid Stenting with Distal Protection in High-Surgical-Risk Patients: One-Year Results of the ASTI Trial

    International Nuclear Information System (INIS)

    PurposeThis prospective, multicenter, nonrandomized study evaluated the periprocedural and 1-year outcomes in high-surgical-risk patients with carotid artery stenosis treated with the Adapt Carotid Stent plus FilterWire EZ distal protection catheter (Boston Scientific Corporation, Natick, MA).Materials and MethodsThe study enrolled 100 patients (32 symptomatic, 63 asymptomatic, 5 unknown) at high risk for carotid endarterectomy due to prespecified anatomical criteria and/or medical comorbidities. Thirty-day and 1-year follow-up included clinical evaluation, carotid duplex ultrasound, and independent neurologic and NIH stroke scale assessments. One-year endpoints included the composite rate of major adverse events (MAE), defined as death, stroke, and myocardial infarction (MI) and the rates of late ipsilateral stroke (31–365 days), target lesion revascularization, and in-stent restenosis.ResultsOf the 100 enrolled patients, technical success was achieved in 90.9 % (90/99). The 30-day MAE rate (5.1 %) consisted of major stroke (2.0 %) and minor stroke (3.1 %); no deaths or MIs occurred. The 1-year MAE rate (12.2 %) consisted of death, MI, and stroke rates of 4.4, 3.3, and 8.9 %, respectively. Late ipsilateral stroke (31–365 days) rate was 1.1 %. Symptomatic patients had higher rates of death (11.1 vs. 1.7 %) and MI (7.4 vs. 1.7 %), but lower rates of major (7.4 vs. 10.0 %) and minor stroke (0.0 vs. 6.7 %), compared with asymptomatic patients.ConclusionResults through 1 year postprocedure demonstrated that carotid artery stenting with Adapt Carotid Stent and FilterWire EZ is safe and effective in high-risk-surgical patients

  4. Short-term outcome of stent-assisted angioplasty for extracranial carotid stenosis

    International Nuclear Information System (INIS)

    Objective: To evaluate the safety and short-term outcome of stent-assisted angioplasty for extracranial carotid stenosis. Methods: From October 2000 to September 2002, 93 cases of extracranial carotid stenosis, including 86 cases of carotid bifurcation stenosis, 4 of extracranial internal carotid stenosis, 2 of common carotid stenosis and 1 of functional external carotid stenosis, were treated by self-expandable stent placement and angioplasty. Results: Stent placement and angioplasty were successfully administered in all the 93 patients. The average stenosis rate was reduced from (79.5 ± 14.6)% before treatment to (11.2 ± 7.8)% after stent-assisted angioplasty. There were only 1 case of TIA (1.1%) and 1 case of minor stroke (1.1%) during the operation, without mortality or major stroke. No cerebral ischemic attach occurred in the 91 patients during clinical follow up for a period of 3-25 months with an average of 7.9 months. twenty-nine patients were angiographically followed up 6 months after treatment with only one asymptomatic restenosis (3.4%). Conclusions: Endovascular stent-assisted angioplasty for extracranial stenosis is safe and effective with considerable good short-term outcome

  5. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... on the prevention of further propagation of carotid disease. Carotid enarterectomy was first described in about 1953 ... the carotid bifurcation where the majority of the disease occurs. We will use special magnifying glasses to ...

  6. In vitro comparison of different carotid artery stents: a pixel-by-pixel analysis using CT angiography and contrast-enhanced MR angiography at 1.5 and 3 T

    International Nuclear Information System (INIS)

    CT angiography (CTA) and MR angiography (MRA) are increasingly used methods for evaluation of stented vessel segments. The purpose of this study was to compare CTA, contrast-enhanced MRA (CEMRA) at 1.5 T, and CEMRA at 3 T for the visualization of carotid artery stents and to define the best noninvasive imaging technique for each stent. CTA and CEMRA appearances of 18 carotid artery stents of different designs and sizes (4.0 to 10.0 mm) were investigated in vitro. The profile of the contrast-to-noise ratio (CNR) of the lumen of each stent was calculated semiautomatically by a pixel-by-pixel analysis using the medical imaging software OSIRIS registered. For each stent, artificial lumen narrowing (ALN) was calculated. In all but one stents, ALN was lower on CEMRA at 3 T than at 1.5 T. With CEMRA at 3 T and at 1.5 T, ALN in most nitinol stents was lower than in the groups of stainless steel and cobalt alloy stents. In most nitinol stents, ALN on CEMRA at 3 T was lower than on CTA. In all stainless steel stents and cobalt alloy stents, ALN was lower on CTA than on CEMRA. With CTA and CEMRA, in most stents ALN decreased with increasing stent diameter. CTA and CEMRA evaluation of vessel patency after stent placement is possible, but considerably impaired by ALN. Investigators should be informed about the method of choice for every stent. (orig.)

  7. Covered Stent-Graft Treatment of a Postoperative Common Carotid Artery Pseudoaneurysm

    International Nuclear Information System (INIS)

    Extracranial carotid artery pseudoaneurysms are rare cases resulting from trauma, mycotic infection, head and neck carcinomas or complications related to their treatment. Trauma is the most common cause of carotid artery pseudoaneurysms. They can also present after surgery, most commonly following endarterectomy, which is a rare cause with an estimated incidence of 0.3–0.6%. A 26-year-old male patient was admitted with swelling in his left neck after left carotid endarterectomy. Angiography confirmed pseudoaneursym in the left carotid bulb and it was treated successfully with two heparin-bonded covered stent grafts. Endovascular treatment of carotid pseudoaneurysms with covered stent-grafts is a safe and efficient method providing definitive arterial reconstruction. But series with longer follow-up periods are needed to evaluate patient compatibility to lifelong antiplatelet theraphy

  8. CT angiography after carotid artery stenting: assessment of the utility of adaptive statistical iterative reconstruction and model-based iterative reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Kuya, Keita; Shinohara, Yuki; Fujii, Shinya; Ogawa, Toshihide [Tottori University, Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Yonago (Japan); Sakamoto, Makoto; Watanabe, Takashi [Tottori University, Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Yonago (Japan); Iwata, Naoki; Kishimoto, Junichi [Tottori University, Division of Clinical Radiology Faculty of Medicine, Yonago (Japan); Kaminou, Toshio [Osaka Minami Medical Center, Department of Radiology, Osaka (Japan)

    2014-11-15

    Follow-up CT angiography (CTA) is routinely performed for post-procedure management after carotid artery stenting (CAS). However, the stent lumen tends to be underestimated because of stent artifacts on CTA reconstructed with the filtered back projection (FBP) technique. We assessed the utility of new iterative reconstruction techniques, such as adaptive statistical iterative reconstruction (ASIR) and model-based iterative reconstruction (MBIR), for CTA after CAS in comparison with FBP. In a phantom study, we evaluated the differences among the three reconstruction techniques with regard to the relationship between the stent luminal diameter and the degree of underestimation of stent luminal diameter. In a clinical study, 34 patients who underwent follow-up CTA after CAS were included. We compared the stent luminal diameters among FBP, ASIR, and MBIR, and performed visual assessment of low attenuation area (LAA) in the stent lumen using a three-point scale. In the phantom study, stent luminal diameter was increasingly underestimated as luminal diameter became smaller in all CTA images. Stent luminal diameter was larger with MBIR than with the other reconstruction techniques. Similarly, in the clinical study, stent luminal diameter was larger with MBIR than with the other reconstruction techniques. LAA detectability scores of MBIR were greater than or equal to those of FBP and ASIR in all cases. MBIR improved the accuracy of assessment of stent luminal diameter and LAA detectability in the stent lumen when compared with FBP and ASIR. We conclude that MBIR is a useful reconstruction technique for CTA after CAS. (orig.)

  9. Clinical experience of cerebral protection with balloon occlusion during carotid artery stenting

    International Nuclear Information System (INIS)

    Purpose: To asses the technical feasibility and the results of cerebral protection with the GuardWire Plus Temporary Occlusion and Aspiration System during carotid artery stenting for high-grade stenosis. Patients and Methods: In 20 patients 20 carotid artery stenoses were treated with stent placement under cerebral protection. A contralateral carotid occlusion was an exclusion criteria for the use of the protection device. In all cases only aspiration, but no flushing was used before deflation of the occlusion balloon. In 17 of 20 patients diffusion-weighted (DW-)MRT imaging of the brain was performed before and 24 hours after the procedure. Results: The stent implantation was successfully performed in all patients. In 3 patients neurologic symptoms occurred during the occlusion time. In these 3 patients the symptoms immediately disappeared after deflation of the balloon. In one case there was dilatation of the internal carotid artery at the site of the balloon inflation. In 3 of the 17 DW-MR images new ipsilateral cerebral lesions, in one case a new contralateral lesion occurred after the procedure. Conclusions: The cerebral protection procedure is technically feasible. The occlusion of the internal carotid artery was not tolerated by all patients. The DW-MR imaging demonstrated cerebral lesions indicating the occurrence of cerebral microemboli during the procedure. Further investigations are necessary to determine if the use of the cerebral protection device will improve the results of the carotid artery stenting for high-grade stenoses. (orig.)

  10. Physician-initiated prospective Italian Registry of carotid stenting with the C-Guard mesh-stent: the IRON-Guard registry. Rationale and design.

    Science.gov (United States)

    Setacci, C; Speziale, F; De Donato, G; Sirignano, P; Setacci, F; Capoccia, L; Galzerano, G; Mansour, W

    2015-10-01

    According to the World Health Organization, every year, 5 million peoples die for stroke and another 5 million are permanently disabled. Although there are many causes of acute stroke, a common treatable cause of acute stroke is atheromatous narrowing at the carotid bifurcation. Carotid endarterectomy is still the standard of car, even if carotid artery stenting (CAS) has become an effective, less invasive alterantive. Unfortunately, CAS procedure is not yet perfect; regardless the use of an embolic protection device (EPD), percutaneous treatment has been correlated with a risk of cerebral ischemic events related to distal embolization. The objective of the IRON-Guard Registry is to evaluate the clinical outcome of treatment by means of stenting with the C-Guard (InspireMD, Boston, MA, USA) in subjects requiring CAS due to significant extracranial carotid artery stenosis with a physician-initiated, Italian, prospective, multicenter, single-arm study. A total of 200 enrolled subjects divided over different centers are planned to be enrolled. CAS will performed by implanting of C-Guard stent. Procedure will be performed according to the physician's standard of care. Standard procedures will be followed based on the Instructions for Use, for the C-Guard device of Inspire. The primary endpoint of this study is the 30-day rate of major adverse events (MAE), defined as the cumulative incidence of any periprocedural (≤30 days postprocedure) death, stroke or myocardial infarction. Secondary endpoints are rate of late ipsilateral stroke (31 through 365 days), system technical success, device malfunctions, major adverse events (MAEs), serious device-related and procedure-related adverse events, target lesion revascularization, and in-stent restenosis rates. PMID:25996843

  11. Emergency placement of stent-graft for symptomatic acute carotid artery occlusion after endarterectomy.

    Science.gov (United States)

    Ko, Jun Kyeung; Choi, Chang Hwa; Lee, Sang Weon; Lee, Tae Hong

    2016-03-01

    A patient underwent a left-sided carotid endarterectomy (CEA) for an asymptomatic 80% carotid artery (CA) stenosis. There were no signs of intolerance during the carotid cross-clamping and an initially uneventful awakening was observed. However, in the third postoperative hour he experienced left amaurosis and dysarthria. An urgent MRI showed an occluded internal CA on the operated site without evidence of acute infarction. To recanalize the occluded internal CA and minimize leakage from the arteriotomy site, a self-expandable stent-graft was placed, covering the dissection and the distal atherosclerotic lesions. Complete recanalization of the left internal CA was achieved and the patient showed a dramatic improvement of his preoperative deficits. To our knowledge, this is the first case of stent-graft implantation for a symptomatic acute CA occlusion following CEA. Stent-graft placement should be considered as an alternative method of treatment for acute CA occlusion or dissection following CEA. PMID:25653229

  12. Cerebral Hemorrhage after Endovascular Treatment of Bilateral Traumatic Carotid Cavernous Fistulae with Covered Stents

    OpenAIRE

    Cho, Kwang-Chun; Seo, Dae-Hee; Choe, Il-Seung; Park, Sung-Choon

    2011-01-01

    Bilateral traumatic carotid-cavernous fistulae (TCCFs) is rarely encountered neurovascular disease. For treatment of TCCF, detachable balloons have been widely used. Nowadays, transarterial and/or transvenous coil embolization with placement of covered stents is adopted as another treatment method. We experienced a patient with a bilateral TCCFs who was successfully treated with covered stents. However, cerebral hemorrhage occurred in the bed of previous infarction one day after treatment. Hy...

  13. Delayed Development of Brain Abscesses Following Stent-Graft Placement in a Head and Neck Cancer Patient Presenting with Carotid Blowout Syndrome

    International Nuclear Information System (INIS)

    We describe the delayed development of intracranial abscesses following emergent treatment with a covered stent-graft for carotid blowout syndrome (CBS) in a patient with head and neck cancer. The patient presented with hemoptysis and frank arterial bleeding through the tracheostomy site. A self-expandable stent-graft was deployed across a small pseudoaneurysm arising from the right common carotid artery (RCCA) and resulted in immediate hemostasis. Three months later, the patient suffered a recurrent hemorrhage. CT of the neck demonstrated periluminal fluid around the caudal aspect of the stent-graft with intraluminal thrombus and a small pseudoaneurysm. Subsequently, the patient underwent a balloon test occlusion study and endovascular sacrifice of the RCCA and right internal carotid artery. MRI of the brain demonstrated at least four ring-enhancing lesions within the right cerebral hemisphere consistent with intracranial abscesses that resolved with broad-spectrum antibiotic coverage.

  14. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... with its appropriate branches, the bifurcation of the internal carotid there, and then the -- moving rightward on ... area of the proximal portion of the left internal carotid artery. The distal vessel is straight and ...

  15. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... There are different ways of collateralizing the carotid circuit, both extracranial -- that is, from the external carotid artery -- to the intracranial circuit, or intracranial to intracranial, which our next slide ...

  16. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... Carotid endarterectomy as shown here is a surgical exposure of the carotid artery in which an incision ... anyway. But it may change my post-procedure management under -- if there are PO collaterals from posterior ...

  17. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... of flow to the brain. Many times during these procedures, there may be signs of low blood ... previous carotid surgery. And finally, neck irradiation. All these factors make patients higher risk for carotid endarterectomy ...

  18. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... catheter into the subclavian artery, just doing an x-ray, visualizing the one vertebral artery, the left one, ... a carotid occlusion and a neurosurgeon constructed a bypass from the external carotid artery and typically the ...

  19. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Science.gov (United States)

    ... catheter into the subclavian artery, just doing an x-ray, visualizing the one vertebral artery, the left one, ... a carotid occlusion and a neurosurgeon constructed a bypass from the external carotid artery and typically the ...

  20. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... receives about $450 million in annual NIH research funding. Its faculty of about 5,000 physicians provides ... carotid circuit, both extracranial -- that is, from the external carotid artery -- to the intracranial circuit, or intracranial ...

  1. Frequency and predictors for angiographically improved inflow of contrast medium after carotid angioplasty and stenting

    International Nuclear Information System (INIS)

    Percutaneous transluminal carotid angioplasty and stenting (PTAS) can result in immediate improvement in cerebral blood flow (CBF) evident through faster transit of contrast medium on angiography. To evaluate frequency and predictors of changes in inflow of contrast medium before and after PTAS, we reviewed 86 patients (mean age 68.6 ± 9.1 years) treated for symptomatic or asymptomatic carotid stenosis. Clinical data and lesion characteristics were extracted from charts and digital angiograms, respectively. Perfusion change was assessed qualitatively by comparing pre- and poststenting images matched for projection and time from injection. Improved inflow was defined on the basis of spatial or temporal distribution of contrast medium: grade -1: fewer vessels visible after stenting; 0: no change; 1: more distal small arteries visible; 2: time-matched poststenting image showing a capillary blush; 3: time-matched poststenting image showing small veins, 4 time-matched poststenting image showing large veins and sinuses. Faster inflow of contrast medium was observed in 74 % of patients (grades 1: 34 %,and 4: 4.7 %). In linear regression analysis, higher degrees of ipsilateral stenosis were associated with greater changes in inflow of contrast medium (P < 0.05). Right internal carotid lesions were associated with greater change in inflow than left-sided lesions (P < 0.01). In 31 patients (36 %) we initially showed contralateral anterior cerebral artery (ACA) filling, and in 39 % of these, normal filling was restored after stenting. Lesser contralateral carotid stenosis was associated with crossed ACA filling and with restoration of normal filling pattern after stenting. Faster appearance of a contrast-medium blush is seen in most cases of carotid angioplasty and stenting and depends on the degree of hemodynamic inflow obstruction relieved by stenting. (orig.)

  2. Treatment of internal carotid artery dissections with endovascular stent placement: report of two cases

    International Nuclear Information System (INIS)

    Extracranial carotid artery dissection may manifest as arterial stenosis or occlusion, or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. We encountered two consecutive cases of trauma-related extracranial internal carotid artery dissection, one in the suprabulbar portion and one in the subpetrosal portion. We managed the patient with suprabulbar dissection using a self-expandable metallic stent and managed the patient with subpetrosal dissection using a balloon-expandable metallic stent. In both patients the dissecting aneurysm disappeared, and at follow-up improved luminal patency was observed

  3. Transcatheter Closure of a Chronic Iatrogenic Arteriovenous Fistula Between the Carotid Artery and the Brachiocephalic Vein with an Amplatzer Duct Occluder in Combination with a Carotid Stent

    International Nuclear Information System (INIS)

    We report an original method of transcatheter closure of an arteriovenous fistula using the combination of an Amplatzer PDA occluder and a carotid stent. The fistula was between the left carotid artery and the brachiocephalic vein. The patient had significant left-to-right shunt and was highly symptomatic. Due to the large orifice and pseudoaneurysmatic enlargement of the fistula, we had to use a large Amplatzer PDA occluder and the protruding part of the PDA device disk had to be covered with a carotid stent. The fistula was completely closed. The patient stopped having symptoms and, 2 years after the procedure, the effect persists.

  4. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... the vessel -- in the vessel for the stent delivery system to be placed. And I think that it's -- ... can't get the stent-retracting device out, delivery system out because you just don't have enough ...

  5. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... length of stent, and then closed-cell versus open-cell. Jim? 00:50:24 JAMES F. McKINSEY, MD: I like the tapered stents, I think, aesthetically, but I don't have any data whatsoever that says that's the right thing to ...

  6. Thirty-day outcome of carotid artery stenting in Chinese patients: a single-center experience

    Institute of Scientific and Technical Information of China (English)

    JIAO Li-qun; SONG Gang; LI Shen-mao; MIAO Zhong-rong; ZHU Feng-shui; JI Xun-ming; YIN Guo-yang

    2013-01-01

    Background Carotid artery stenting (CAS) as a competing treatment modality has had to adhere to limits to gain widespread acceptance in some studies.This study analyzed the clinical data of 1700 consecutive patients after CAS to retrospectively evaluate the 30-day outcome of CAS for internal carotid artery stenosis in a Chinese population.Methods Medical records of 1700 patients who underwent CAS at Xuanwu Hospital affiliated to Capital Medical University between January 2001 and August 2012 were reviewed.Postoperative 30-day complication rates were analyzed and compared with those of other studies.Univariate and multivariate Logistic regression analyses were used to identify factors associated with perioperation myocardial infarction (MI),stroke,and death.Results The overall 30-day rate of MI,stroke,and death after CAS was 2.53%.In univariate analysis,patients who were symptomatic,had a neurological deficit (modified Rankin score (mRS) ≥3; P=0.001),and who were not taking statins experienced a significantly increased rate of MI,stroke,and death (P=-0.017).In multivariate Logistic regression analysis,the presence of symptoms (odds ratio (OR)=2.485; 95% confidence interval (CI)=1.267-4.876; P=0.008) and a neurological deficit (mRS ≥3) (OR=3.025; 95% CI=1.353-6.763; P=0.007) were independent risk factors for perioperative MI,stroke,and death.Conclusions According to this single-center experience,CAS may effectively prevent and treat carotid artery stenosis that would otherwise lead to stroke.Being symptomatic and having a neurological deficit (mRS ≥3) increased the risk of perioperative MI,stroke,and death.

  7. Quantitative evaluation of cerebral blood flow by XeCT in stenting angioplasty for carotid artery

    International Nuclear Information System (INIS)

    Objective: To evaluate the hemodynamic characteristics of severe carotid artery stenosis and curative effect of stent angioplasty through XeCT. Methods: From April 2006 to November 2006, 13 patients with severe carotid artery stenoses underwent stent angioplasty in our hospital, including 11 male and 2 females, in an average age of 57.31 ± 6.12. All patients underwent XeCT examination to evaluate the quantitative cerebral blood flow (CBF). The ischemic cortex is categorized into 4 kinds, the normal region, oligemia area, reversible ischemic site and ischemic core center. Measurement and comparison of the changes were taken before and after the therapy. Results: Preoperative XeCT revealed different decrease of CBF in the ipsilateral cortex, especially in MCA distributing territory. Ischemic areas reduced significantly after the stenting angioplasty. Oligemia area reduced from 32.63% to 14.22%. Reversible ischemic area reduced from 13.54% to 8.38%. Normal area increased from 47.51% to 71.13%. But ischemic core center showed no significant changes. Conclusions: XeCT is beneficial for evaluation of the hemodynamic characteristics of carotid artery stenoses and also for accurately demonstrating the curative effects of the stent angioplasty. (authors)

  8. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... The next video is going to be angiographic description, really, of the sheath access into the carotid ... choice of size and pressure, but more importantly, management of hypotension/hypertension, post-procedural bradycardia and so ...

  9. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... high- and low-risk patients based on their anatomy as well as their medical comorbidities, including coronary ... The catheters are multiple shapes, depending on the anatomy of the aortic arch in the carotid, and ...

  10. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... differential in many other individual and some multicenter expert sites, we don't see this age differential. ... not comfortable, certainly a referral to a carotid expert as on the panel today or a neurologist ...

  11. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... that'll allow me to get a reasonable seat within the common carotid artery. Now, care has ... This one has a peel-away type of cover that allows the filter to then pop open ...

  12. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... the treatment options for carotid stenosis that can lead to stroke or to help prevent stroke is ... position, especially if you're inexperienced, that could lead to devastating results. As you start looking at ...

  13. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... measure the degree of carotid stenosis. The NASCET group actually proposed a very simple and straightforward way ... it's more of an unbiased report. The multidisciplinary group consists of vascular surgery, the interventional neuroradiologists, the ...

  14. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... will typically involve patients who have poor renal function and in whom pre- procedural imaging might have ... got good position. And then the catheter is advanced over the glide wire into the common carotid ...

  15. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... and receives about $450 million in annual NIH research funding. Its faculty of about 5,000 physicians ... prior surgery in the neck, such as for cancer or previous carotid surgery. And finally, neck irradiation. ...

  16. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... University, a division of New York-Presbyterian Hospital System. To my right is Dr. Pierre Gobin, who ... to the brain. At New York-Presbyterian Hospital Systems, we looked at the results of our carotid ...

  17. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... carotid, but suppose you did, what are your methods for getting through that? And I'll now ... what do you do there, what are your methods? And then lastly, we should talk about, and ...

  18. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... to present today, and we're going to base our commentary and discussion around the case primarily, ... hypoplastic, so then the trilateral carotid artery will give both anterior cerebral arteries. 00:24:23 WILLIAM ...

  19. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... re in relative agreement here at the two institutions that both a carotid angiogram bilaterally as well ... country. We're doing a trial at this institution on flow reversal, and we -- I think it's ...

  20. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... as the thing becomes more complicated or more complex, the endarterectomy component or option becomes more prominent, ... to external carotid artery anastomotic stenosis? A pretty complex question here, Pierre. 01:14:48 Y. PIERRE ...

  1. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... the majority of the disease occurs. We will use special magnifying glasses to feather out the plaque ... stent angioplasty. In special cases, we may actually use a distal occluding balloon as seen in the ...

  2. Cerebral foreign body reaction after carotid aneurysm stenting

    DEFF Research Database (Denmark)

    Lorentzen, Anastasia Orlova; Nome, Terje; Bakke, Søren Jacob; Scheie, David; Stenset, Vidar; Aamodt, Anne Hege

    2016-01-01

    distally to the stent site. Although previously described, embolization of polymer material from intravascular equipment is rare. We could not identify any other biopsy verified case in the literature, with this particular presentation of intracerebral polymer embolization - a multifocal inflammation...

  3. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... the collateral circuit may be important for procedural planning purposes. We may choose a filter in one ... that's shorter than the stent that I'm planning to use, because most of the time I ...

  4. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... work from that and keep a very stable environment to pass balloon stents and filters during the ... circle is constructed of both the anterior and middle cerebral artery portions as well as the anterior ...

  5. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... ten seconds, the patient may have loss of consciousness or seizure related to that, but I'm ... vessel -- in the vessel for the stent delivery system to be placed. And I think that it's -- ...

  6. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... you found that there wasn't an adequate circulatory collateral to that segment, if it was isolated? ... vessel -- in the vessel for the stent delivery system to be placed. And I think that it's -- ...

  7. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... of stents we can use. Some have closed cell, as seen on the top, of a stainless steel variety, and then others have an open cell, meaning there's breaks between the connections of the ...

  8. Endovascular stent-assisted thrombolysis in acute occlusive carotid artery dissection

    Energy Technology Data Exchange (ETDEWEB)

    Mourand, Isabelle [Hopital Gui de Chauliac, Department of Neurology, CHU Montpellier, Montpellier, Cedex 5 (France); Hopital Gui de Chauliac, Department of Neurology, Service de Neurologie, Montpellier, Cedex 5 (France); Brunel, Herve; Vendrell, Jean-Francois; Bonafe, Alain [Hopital Gui de Chauliac, Department of Neuroradiology, CHU Montpellier, Montpellier, Cedex 5 (France); Thouvenot, Eric [Hopital Gui de Chauliac, Department of Neurology, CHU Montpellier, Montpellier, Cedex 5 (France)

    2010-02-15

    Internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion may be responsible for large cerebral infarction that carries a general poor prognosis. Recanalization of internal carotid artery (ICA) dissection by stent-assisted thrombolysis has been recently proposed. We report two cases of acute symptomatic ICA dissection with tandem occlusion successfully treated with emergent endovascular stent-assisted thrombolysis using new self-expandable intracranial stents. A 37-year-old woman and a 59-year-old man were admitted in our hospital after acute severe symptoms of right-hemispheric stroke with National Institutes of Health Stroke Scale (NIHSS) scores of 15 and 18, respectively. In both cases, magnetic resonance angiography showed tandem occlusion and angiography confirmed tandem occlusion with ICA dissection. An extensive mismatch region was diagnosed by Perfusion-diffusion MRI of the brain within 3 h after symptoms onset. Treatment was initiated 4 h after symptom onset by implantation of self-expandable intracranial stents into the dissected ICA and administration of intra-arterial recombinant tissue plasminogen activator. Recanalization of the ICA and middle cerebral artery (MCA) was accomplished within 6 h after symptoms onset. In both cases, no periprocedural complication was observed and follow-up CT scan showed only a mild brain infarct in the MCA territory. After, respectively, 12 and 10 months follow-up, patients had a favorable outcome with NIHSS 0 and mRS {<=}1. Endovascular stent-assisted thrombolysis appears to be a promising treatment in tandem occlusion due to ICA dissection. Our work underline the potential use of self-expandable intracranial stents in symptomatic acute ICA dissection. (orig.)

  9. Stenting for symptomatic vertebral artery stenosis associated with bilateral carotid rate mirabile: The long-term clinical and angiographic outcome

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Jang Hyun; Kim, Byung Moon [Dept. of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2015-06-15

    Symptomatic vertebral artery (VA) stenosis associated with bilateral carotid rate mirabile (CRM) has not been reported. We report the long-term clinical and angiographic outcome after stenting for symptomatic VA stenosis in the patient with bilateral CRM. This report is the first case that symptomatic VA stenosis associated with bilateral CRM was treated with stenting.

  10. Outcomes of emergent carotid artery stenting within 6 hours of symptom onset in patients with acute ischemic stroke

    International Nuclear Information System (INIS)

    To investigate clinical outcomes following the emergent carotid artery stenting for treatment of acute ischemic stroke. Twenty-eight consecutive patients with acute stroke due to atherosclerotic steno-occlusive diseases of extracranial internal carotid artery underwent emergent carotid artery stenting. Of these, 23 patients had tandem intracranial arterial occlusions. Extracranial carotid stenting was successful in all patients. From the 13 patients who underwent intracranial recanalization procedures, successful recanalization occurred in 84.6% (11/13). 57% of patients (16/28) had a good clinical outcome (modified Rankin Scale 0-2) after 3 months. Patients with successful intracranial/extracranial recanalization had a significantly higher rate of good outcome than those without recanalization after 3 months (75% vs. 33%, p = 0.027). Patients without intracranial tandem occlusions had a more favorable clinical outcome than those with intracranial tandem occlusions (100% vs. 48%, p = 0.033). Symptomatic intracerebral hemorrhage occurred in one patient (3.6%). Mortality rate was 0% (0/28) after 3 months. Emergent carotid artery stenting in setting of acute stroke was a safe and effective treatment modality. Successful recanalization (extracranial and intracranial) and absence of intracranial tandem occlusion are significantly associated with a good outcome for our cohort of patients whom undergone emergent carotid artery stenting.

  11. Safety and efficacy of the Perclose suture-mediated closure device following carotid artery stenting under clopidogrel platelet blockade

    Energy Technology Data Exchange (ETDEWEB)

    Zorger, Niels; Finkenzeller, Thomas; Lenhart, Markus; Hamer, Okka; Paetzel, Christian; Borisch, Inghita; Toepel, Ingolf; Feuerbach, Stefan; Link, Johann [University of Regensburg Klinikum, Franz-Josef-Strauss-Allee 11, 93042, Regensburg (Germany)

    2004-04-01

    The aim of this study was evaluation of a closure device (Perclose, Menlo Park, Calif.) for closure of the femoral artery access site in patients undergoing aggressive anticoagulation and platelet blockade after carotid stenting. Fifty-five patients who received clopidogrel in addition to aspirin and heparin as medication for carotid stenting were included for suture of the femoral access site after using 7- or 8-F guide catheters. The technical success, the time for suture, the clotting parameters, and complications were examined. Follow-up investigations, including ultrasound and clinical examinations, were performed. The groin was checked for possible hematoma, pseudoaneurysm, arteriovenous fistula, and local infection. Technical success was obtained in 51 of 54 patients (94%) after a mean procedure time of 6 min (range 5-10 min). The suture device was not used in one patient (2%) for anatomical reasons and failed to obtain hemostasis in 3 of 54 (6%) patients. In 4 of 54 patients (7%) bleeding was observed at the punctured site 4-6 h after intervention which was treated by a compression bandage. The mean dedicated activated clotting time was 137 s (range 29-287 s) before intervention and 349 s (150-958 s) just before deploying the Perclose device. During follow-up after 2 days (range 2-6 days) and 6 months no further complications of the puncture site were observed except for two large groin hematomas. No major complications occurred. Closure of the femoral access site after carotid stenting using a Perclose closure device is safe and effective even in patients receiving an aggressive anticoagulation and antiplatelet therapy. (orig.)

  12. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... we can do it under local anesthesia. Severe lung dysfunction, so patients can't lay flat on an operating room table, and prior surgery in the neck, such as for cancer or previous carotid surgery. And finally, neck irradiation. ...

  13. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... embolization. And that was some of the early work that was -- helped define the work when we compared carotid endarterectomy to maximum medical ... a larger catheter, which will allow us to work from that and keep a very stable environment ...

  14. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... stroke per year. Stroke is the third leading cause of death in the U.S.A., and the first cause of adult disability. Symptoms of stroke: the -- what ... carotid artery to embolize the brain and potentially cause a stroke. There are several ways that we ...

  15. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... Gray, who is the director of the Endovascular Therapy for Interventional Therapy at Columbia University. Tonight, Pierre, can you start ... 44 JAMES F. McKINSEY, MD: Some of the treatment options for carotid stenosis that can lead to ...

  16. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... work from that and keep a very stable environment to pass balloon stents and filters during the ... real-world, if you will, or the clinical environment. 01:02:27 JAMES F. McKINSEY, MD: So, ...

  17. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... if it looks like I'm going to land and I'm going to have a kink ... we'll use a little longer stent or land a little bit lower, depending on what I ... then what you have to do is to change -- change the anatomy. And you know, those vessels, ...

  18. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... 5-0 balloon is probably a reasonably safe thing to do and gives us a good caliber stent result. I tend to not go ... pictures, because I think we can combine those things. Can we go to the ... know, this is a pretty good-looking result. You can see that the area ...

  19. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... if it looks like I'm going to land and I'm going to have a kink ... we'll use a little longer stent or land a little bit lower, depending on what I ... from a local neurologic standpoint that palsy is rare if it ever happens. And so I don' ...

  20. Accordion effect during carotid artery stenting. Report of two cases and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Tsutsumi, Masanori; Kazekawa, Kiyoshi; Onizuka, Masanari; Aikawa, Hiroshi; Iko, Minoru; Kodama, Tomonobu; Nii, Kouhei; Matsubara, Shuko; Etou, Housei; Tanaka, Akira [Fukuoka University Chikushi Hospital, Department of Neurosurgery, Fukuoka (Japan)

    2007-07-15

    The term ''accordion effect'' is used to describe a mechanical distortion of tortuous arteries mimicking spasm or dissection. This phenomenon has been reported in patients undergoing percutaneous coronary intervention. To our knowledge, this is the first documentation of the accordion effect during carotid artery intervention. Two patients who developed the accordion effect during carotid artery stenting (CAS) are described. Angiograms obtained just after CAS showed a stenosing lesion with wall irregularity at the distal part of the stent. This lesion disappeared and tortuosity of the internal carotid artery developed after withdrawing the guidewire until its floppy segment rested equally on the lesion. In another patient, the lesion did not disappear completely until the guiding catheter had been withdrawn to the proximal portion of the common carotid artery. We conclude that these stenosing lesions reflected the accordion effect. It is essential to differentiate the accordion effect from dissection, spasm, and thrombosis because the management is importantly different. We report our findings and present a review of the literature. (orig.)

  1. Carotid artery stenting: a single-centre experience with up to 8 years' follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Simonetti, Giovanni; Gandini, Roberto; Pampana, Enrico; Fabiano, Sebastiano; Stefanini, Matteo; Spinelli, Alessio; Reale, Carlo Andrea; Di Primio, Massimiliano; Gaspari, Eleonora [University Hospital ' ' Tor Vergata' ' , Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, Rome (Italy); Versaci, Francesco [University Hospital ' ' Tor Vergata' ' , Department of Internal Medicine, Unit of Cardiology, Rome (Italy)

    2009-04-15

    Carotid artery stenting (CAS) may be an alternative to surgical endoarterectomy not only in high-risk patients. We report results in the endovascular treatment of carotid artery disease with up to 8 years' follow-up. In this retrospective study, we analysed data from 853 consecutive patients (946 arteries) treated for carotid artery stenosis between April 1999 and March 2007; 491 (52%) arteries were symptomatic and 455(48%) were asymptomatic. Preprocedural evaluation of the patients was performed with echo Doppler, magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) and a neurological examination. A cerebral protection device was used in 879 (92.9%) procedures. Anti-platelet therapy was administered before and after the procedure. All patients were included in a follow-up of up to 8 years. Technical success was achieved in 943 (99.6%) lesions. At 30 days, there was a 0.21% (n = 2) death rate, a 0.42% major stroke rate, a 1.69% minor stroke/transient ischaemic attack (TIA) rate and a combined 2.32% TIA/stroke and death rate. During follow-up, echo Doppler evidenced restenosis in 39 (4.85%) cases; of these, only five, presenting restenosis >80%, were treated with an endovascular reintervention. At the long-term follow-up, two strokes (0.23%) were reported, which both occurred within the first 2 years. In our experience, carotid artery stenting seems to be a safe and effective treatment, providing satisfactory long-term clinical results. (orig.)

  2. Safety of Early Carotid Artery Stenting after Systemic Thrombolysis: A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Fabrizio Sallustio

    2012-01-01

    Full Text Available Background. Patients with acute ischemic stroke due to internal carotid artery (ICA disease are at high risk of early stroke recurrence. A combination of IV thrombolysis and early carotid artery stenting (CAS may result in more effective secondary stroke prevention. Objective. We tested safety and durability of early CAS following IV thrombolysis in stroke patients with residual stenosis in the symptomatic ICA. Methods. Of consecutive patients treated with IV rtPA, those with residual ICA stenosis ≥70% or 24 hours. The protocol included pre-rtPA MRI and MR angiography, and post-rtPA carotid ultrasound and CT angiography. Stroke severity was assessed by the NIH Stroke Scale (NIHSS. Three- and twelve-month stent patency was assessed by ultrasound. Twelve-month functional outcome was assessed by the modified Rankin Scale (mRS. Results. Of 145 consecutive IV rtPA-treated patients, 6 (4% underwent early CAS. Median age was 76 (range 67–78 years, median NIHSS at stroke onset was 12 (range 9–16 and 7 (range 7-8 before CAS. Median onset-to-CAS time was 48 (range 30–94 hours. A single self-expandable stent was implanted to cover the entire lesion in all patients. The procedure was uneventful in all patients. After 12 months, all patients had stent patency, and the functional outcome was favourable (mRS ≤ 2 in all but 1 patient experiencing a recurrent stroke for new-onset atrial fibrillation. Conclusion. This small case series of a single centre suggests that early CAS may be considered a safe alternative to CEA after IV rtPA administration in selected patients at high risk of stroke recurrence.

  3. The use of intraoperative monitoring and treatment of symptomatic microemboli in carotid artery stenting: case report and discussion

    Energy Technology Data Exchange (ETDEWEB)

    Rangi, P.S.; Clifton, A. [St Georges Hospital, Department of Neuroradiology, Atkinson Morley Wing, Tooting, London (United Kingdom); Markus, H.S.; Punter, M.N.M. [St Georges University of London, Centre for Clinical Neuroscience, Cranmer Terrace, London (United Kingdom)

    2007-03-15

    Carotid artery stenting is a recently introduced treatment in symptomatic atherosclerotic carotid artery disease with acceptable complication rates. The major risk is perioperative embolic stroke. Transcranial Doppler ultrasonography (TCD) can be used to identify embolic signals and guide therapy. We present a case of symptomatic embolization in a 72-year-old female following carotid stent deployment complicated by haemodynamic changes. Despite concurrent dual antiplatelet medication significant symptomatic embolization occurred even after restoration of the blood pressure, and modulation of the rate of embolization was achieved using dextran-40 guided by TCD monitoring. The patient recovered from an initially profound hemiparesis and dysphasia to minor sensory changes. Microemboli are common following carotid artery stenting and there appears to be a threshold phenomenon associated with prolonged embolization and progression to cerebral infarction. TCD can be used to detect particulate microemboli and therefore may be useful in guiding antithrombotic therapy in this setting. Dextran-40 has been shown to reduce the embolic load following carotid endarterectomy and was used to good effect in this patient in terms of both embolic load and clinical outcome. This is the first case of embolization following carotid stenting successfully treated with dextran-40, and offers a further option for therapeutic intervention in microembolism detected by TCD and stresses the importance of perioperative monitoring of embolic load for postoperative stroke risk. (orig.)

  4. The use of intraoperative monitoring and treatment of symptomatic microemboli in carotid artery stenting: case report and discussion

    International Nuclear Information System (INIS)

    Carotid artery stenting is a recently introduced treatment in symptomatic atherosclerotic carotid artery disease with acceptable complication rates. The major risk is perioperative embolic stroke. Transcranial Doppler ultrasonography (TCD) can be used to identify embolic signals and guide therapy. We present a case of symptomatic embolization in a 72-year-old female following carotid stent deployment complicated by haemodynamic changes. Despite concurrent dual antiplatelet medication significant symptomatic embolization occurred even after restoration of the blood pressure, and modulation of the rate of embolization was achieved using dextran-40 guided by TCD monitoring. The patient recovered from an initially profound hemiparesis and dysphasia to minor sensory changes. Microemboli are common following carotid artery stenting and there appears to be a threshold phenomenon associated with prolonged embolization and progression to cerebral infarction. TCD can be used to detect particulate microemboli and therefore may be useful in guiding antithrombotic therapy in this setting. Dextran-40 has been shown to reduce the embolic load following carotid endarterectomy and was used to good effect in this patient in terms of both embolic load and clinical outcome. This is the first case of embolization following carotid stenting successfully treated with dextran-40, and offers a further option for therapeutic intervention in microembolism detected by TCD and stresses the importance of perioperative monitoring of embolic load for postoperative stroke risk. (orig.)

  5. Risk analysis of carotid stent from a population-based database in Taiwan.

    Science.gov (United States)

    Cheng, Chun-An; Chien, Wu-Chien; Hsu, Chien-Yeh; Lin, Hui-Chen; Chiu, Hung-Wen

    2016-08-01

    Because stroke is the third leading disease that causes mortality in the world, the prevention of stroke from advanced carotid stenosis is an important issue. The carotid stent (CAS) is a less invasive to treat advanced carotid stenosis, but for high-risk patients it may cause some events after the procedure that reduces the benefit of stroke prevention. Because patients and their families have less information about risk of events after CAS and are easy concerned, this study calculates the individual probability of major adverse cardiovascular events including any stroke, myocardial infarction, or death after procedure.The analyzed dataset was composed of patients undergoing CAS from the longitudinal National Health Insurance claim database in Taiwan. The validation dataset was composed of patients undergoing CAS from the Tri-Service General Hospital. We excluded patients under 18 years of age. The prediction model was constructed with a multivariable Cox proportional hazard regression and performed with forward stepwise selection. The nomogram construction was based on the multivariable Cox model.The risk factors were determined as follows: age with a hazard ratio (HR) of 1.027 (95% confidence interval [CI]: 1.002-1.053) for every 1 year older, congestive heart failure with a HR of 2.196 (95% CI: 1.368-3.524), malignant disease with a HR of 1.724 (95% CI: 1.009-2.944), diabetes mellitus with a HR of 1.722 (95% CI: 1.109-2.674), and symptomatic status with a HR of 1.604 (95% CI: 1.027-2.507). The model showed good discrimination with a P information, and it is easy to use in clinical practice. The integer-base method may support communication between clinicians and patients before CAS to reduce the anxiety about making a treatment decision. However, insofar as older patients with multiple comorbidities are at high risk, the option of an alternative treatment strategy with medical therapy should be suggested. In the future, prospective tests should be performed to

  6. Angioplasty treatment and stent implant vs. surgical treatment in patients with stenosis of the cervical carotid artery

    International Nuclear Information System (INIS)

    Angioplasty with stent implant is a less invasive procedure than surgical intervention in the treatment of significant stenosis of the common cervical carotid artery (common and internal) (5). Currently the major published studies, in which angioplasty and surgical treatment are compared, show similar results in the major events, as cerebrovascular accidents and mortality, but a greater significant difference in the apparition of acute myocardial infarction, during surgical intervention (5,11). The objective of this study is to compare in both treatment methods the major and minor clinical events, like cerebrovascular accident, acute myocardial infarction, death, bradycardia, hypotension and encephalopathy during the intervention, the hospitalization and the follow-up year, as well as the re-intervention, the time of hospital stay and the complications of the surgical incision. Materials and methods: in this study of historical cohort, 46 patients with significant stenosis of the cervical carotid arteries, who were subjected to intervention from January 1st 2001 to December 31st 2003, were included. 21 patients were treated with angioplasty and stent implant and 25 with surgery (endarterectomy) Results: 1 (4.8%) major cerebrovascular accident occurred during angioplasty, whereas none occurred in the patients treated with surgery. 1 (4%) acute myocardial infarction occurred during intervention in the group of patients treated with surgery, and none in the patients treated with angioplasty. No deaths occurred in any of the groups during intervention, hospitalization and the follow-up year. After 8 months 1 (4%) patient treated with surgery was intervened again with angioplasty and stent implant. There were no statistically significant differences between both groups during hospitalization, and in the apparition of minor complications as bradycardia and hypotension. 2 (8%) complications related to the incision of the neck compromising cranial nerves, occurred in the

  7. United Kingdom Carotid Artery Stent Registry: Short- and Long-Term Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Goode, S. D., E-mail: s.goode@sheffield.ac.uk; Cleveland, T. J.; Gaines, P. A. [Northern General Hospital, Sheffield Vascular Institute (United Kingdom)

    2013-10-15

    Background: Carotid artery stenting (CAS) has evolved to treat carotid artery disease with the intention of prevent stroke. The British Society of Interventional Radiologists developed a voluntary registry to monitor the practice of this novel procedure. We present the data from the United Kingdom (UK) CAS registry for short and long-term outcomes for symptomatic and asymptomatic carotid disease. Methods: The UK CAS registry collected data from 1998 to 2010 from 31 hospitals across the UK for 1,154 patients. All interventions were enrolled in the registry for both asymptomatic and symptomatic patients. Initial entry forms were completed for each patient entered with data including indications, demographic data, CAS data (including stents and protection device details) and 30-day outcomes. Complications were documented. Follow-up data were collected at yearly intervals. Results: Nine hundred fifty-three (83 %) symptomatic and 201 (17 %) asymptomatic patients were enrolled into the registry. The 30-day all stroke and death rates for symptomatic patients were 5.5 and 2.2 % for those with asymptomatic disease. The 30-day mortality rate was 1.7 % for symptomatic and 0.6 % for asymptomatic patients. For symptomatic patients undergoing CAS, the 7-year all-cause mortality rate was 22.2 % and for asymptomatic patients 18.1 %. The 7-year all-cause mortality and disabling stroke rates were 25.3 and 19.4 %, respectively. Conclusion: These data indicate that outside of the tight constraints of a randomised trial, CAS provides effective prophylaxis against stroke and death.

  8. Prediction of cerebral hyperperfusion syndrome after carotid artery stenting by CT perfusion imaging with acetazolamide challenge

    Energy Technology Data Exchange (ETDEWEB)

    Yoshie, Tomohide; Ueda, Toshihiro; Takada, Tatsuro; Nogoshi, Shinji; Fukano, Takayuki [St. Marianna University Toyoko Hospital, Department of Strokology, Stroke Center, Kawasaki (Japan); Hasegawa, Yasuhiro [St. Marianna University School of Medicine, Department of Internal Medicine, Division of Neurology, Kawasaki (Japan)

    2016-03-15

    Cerebral hyperperfusion syndrome (HPS) is an uncommon but serious complication of carotid artery stenting (CAS). The purpose of this study was to investigate the efficacy of CT perfusion imaging (CTP) with acetazolamide challenge to identify patients at risk for HPS after CAS. We retrospectively analyzed 113 patients who underwent CTP with rest and acetazolamide challenge before CAS. CTP maps were assessed for absolute and relative cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and change of each parameter before and after acetazolamide challenge. Patients were divided into two groups according to the HPS after the CAS. Receiver-operating characteristic (ROC) curve analysis was performed to determine the most accurate CTP parameter for the prediction of HPS. Nine of 113 patients had HPS. There were significant differences for absolute and relative values of resting CBF (p = 0.001 and p = 0.026), resting MTT (p < 0.001 and p = 0.004), post-acetazolamide CBF (p < 0.001 and p = 0.001), post-acetazolamide MTT (p < 0.001 and p = 0.002), and %changes of CBF (p = 0.009) between the HPS and non-HPS groups. ROC curve analysis showed that the CTP parameters with the maximal area under the receiver-operating characteristic curve (AUC) for HPS was the absolute value of post-acetazolamide MTT (AUC 0.909) and the absolute value of resting MTT (AUC 0.896). Pretreatment CTP with acetazolamide challenge could identify patients at risk for HPS after CAS. Although the CTP parameter that most accurately identified patients at risk for HPS was the absolute value of post-acetazolamide MTT, resting MTT was sufficiently accurate. (orig.)

  9. Stent placement in arteriovenous fistula : an experimental study

    International Nuclear Information System (INIS)

    To determine the efficacy of metallic stents in the treatment of experimentally created carotid-jugular fistulas. Materials and Methods : Carotid-jugular fistulas were constructed surgically in four mongrel swines. Three Wallstents (Schneider, Bulbanch, Switzerland), 6mm in diameter and 23mm in length, and one Nir stent (Boston Scientific Corporation, Boston, U.S.A.), 3-5mm in diameter and 16mm in length, were placedendovascularly across the fistula holes within the carotid artery. Carotid angiography was performed before,immediately after, and 1-3 months after stent placement. Fistula specimens were obtained after final angiography and gross and microscopic examination was performed. Results : Angiography demonstrated decreased flow through the fistula immediately after stent placement. During follow-up, flow through the fistula decreased progressively but complete closure did not occur. Carotid arteries p in which Wallstents were placed were patent throughout the follow-up period. A carotid artery in which a Nir stent was used showed no decreased flow during follow-up angiography lasting two months. Pathologically, a thin layer of endothelium covered the stent wires; there was a transitional zone between the fibrous connective tissue of organizing thrombus, and endothelial proliferation occurred in the overlying fistula hole. Conclusions : Stent placement effectively reduced flow through the fistulas but during the ensuing three months closure did not occur. Occlusion was then progressive.Pathologically, intimal proliferation arose from the organizing thrombus on the surface of the stent mesh

  10. Severe compression of a bailout self-expanding chimney stent for rescuing the miscoverage of left common carotid artery during TEVAR of a type B aortic dissection.

    Science.gov (United States)

    Wang, Lixin; Guo, Daqiao; Jiang, Junhao; Shi, Zhenyu; Fu, Weiguo; Wang, Yuqi

    2014-04-01

    A 54-year-old man who suffered from paraplegia due to type B aortic dissection was treated with a Valiant stent-graft. However, attempts to gain secure proximal sealing resulted in an inadvertent coverage of the left common carotid artery by the endograft. The blood flow in the left common carotid artery was restored by a transcarotid Smart Control stent in a chimney fashion. At 6- and 18-month follow-up, computed tomography scan showed that the chimney stent was severely compressed by the stent graft, although the patient remained neurologically asymptomatic. PMID:24309751

  11. EFFECT OF STENT ABSORBED c-myc ANTISENSE OLIGODEOXYNUCLEOTIDE ON SMOOTH MUSCLE CELLS APOPTOSIS IN RABBIT CAROTID ARTERY

    Institute of Scientific and Technical Information of China (English)

    张新霞; 崔长琮; 李江; 崔翰斌; 徐仓宝; 朱参战

    2002-01-01

    Objective To investigate the effect of gelatin coated Platinium-Iridium stent absorbed c-myc antisense oligodeoxynucleotide (ASODN) on smooth muscle cells apoptosis in a normal rabbit carotid arteries. Methods Gelatin coated Platinium-Iridium stents were implanted in the right carotid arteries of 32 rabbits under vision. Animals were randomly divided into control group and treated group receiving c-myc ASODN (n=16, respectively). On 7, 14, 30 and 90 days following the stenting procedure ,morphometry for caculation of neointimal area and mean neointimal thickness were performed.The expression of c-myc protein was detected by immunohistochemical method. Apoptotic smooth muscle cells was detected by terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL). Results At 7 and 14 days after stenting,there were no detectable apoptotic cells in both groups. The apoptotic cells occurred in the neointima 30 and 90 days after stenting, and the number of apoptotic cells at 30 days were less [4.50±1.29 vs 25.75±1.89 (number/0.1mm2)] than that at 90 days [13.50±1.91 vs 41.50±6.46 (number/0.1mm2)]. Meanwhile c-myc ASODN induced more apoptotic cells than the control group(P<0.0001). c-myc protein expression was weak positive or negative in treated group and positive in control group.Conclusion c-myc ASODN can induce smooth muscle cells apoptosis after stenting in normal rabbit carotid arteries,and it can be used to prevent in-stent restenosis.

  12. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... so patients can't lay flat on an operating room table, and prior surgery in the neck, ... been studies that showed with the duplex alone operating, even if there was intracranial disease, turned out ...

  13. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... see a Back to the Future kind of evolution of access for cryostenting which will include not ... to this at the end, the development, the evolution of flow reversal, which is now in study ...

  14. Simultaneous Bilateral Carotid Stenting for Symptomatic Bilateral High-Grade Carotid Stenosis: A Retrospective Clinical Investigation

    Science.gov (United States)

    Ye, Ziming; Liu, Ying; Deng, Xiao; Chen, Xiangren; Lin, Cuiting; Tang, Yanyan; Su, Ying; Fang, Lanji; Wu, Yuan; Qin, Chao

    2016-01-01

    Background This retrospective clinical investigation aimed to evaluate the short-term effectiveness and safety of SBCAS for symptomatic bilateral high-grade CS. Material/Methods From 2009 to 2014, 145 patients were recruited. Among them, 70 underwent SBCAS, and other 75 patients underwent SAMM and served as controls. The immediate postprocedural complications and postprocedural neurological evaluation, as well as restenosis at 6-month and 1-year follow-ups in the SBCAS group are reported. Additionally, baseline risk factors for ischemic stroke, adverse effects of drugs, and outcomes at 30-day, 6-month, and 1-year follow-ups were compared between the 2 groups. Results Our data did not reveal significant differences between the 2 groups in baseline risk factors for ischemic stroke. In the SBCAS group, both HPS (5.7%) and HD (40%) occurred, but they were not very severe, and no patients had postprocedural neurological deficit. Moreover, restenosis only occurred in 3 patients at 3 stent placement sites (4.3%) at 1-year follow-up. Adverse effects of drugs did not occur in SBCAS group, but adverse effects of Bayer aspirin and Lipitor occurred in 4 patients (5.4%) and 18 patients (24.3%), respectively, at 6-month follow-up in the control group. Furthermore, there were significant differences in outcomes between the 2 groups at 30-day, 6-month, and 1-year follow-ups, in that NIHSS, CS ratio, and incidence of endpoint events, as well as 1-year cumulative probability of endpoint events, were all lower in the SBCAS group than in the control group (p<0.05). Conclusions Compared to SAMM, we found that SBCAS was more effective and safer for symptomatic bilateral high-grade CS. PMID:27542158

  15. Lateral abdominal wall hematoma as a rare complication after carotid artery stenting: a case report

    Directory of Open Access Journals (Sweden)

    Satomi Jyunichiro

    2009-11-01

    Full Text Available Abstract Abdominal wall hematoma is a rare and life-threatening complication after carotid artery stenting (CAS, but it can occur when activated clotting time is prolonged. We report a right lateral abdominal wall hematoma caused by rupture of the superficial circumflex iliac artery after CAS in a 72-year-old man with severe stenosis of the origin of the right internal carotid artery. We performed CAS for the targeted lesion while activated clotting time exceeded 300 seconds. After 2 hours, he complained of right lateral abdominal pain. Abdominal computed tomography revealed an extensive hematoma in the right lateral abdominal wall. Activated clotting time was 180 seconds at this point. Seven hours later, he developed hypotension and hemoglobin level dropped to 11.3 g/dl. Subsequent computed tomography showed enlargement of the hematoma. Emergent selective angiography of the external iliac artery revealed active bleeding from the right superficial circumflex iliac artery. Transcatheter arterial embolization with Gelfoam and microcoils was performed successfully. With more CAS procedures being performed, it is important for endovascular surgeons and radiologists to consider the possibility of abdominal wall hematoma in this situation.

  16. Local Delivery of C-myc Antisense Oligodeoxynucleotide by Gelatin Coated Platinium-Iridium Stent to Prevent Restenosis in a Normal Rabbit Carotid Artery

    Institute of Scientific and Technical Information of China (English)

    Zhang Xinxia; Wei Wenbin; Duan Wen; Xu Xiangguang; Hu Xuesong

    2005-01-01

    Objectives To investigate the feasibility and effect of local deliveryof c-myc antisense oligodeoxynucleotide (ASODN) by gelatin coated Platinium-Iridium stent to prevent restenosis in a normal rabbit carotid artery. Methods Gelatin coated Platinium-Iridium stent were implanted in the right carotid arteries of 32 rabbits under vision. Animals were randomized to the control group and the treated group receiving c-myc ASODN (n=16 respectively).7,14,30,90 days following the stenting procedure,morphometry for caculation of neointimal area and mean neointimal thickness were performed.The expression of c-myc protein was detected by immunohistochemical methods. Results 32 stents were successfully implanted into the right carotid arteries in 32 animals. Morphometric analysis showed that neointimal area and mean neointimal thickness siginificantly increased continuously up to 12 weeks after stent implantation,and at each time point ,neointimal area and mean neointimal thickness were siginificantly smaller in the treated group than control group. (P<0.001 ,respectively).c-myc protein expression was weak positive or negative in treated group and positive in control group. Conclusions Gelatin coated Platinium-Iridium stent mediated local delivery of c-myc ASODN is feasibility , and it can inhibit neointimal hyperplasia to prevent restenosis in a normal rabbit carotid artery.

  17. Evaluation of changes of intracranial blood flow after carotid artery stenting using digital subtraction angiography flow assessment

    Institute of Scientific and Technical Information of China (English)

    Hajime; Wada; Masato; Saito; Kyousuke; Kamada

    2015-01-01

    AIM: To evaluate the changes of intracranial blood flow after carotid artery stenting(CAS), using the flow assessment application "Flow-Insight", which was developed in our department.METHODS: Twenty patients treated by CAS participated in this study. We analyzed the change in concentration of the contrast media at the anterior-posterior and profile view image with the flow assessment application "Flow-Insight". And we compared the results with N-isopropyl-p-[123I] iodoamphetamine-single-photon emission computed tomography(IMP SPECT) performed before and after the treatment. RESULTS: From this study, 200% of the parameter "blood flow" change in the post/pre-treatment is suggested as the critical line of the hyperperfusion syndrome arise. Although the observed blood flow increase in the digital subtraction angiography system did not strongly correlate with the rate of increase of SPECT, the "Flow-Insight" reflected the rate of change of the vessels well. However, for patients with reduced reserve blood flow before CAS, a highly elevated site was in agreement with the site analysis results. CONCLUSION: We concluded that the cerebral angiography flow assessment application was able to more finely reveal hyperperfusion regions in the brain after CAS compared to SPECT.

  18. Urgent stenting for patients with acute stroke due to atherosclerotic occlusive lesions of the cervical internal carotid artery

    International Nuclear Information System (INIS)

    Acute symptomatic occlusion of the cervical internal carotid artery (ICA) can be treated by intravenous administration of tissue plasminogen activator, percutaneous transluminal angioplasty, and carotid endarterectomy. Carotid artery stenting (CAS) is now indicated for cervical ICA stenosis, but the safety and the efficacy of urgent CAS have not been established. We retrospectively reviewed 10 patients treated by urgent CAS for atherosclerotic occlusive lesions of cervical ICA with acute stroke. Five patients had complete occlusions and five had near total occlusions. Five of the 10 patients had intracranial tandem occlusions. Indication for urgent CAS was determined by mismatch of diffusion-weighted and perfusion-weighted magnetic resonance imaging findings. Stents were successfully deployed in all lesions. Three of five patients with concomitant intracranial tandem occlusions were treated by additional intraarterial fibrinolysis after the CAS. Intracranial artery occlusions were completely recanalized in one patient, and partially recanalized in two by fibrinolysis. Hyperperfusion syndrome did not occur in any of the patients. A favorable outcome (modified Rankin Scale ≤1) was obtained in all of the five patients with isolated cervical ICA occlusion and one of the five patients with intracranial tandem occlusions. Urgent CAS is a safe and effective treatment in patients with isolated cervical ICA occlusion. Treatment of intracranial tandem occlusions is an issue that must be resolved. (author)

  19. Evaluation of changes in the parameters of brain tissue perfusion in multi-slice computed tomography in patients after carotid artery stenting

    International Nuclear Information System (INIS)

    CT perfusion of the brain allows functional evaluation of cerebral blood flow. Patients with chronic internal carotid artery (ICA) stenosis may suffer from malperfusion. Improvement of cerebral blood flow and remission of neurological symptoms indicate the effectiveness of treatment of internal carotid artery stenosis. Material/Methods: The aim of the study was to analyze alterations within cerebral perfusion parameters in CT brain perfusion examination in patients who were scheduled for endovascular therapy due to ICA stenosis. Forty patients with ICA stenosis of over 79% who were included in this prospective study underwent perfusion CT examination twice - 24 hours prior to stenting and after 6-8 weeks following the procedure. CBF, CBV, MTT and TTP were evaluated. Results: Prior to endovascular therapy, an increase in MTT and TTP, and a decrease in CBV and CBF were observed within arterial supply of the hemisphere ipsilateral to stenosis. After the procedure, a decrease in MTT and TTP was seen in all cases, while no statistically significant changes of CBF or CBV were observed. MTT proved to be the most sensitive indicator of ICA stenosis, as its values allowed differentiation between critical and non-critical stenosis. No correlation between the degree of ICA stenosis and TTP values was found. Mild cerebral hyperperfusion syndrome (CHS) was observed in only one patient and the difference between pre-treatment MTT values calculated for both hemispheres was shown to be a prognostic factor for CHS incidence. Conclusions: Endovascular stent placing in patients with hemodynamically significant internal carotid artery stenosis results in alteration of perfusion parameters, especially concerning TTP and MTT. (authors)

  20. An Efficient Finite Element Framework to Assess Flexibility Performances of SMA Self-Expandable Carotid Artery Stents

    Science.gov (United States)

    Ferraro, Mauro; Auricchio, Ferdinando; Boatti, Elisa; Scalet, Giulia; Conti, Michele; Morganti, Simone; Reali, Alessandro

    2015-01-01

    Computer-based simulations are nowadays widely exploited for the prediction of the mechanical behavior of different biomedical devices. In this aspect, structural finite element analyses (FEA) are currently the preferred computational tool to evaluate the stent response under bending. This work aims at developing a computational framework based on linear and higher order FEA to evaluate the flexibility of self-expandable carotid artery stents. In particular, numerical simulations involving large deformations and inelastic shape memory alloy constitutive modeling are performed, and the results suggest that the employment of higher order FEA allows accurately representing the computational domain and getting a better approximation of the solution with a widely-reduced number of degrees of freedom with respect to linear FEA. Moreover, when buckling phenomena occur, higher order FEA presents a superior capability of reproducing the nonlinear local effects related to buckling phenomena. PMID:26184329

  1. Self-made Palmaz stent: an experimental swine model study

    International Nuclear Information System (INIS)

    Objective: To investigate the histologic changes and physicochemical stability of self-made Palmaz stent placed in swine arteries. Methods: The self-made Palmaz stent was made of 316L stainless steel wire. Nine stents were respectively placed within internal carotid, renal and iliac arteries of six pigs. Pigs were euthanized at intervals of 0.5, 1 and 3 months respectively and angiography were performed. Immediately followed by light and electro scanning microscopy for the stent zones. Results: All stents were successfully implanted in the target arteries and were patent shown in the angiographic examination immediately after the stent placement. Eight stents (8/9) remained patent at the time before euthanasia. No migration of stent were shown in the follow-up angiography. Light and electron scanning microscopy showed that the surface of the stents was covered by a thin layer of endothelial cells 2 weeks after the procedure and completely covered after 4 weeks. No inflammation occurred. Conclusions: The self-made Palmaz stent has good physicochemical stability and histocompatibility with easy placement, rather long term patency, histopathologic stability and thus the promising for clinical application

  2. A new experimental model of intracranial internal carotid artery and its application in testing the navigability of the covered stents

    International Nuclear Information System (INIS)

    Objective: By using rapid prototyping technique to establish a vascular model in dogs with its twisting shape simulated to the human intracranial carotid artery (ICA) and by using this vascular model to test the navigability of the Willis covered stents. Methods: A cultivated digital tube was made based on the raw MR images of human ICA. Then the digital tube was transferred into a real physical model in a 3D rapid prototyping machine. Silicon was coated. The carotid arteries of canine were exposed and cut, and then the tube was put through and anatomized to get the vascular model. Eight e-PTFE covered stents (two each at size of 3.5 mm x 16 mm, 3.5 mm x 13 mm, 3.5 mm x 10 mm and 3.5 mm x 7 mm, Shanghai Microport Co. Ltd.) were implanted one week later. Two dogs were taken as control group. Device performance was evaluated by angiography and histopathological examination. Results: Ten animal models were successfully established. Neither vascular spasm nor thrombosis was seen on angiography. Destruction of tunica media was found in the group of 3.5 mm x 16 mm and destruction of endothelium in the group of 3.5 mm x 13 mm, while only flattening of the endothelium was noted in both groups of 3.5 mm x 10 mm and 3.5 mm x 7 mm. Conclusion: Simulating the three-dimensional anatomy of human ICA and providing an effective tool for the research and for the testing of neurovascular devices, this experimental vascular model can be easily established and the procedure is of high controllability, repeatability and factuality. It is also a useful devise in training the neuroradiologists and interventional physicians. The navigability of the tested covered stents becomes decreased with the increasing of its length. (authors)

  3. Magnetic resonance plaque imaging to predict the occurrence of the slow-flow phenomenon in carotid artery stenting procedures

    International Nuclear Information System (INIS)

    The purpose is to investigate the feasibility of magnetic resonance (MR) plaque imaging in predicting the arterial flow impairment (slow-flow phenomenon) during carotid artery stenting (CAS) using a filter-type protection device. Thirty-one carotid artery stenotic lesions in 30 patients (28 men and two women; mean age, 71.8 years) were evaluated by MR plaque imaging with black blood T1- and T2-weighted and time-of-flight sequences before CAS. Main plaque components were classified as vulnerable (intraplaque hemorrhage and lipid-rich/necrotic core) or stable (fibrous tissue and dense calcification) from the signal pattern. The plaque classification was statistically compared with the occurrence of slow-flow phenomenon. The slow-flow phenomenon was observed in ten CAS procedures (five flow arrests and five flow reductions). Flow arrests consisted of four vulnerable and one stable plaque, and flow reductions consisted of four vulnerable and one stable plaque. The slow-flow phenomenon occurred significantly (P < 0.01) more frequently in patients with vulnerable plaque. Vulnerable carotid plaques have a significantly higher risk of slow-flow phenomenon than stable plaques. The occurrence of the slow-flow phenomenon can be predicted by MR plaque imaging before CAS. (orig.)

  4. Magnetic resonance plaque imaging to predict the occurrence of the slow-flow phenomenon in carotid artery stenting procedures

    Energy Technology Data Exchange (ETDEWEB)

    Sakamoto, Masahiko; Taoka, Toshiaki; Nakagawa, Hiroyuki; Wada, Takeshi; Akashi, Toshiaki; Kichikawa, Kimihiko [Nara Medical University, Department of Radiology, Nara (Japan); Takayama, Katsutoshi; Myouchin, Kaoru [Ishinkai Yao General Hospital, Department of Interventional Neuroradiology, Osaka (Japan); Miyasaka, Toshiteru [Nara Prefectural Nara Hospital, Department of Radiology, Nara (Japan); Fukusumi, Akio [Takanohara Central Hospital, Department of Radiology, Nara (Japan); Iwasaki, Satoru [Higashiosaka General Hospital, Department of Radiology, Osaka (Japan)

    2010-04-15

    The purpose is to investigate the feasibility of magnetic resonance (MR) plaque imaging in predicting the arterial flow impairment (slow-flow phenomenon) during carotid artery stenting (CAS) using a filter-type protection device. Thirty-one carotid artery stenotic lesions in 30 patients (28 men and two women; mean age, 71.8 years) were evaluated by MR plaque imaging with black blood T1- and T2-weighted and time-of-flight sequences before CAS. Main plaque components were classified as vulnerable (intraplaque hemorrhage and lipid-rich/necrotic core) or stable (fibrous tissue and dense calcification) from the signal pattern. The plaque classification was statistically compared with the occurrence of slow-flow phenomenon. The slow-flow phenomenon was observed in ten CAS procedures (five flow arrests and five flow reductions). Flow arrests consisted of four vulnerable and one stable plaque, and flow reductions consisted of four vulnerable and one stable plaque. The slow-flow phenomenon occurred significantly (P < 0.01) more frequently in patients with vulnerable plaque. Vulnerable carotid plaques have a significantly higher risk of slow-flow phenomenon than stable plaques. The occurrence of the slow-flow phenomenon can be predicted by MR plaque imaging before CAS. (orig.)

  5. Comparison of enterprise and neuroform stent-assisted coil embolization of distal internal carotid artery aneurysms: Midterm results from a single-center experience

    International Nuclear Information System (INIS)

    To compare the mid-term follow-up angiographic findings in distal internal carotid artery (ICA) aneurysms treated by stent-assisted coil embolization using the Enterprise or Neuroform stent. We included 68 patients with 70 aneurysms: 31 cases with Enterprise and 39 cases with Neuroform. Inclusion criteria were 1) location of the stent within the distal ICA, including the carotid siphon; 2) follow-up angiogram after > 6 months, and 3) single use of the stent for 1 parent artery. The patients' mean age was 54.9 years (16 male and 52 female). Mean follow-up duration was 9.1 months. At follow-up, there were intraluminal filling defects of the parent artery in 19.4% of the Enterprise group and no filling defect in the Neuroform group. There was no significant in-stent stenosis in either group. Straightening of the parent artery was seen in 35.5% of the Enterprise group and 20.5% of the Neuroform group. Two Enterprise cases showed delayed migration. The Enterprise showed statistically significant intraluminal filling defects of the parent artery compared with the Neuroform. The rates of significant in-stent stenosis and straightening of the parent artery were not significantly different between the Enterprise and the Neuroform groups.

  6. Association of CYP2C19 Polymorphisms with the Clinical Efficacy of Clopidogrel Therapy in Patients Undergoing Carotid Artery Stenting in Asia

    Science.gov (United States)

    Zhu, Wen-Yao; Zhao, Ting; Xiong, Xiao-Yi; Li, Jie; Wang, Li; Zhou, Yu; Gong, Zi-Li; Cheng, Sai-Yu; Liu, Yong; Shuai, Jie; Yang, Qing-Wu

    2016-01-01

    The CYP2C19 gene plays a detrimental role in the metabolism of clopidogrel. This study aimed to investigate the association between CYP2C19 polymorphisms and the clinical efficacy of clopidogrel therapy in patients who have undergone carotid artery stenting (CAS). CYP2C19 genotype screening was performed on 959 ischemic stroke patients. Of these patients, 241 who had undergone CAS were enrolled in the study. They were all followed up for 1 year after stent surgery, and the primary clinical end-points were ischemic events. The frequencies of the CYP2C19*2 and *3 alleles among the 959 patients were 31.80% and 5.06%, respectively. Regarding the 241 participants who had undergone CAS, multivariate Cox regression analysis showed that the CYP2C19 loss-of-function (LOF) alleles (*2 and *3) were risk factors for post-CAS prognosis. Within 1 year of follow-up, the patients carrying the CYP2C19 LOF alleles were more likely to experience ischemic events than those carrying none. The occurrence of ischemic events did not significantly differ between the *2 and *3 allele carriers. Our results suggest that CYP2C19 LOF alleles (*2 and *3) significantly impact the prognosis of patients on clopidogrel therapy after CAS and that the CYP2C19*2 and CYP2C19*3 alleles have the same effects on prognosis. PMID:27137706

  7. Short- and long-term major cardiovascular adverse events in carotid artery interventions: a nationwide population-based cohort study in Taiwan.

    Directory of Open Access Journals (Sweden)

    Ming-Lung Tsai

    Full Text Available Carotid artery stenosis is one of the leading causes of ischemic stroke. Carotid artery stenting has become well-established as an effective treatment option for carotid artery stenosis. For this study, we aimed to determine the efficacy and safety of carotid stenting in a population-based large cohort of patients by analyzing the Taiwan National Healthcare Insurance (NHI database.2,849 patients who received carotid artery stents in the NHI database from 2004 to 2010 were identified. We analyzed the risk factors of outcomes including major adverse cardiovascular events including death, acute myocardial infarction, and cerebral vascular accidents at 30 days, 1 year, and overall period and further evaluated cause of death after carotid artery stenting.The periprocedural stroke rate was 2.7% and the recurrent stroke rate for the overall follow-up period was 20.3%. Male, diabetes mellitus, and heart failure were significant risk factors for overall recurrent stroke (Hazard Ratio (HR = 1.35, p = 0.006; HR = 1.23, p = 0.014; HR = 1.61, p < 0.001, respectively. The periprocedural acute myocardial infarction rate was 0.3%. Age and Diabetes mellitus were the significant factors to predict periprocedural myocardial infarction (HR = 3.06, p = 0.019; HR = 1.68, p < 0.001, respectively. Periprocedural and overall mortality rates were 1.9% and 17.3%, respectively. The most significant periprocedural mortality risk factor was acute renal failure. Age, diabetes mellitus, acute or chronic renal failure, heart failure, liver disease, and malignancy were factors correlated to the overall period mortality.Periprocedural acute renal failure significantly increased the mortality rate and the number of major adverse cardiovascular events, and the predict power persisted more than one year after the procedure. Age and diabetes mellitus were significant risk factors to predict acute myocardial infarction after carotid artery stenting.

  8. Carotid artery stenting and follow-up: Value of 64-MSCT angiography as complementary imaging method to color-coded duplex sonography

    International Nuclear Information System (INIS)

    Purpose: To compare 64-multi-slice-CT angiography (64-MSCTA) to color-coded duplex sonography (CCDS) in the follow-up after carotid artery stenting (CAS). Methods: Thirty patients who had an MSCTA and CCDS examination prior and after CAS were included. Twelve closed-cell and 24 open-cell stents were implanted. Neointimal surface, in-stent-restenosis (ISR), stent expansion, and fracture were evaluated. In addition, the occurrence of atherosclerotic lesions leading to a > 50% stenosis in supraaortic vessels was assessed. Results: With MSCTA, >50% ISR was found in 5.6% of cases during a mean follow-up of 41.7 months. Comparing MSCTA and CCDS, grading of ISR and absolute diameters of neointimal surface correlated moderately (Spearman = 0.402, p = 0.015; Pearson = 0.404, p = 0.03). Assessment of the neointimal surface was significantly better with MSCTA (100% vs. 80.6%; p = 0.011). Stent expansion was significant, compared to the basic value, with both modalities and stent types (p 50% stenosis was detected in 38 (16.0%) vessel segments. Findings were stable in 25 (10.5%) and progressed in 11 (4.6%) vessel segments. Five small intracranial aneurysms were detected in four (13.3%) patients. Of 21 incidental findings in 16 (51.6%) patients there was one with malignancy (4.8%). Conclusion: With regard to ISR and stent expansion, no significant difference was found, when MSCTA and CCDS were compared. CTA is quite applicable as a complementary imaging method for the follow-up of patients with carotid artery stents. Additional advantages are the detection of supraaortic vessel pathologies and incidental findings.

  9. Thrombin Injection Failure with Subsequent Successful Stent-Graft Placement for the Treatment of an Extracranial Internal Carotid Pseudoaneurysm in a 5-Year-Old Child

    International Nuclear Information System (INIS)

    Internal carotid artery pseudoaneurysm is a rare life-threatening condition that may develop in different clinical situations. We report the case of an extracranial internal carotid artery pseudoaneurysm secondary to a throat infection in a pediatric patient that was initially treated with percutaneous thrombin injection under ultrasound guidance. However, recanalization occurred at 48 h, and definitive treatment was then performed by endovascular stent-graft placement. We briefly review the clinical characteristics of this uncommon clinical condition as well as the treatment options.

  10. Computational Study of Axial Fatigue for Peripheral Nitinol Stents

    Science.gov (United States)

    Meoli, Alessio; Dordoni, Elena; Petrini, Lorenza; Migliavacca, Francesco; Dubini, Gabriele; Pennati, Giancarlo

    2014-07-01

    Despite their success as primary treatment for vascular diseases, Nitinol peripheral stents are still affected by complications related to fatigue failure. Hip and knee movements during daily activities produce large and cyclic deformations of the superficial femoral artery, that concomitant to the effects of pulsatile blood pressure, may cause fatigue failure in the stent. Fatigue failure typically occurs in cases of very extended lesions, which often require the use of two or more overlapping stents. In this study, finite element models were used to study the fatigue behavior of Nitinol stents when subjected to cyclic axial compression in different conditions. A specific commercial Nitinol stent was chosen for the analysis and subjected to cyclic axial compression typical of the femoral vascular region. Three different configurations were investigated: stent alone, stent deployed in a tube, and two overlapping stents deployed in a tube. Results confirm that stent oversizing has an influence in determining both the mean and amplitude strains induced in the stent and plays an important role in determining the fatigue response of Nitinol stents. In case of overlapping stents, numerical results suggest higher amplitude strains concentrate in the region close to the overlapping portion where the abrupt change in stiffness causes higher cyclic compression. These findings help to explain the high incidence of stent fractures observed in various clinical trials located close to the overlapping portion.

  11. Is provisional stenting the effective option? The WIDEST study (Wiktor stent in de novo stenosis)

    OpenAIRE

    Fluck, D.; Chenu, P; Mills, P; Davies, A; Street, J.; Paul, E; Balcon, R; Layton, C; Investigators', G

    2000-01-01

    AIM—To compare the immediate and late outcomes of patients treated by a policy of routine stent implantation with routine balloon angioplasty and the use of stents only when an ideal result has not been obtained.
METHODS—A nine centre, multinational, randomised study of 300 patients with coronary artery disease thought suitable for treatment of a single lesion by balloon angioplasty or stent implantation. Only new lesions in patients who had not undergone previous bypass surgery were included...

  12. Análise morfométrica da carótida de suínos submetidos a angioplastia com ou sem implante de stent de cromo-cobalto Morphometric analysis of swine carotid artery angioplasty with or without cobalt-chromium stent implantation

    Directory of Open Access Journals (Sweden)

    João Luiz de Lara Elesbão

    2010-06-01

    Full Text Available Contexto: A hiperplasia intimal é a reação tardia mais comum decorrente da angioplastia. O uso de stents de cromo-cobalto é bem estudado na circulação coronariana, porém não há muitos estudos que abordem o uso desses stents nas circulações carotídea e periférica. Objetivo: Analisar mediante morfometria a reação intimal presente na artéria carótida de suínos submetidos a angioplastia isoladamente e a angioplastia seguida de implante de stent de cromo-cobalto. Materiais e métodos: Em oito suínos, foi realizada angioplastia da artéria carótida comum direita e angioplastia seguida de implante de um stent de cromo-cobalto na artéria carótida comum esquerda. Após 4 semanas, os animais foram submetidos a eutanásia para a retirada de amostras de tecido arterial e preparo de lâminas histológicas. As imagens das lâminas foram digitalizadas e analisadas por programa de morfometria digital. A análise estatística foi realizada através da média e desvio padrão das áreas em cada grupo, utilizando-se o Teste t de Student. O valor de p Background: Intimal hyperplasia is the most common delayed response to angioplasty. The use of cobalt-chromium stents is well studied in the coronary circulation; however, there are few studies on their use in the carotid and peripheral circulation. Objective: To analyze the intimal reaction in a swine carotid artery undergoing simple angioplasty and angioplasty followed by implantation of cobalt-chromium stent. Materials and methods: We carried out angioplasty in the right common carotid artery and angioplasty with cobalt-chromium stent in the left common carotid artery in eight swine. Four weeks later, all animals were sacrificed for arterial tissue sampling and preparation of histological slides. Slide images were scanned and analyzed using a digital morphometry program. Statistical analysis was performed by mean values and standard deviations of the areas in each group, using the Student's t

  13. A preliminary anatomical study on carotid body of Makouei sheep

    Directory of Open Access Journals (Sweden)

    Gholamreza Najafi

    2013-06-01

    Full Text Available The carotid is a small mass of chemoreceptor's and sustentacular cells that detects changes in the composition of the arterial blood. The aim of the present study was to identify the size, color, location, blood and nerve supply of the carotid body in Makouei sheep. Fourteen heads of sheep from both sexes were collected from Urmia public slaughter-house. The exact situation and nerve supply of the carotid body was determined. Before dissection, blue latex was injected into right and left common carotid arteries. All the branches of the common carotid artery and the branch supplying carotid body were investigated. This study showed that, carotid body in sheep has been situated around the muscular branch of the occipital artery. The mean weight, width and length, thickness of carotid body were 0.01 g, 0.83 mm, 1.07 mm, and 1.06 mm respectively. Blood to the carotid body was supplied by glomic artery which was a branch of occipital artery. It was innervated by herring nerve which was a branch of glossopharyngeal nerve.

  14. Stents

    Science.gov (United States)

    ... Topics Aneurysm Carotid Artery Disease Coronary Heart Disease Percutaneous Coronary Intervention Peripheral Artery Disease Send a link to NHLBI ... an artery as part of a procedure called percutaneous coronary intervention (PCI), also known as coronary angioplasty. PCI restores ...

  15. Outpatient primary stent-PTA in a symptomatic internal carotid artery stenosis under protection

    International Nuclear Information System (INIS)

    In a 69 year old patient, with a symptomatic ICA stenosis a stent implantation was performed under outpatient conditions. An interdisciplinary consensus was reached that the patient was suitable for outpatient therapy. In accordance with the NASCET criteria, the patient was to be classified to the high-risk group. Within 120 days before the intervention, the following clinical symptoms had occurred: 1 TIA, 2 amaurosis fugax. In the diagnostic angiography a right postbulbar ICA stenosis of 97% was verified. The stent application and subsequent PTA were performed under protection using a filter system. The transfemoral route was always fitted with an endovascular closure system. The neck vessels were followed-up by means of colour coded duplex sonography (CCDS) on days 1, 30, 180 and 360. A contrast-medium intensified MRI was performed on the 5th day post-intervention. The implantation of the stent and PTA were done without any complications. Atheromatous plaque fragments were found in the protection system. A plaque embolism was excluded clinically and in the contrast-medium intensified MRI 5 days after the intervention. After 360 days, no restenosis was found in the CCDS, the ECA was perfused. The method presented is low in complications and shows a high success rate. If patient recruitment is adequate, this intervention can be performed on an outpatient basis. (orig.)

  16. An in vitro study of silk stent morphology

    Energy Technology Data Exchange (ETDEWEB)

    Aurboonyawat, Thaweesak [University of Paris 7 Bichat School of Medicine, Department of Functional and Interventional Neuroradiology, Fondation Rothschild Hospital, Paris (France); Siriraj Hospital, Mahidol University, Division of Neurosurgery, Department of Surgery, Bangkok (Thailand); Blanc, Raphael; Piotin, Michel; Spelle, Laurent; Moret, Jacques [University of Paris 7 Bichat School of Medicine, Department of Functional and Interventional Neuroradiology, Fondation Rothschild Hospital, Paris (France); Schmidt, Paul [University of Paris 7 Bichat School of Medicine, Department of Functional and Interventional Neuroradiology, Fondation Rothschild Hospital, Paris (France); The Duluth Clinic Ltd, Duluth, MN (United States); Nakib, Amir [Universite de Paris 12, Laboratoire Images, Signaux et Systemes Intelligents (LISSI, E. A. 3956), Creteil (France)

    2011-09-15

    Morphology of the Silk stent (Balt, Montmorency, France) after deployment is not fully understood, especially in tortuous vessels. An in vitro study was conducted to study morphology and flow-diverting parameters of this stent. Two sets of different-sized and curved polytetrafluoroethylene tubes were studied. To simulate the aneurysm neck, a small hole was created in a tube. A stent was placed in each of the different tubes. Angiographic computerized tomography and macroscopic photography were then obtained. The images were analyzed to calculate a Percentage of Area Coverage (PAC). Good stent conformability was observed. The PAC was 21% in the straight model with matched stent and vessel diameter. In the straight model with an oversized stent, the PAC was increased. In the curved models, dynamic wire repositioning occurred. The repositioning was affected by the size of the stent and the angle of the vessel curve. Compared to the straight model, this increased the PAC in two instances: on the convexity (oversized stent), and on the concavity (matched stent and vessel diameter). The PAC did not significantly change at the sides of the curve. By design, the wires of the silk stent move relative to each other. In a curved model, the PAC is different at the convexity, concavity, and lateral walls. The stent diameter affects the PAC. These results are clinically relevant because it is desirable to maximize and minimize the PAC across the aneurysm neck and branch vessel orifice, respectively. (orig.)

  17. Surgical treatment of internal carotid artery restenosis following eversion endarterectomy

    OpenAIRE

    Radak Đorđe; Tanasković Slobodan; Vukotić Miloje; Babić Srđan; Aleksić Nikola; Kolar Jovo; Popov Petar; Nenezić Dragoslav; Vučurević Goran; Gajin Predrag; Ilijevski Nenad

    2012-01-01

    Introduction. Carotid angioplasty and internal carotid artery stenting is the therapeutic method of choice in the treatment of carotid restenosis, but when it is not technically feasible (expressed tortuosity of supraaortic branches, calcifications, presence of pathological elongation of very long lesions) a redo surgery is indicated. Objective. The aim of our study was to examine the benefits and risks of redo surgery in patients with symptomatic and asymptomatic significant internal c...

  18. Use of a new self-expanding endovascular stent prosthesis: Experimental study

    International Nuclear Information System (INIS)

    The authors developed a new type of self-expanding endovascular stent prosthesis and a unique, specifically designed 5-French delivery system. Prototype evaluation was performed in our animal laboratories. Forty-seven grafts, 3-5 mm in diameter and 1.5-5 cm long, were placed in 28 animals. The new prosthesis was evaluated in various intraluminal positions: coronary (n=20), renal (n=5), carotid (n=3), and femoropopliteal (n=16) arteries, and three femoral veins. The follow-up period lasted 1 day to 6 months. Histologic studies of early carotid, iliac, renal, femoropopliteal, and coronary artery implants revealed the mechanisms by which these prostheses migrate into the intimal layer up to the elastic laminae and induce intimal thickening, which leads to total encapsulation of the prosthesis elements within a few days, thereby protecting them from subsequent infection or thrombogenesis. Patency of side branches arising at the level of the graft was observed angiographically and histologically

  19. 4D phase contrast flow imaging for in-stent flow visualization and assessment of stent patency in peripheral vascular stents – A phantom study

    International Nuclear Information System (INIS)

    Purpose: 4D phase contrast flow imaging is increasingly used to study the hemodynamics in various vascular territories and pathologies. The aim of this study was to assess the feasibility and validity of MRI based 4D phase contrast flow imaging for the evaluation of in-stent blood flow in 17 commonly used peripheral stents. Materials and methods: 17 different peripheral stents were implanted into a MR compatible flow phantom. In-stent visibility, maximal velocity and flow visualization were assessed and estimates of in-stent patency obtained from 4D phase contrast flow data sets were compared to a conventional 3D contrast-enhanced magnetic resonance angiography (CE-MRA) as well as 2D PC flow measurements. Results: In all but 3 of the tested stents time-resolved 3D particle traces could be visualized inside the stent lumen. Quality of 4D flow visualization and CE-MRA images depended on stent type and stent orientation relative to the magnetic field. Compared to the visible lumen area determined by 3D CE-MRA, estimates of lumen patency derived from 4D flow measurements were significantly higher and less dependent on stent type. A higher number of stents could be assessed for in-stent patency by 4D phase contrast flow imaging (n = 14) than by 2D phase contrast flow imaging (n = 10). Conclusions: 4D phase contrast flow imaging in peripheral vascular stents is feasible and appears advantageous over conventional 3D contrast-enhanced MR angiography and 2D phase contrast flow imaging. It allows for in-stent flow visualization and flow quantification with varying quality depending on stent type

  20. Development and pilot feasibility study of a health information technology tool to calculate mortality risk for patients with asymptomatic carotid stenosis: the Carotid Risk Assessment Tool (CARAT)

    OpenAIRE

    Faerber, Adrienne E.; Horvath, Rebecca; Stillman, Carey; O’Connell, Melissa L; Hamilton, Amy L; Newhall, Karina A; Likosky, Donald S.; Goodney, Philip P.

    2015-01-01

    Background Patients with no history of stroke but with stenosis of the carotid arteries can reduce the risk of future stroke with surgery or stenting. At present, a physicians’ ability to recommend optimal treatments based on an individual’s risk profile requires estimating the likelihood that a patient will have a poor peri-operative outcomes and the likelihood that the patient will survive long enough to gain benefit from the procedure. We describe the development of the CArotid Risk Assess...

  1. Comparison between Willis covered stent placement and coil embolization in the treatment of cranial internal carotid artery aneurysm: a nonrandomized prospective trial

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical results of Willis covered stent implantation and coil embolization in the treatment of cranial internal carotid artery (CICA) aneurysm. Methods: Eighty-nine patients with CICA aneurysms were selected for treatment with Willis covered stents (n=43, group A) or coil embolization (n=46, group B) according to the patients' will. Data on the technical success, initial procedure time and in-hospital interval, initial and final angiographic results, mortality, morbidity, and final clinical outcomes were collected and analyzed for the two groups at 6 months post-procedure. Results: Endovascular covered stent placement and coil embolization were technically successful in all patients, except for one patient in group A. The initial angiographic results showed complete occlusion in 34 patients of group A (81% , 95% CI: 69%, 93%) and 24 patients of group B (52%, 95% CI: 37%, 67%) (P< 0.05). The final angiographic results indicated complete occlusion in 39 patients of group A (39/41, 95%, 95% CI: 88%, 102%) and 22 patients of group B (22/45, 49%, 95% CI: 34%, 64%, P<0.01). The average procedure time was (103±13) min in group A and (143±39) min in group B (P<0.01). No significant differences were seen between the two groups in technique success, mortality, morbidity, or final clinical outcomes. Conclusion: In this nonrandomized, prospective trial, CICA aneurysm treatment with covered stents yielded midterm angiographic results that were superior to those of coil embolization. (authors)

  2. Endoscopic dacryocystorhinostomy with and without silicone stenting: A comparative study

    Directory of Open Access Journals (Sweden)

    K. Shashidhar

    2014-07-01

    Full Text Available Background and objectives: The objective of the present study is to compare the results of performing endonasal dacryocystorhinostomy for primary nasolacrimal duct obstruction with and without silicone stenting. Methods: This is a prospective randomized study including 57 patients who underwent 62 endonasal DCR procedures. 32 eyes underwent DCR with bicanalicular silicone stenting which was kept for 6 weeks. 30 eyes underwent DCR without stenting. Follow up was done for 6 months. Outcome of the surgery was noted as success in terms of complete relief from epiphora, patency of the ostium assessed by nasal endoscopy and lacrimal sac syringing. Results: The overall success rate for endoscopic endonasal DCR was 90.3%. Success rates were 93.7% with stenting and 86.7% without stenting. There was no statistical difference in the outcome of the two groups (p=0.4180. Complications noted were granulations, synechiae, periorbital edema and punctal trauma, with no difference in the frequency of occurrence in the two groups. Conclusion: There is no significant increase in the success rates of DCR on using silicone stenting. A selective stenting approach may be advocated, using stenting for specific indications. With proper technique and good follow up, stenting is not associated with any significant complications.

  3. Efficacy and safety of stenting for elderly patients with severe and symptomatic carotid artery stenosis: a critical meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Ouyang YA

    2015-10-01

    Full Text Available Yi-An Ouyang, Yugang Jiang, Mengqiang Yu, Yunze Zhang, Hao HuangDepartment of Neurosurgery, Second Xiang-Ya Hospital of Central South University, Changsha, People’s Republic of ChinaObjective: To investigate both short-term and long-term therapeutic efficacy and safety of carotid artery stenting (CAS and carotid artery endarterectomy (CEA for elderly patients with severe and symptomatic carotid artery stenosis.Methods: PubMed, EMBASE, Cochrane Library, Clinical Trials Register Centers, and Google Scholar were comprehensively searched. After identifying relevant randomized controlled trials, methodological quality was assessed by using Cochrane tools of bias assessment. Meta-analysis was performed by RevMan software, and subgroup analyses according to different follow-up periods were also conducted.Results: Sixteen articles of nine randomized controlled trials containing 6,984 patients were included. Compared with CEA, CAS was associated with high risks of stroke during periprocedural 30 days (risk ratio [RR]=1.47, 95% confidence interval [CI]: 1.15–1.88, 48 months (RR=1.37, 95% CI: 1.11–1.70, and >48 months (RR=1.76, 95% CI: 1.34–2.31. There was no significant difference in the aspects of death, disabling stroke, or death at any time between the groups. For other periprocedural complications, CAS decreased the risk of myocardial infarction (RR=0.44, 95% CI: 0.26–0.75, cranial nerve palsy (RR=0.09, 95% CI: 0.04–0.22 and hematoma (RR=0.31, 95% CI: 0.14–0.68 compared with CEA, while it increased the risk of bradycardia or hypotension (RR=8.45, 95% CI 2.91–24.58.Conclusion: Compared with CEA, CAS reduced hematoma, periprocedural myocardial infarction, and cranial nerve palsy, while it was associated with higher risks of both short-term and long-term nondisabling stroke. And they seemed to be equivalent in other outcome measures. As regards to its minimal invasion, it should be applied only in specific patients.Keywords: symptomatic

  4. Experiment Study of The Preventive Effects of Valsartan Eluting Stent on In- stent Restenosis

    Institute of Scientific and Technical Information of China (English)

    陈津; 陈纪言; 周颖玲; 李光; 罗建方; 余丹青; 张励庭; 黄文晖

    2003-01-01

    Objectives Background -Neointima hyperplasia and arterial re modeling are themain mechanisms of restenosis after percutaneoustransluminal coronary angioplasty. The successful useof coronary stents neutralizes the ac ute elastic recoiland improves the remodeling mode with reducingrestenosis rate by 10 % . But the in - stent neointimahyperplasia becomes more severe. This study aims toset up model of in - stent restenosis in vivo, and to e-valuate the preventive role of implantation of valsartaneluting stent for restenosis. Methods and ResultsTwenty -two male New Zealand white rabbits were di-vided into control group and valsartan group. In-travascular ultrasonic (IVUS) results showed the in-trastent neointimal areas of the control group werelarger than those of the valsartan group ( P < 0.01 ) .The minimal lumen area of control group was smallerthan that of the valsartan group ( P < 0.01). Angiog-raphy results showed the normal lumen diameters weresimilar between two groups ( P> 0.05) . The lumenstenosis rates compared with the normal diameters ofthe valsartan group were significantly improved overthat of the control group ( P < 0. 05) . It was compa-rable to the IVUS analysis. There were no cases of a-neurysm or thrombosis. Conclusions Valsartan e-luting stents produced a significant inhibition ofneointimal hyperplasia and luminal encroachment inrabbits without obviously producing any serious side -effects. These results demonstrate the potential thera-peutic benefit of valsartan eluting stents in the pre-vention and treatment of human coronary restenosis.

  5. Carotid Artery Ultrasonographic Assessment in Patients from the Fremantle Diabetes Study Phase II with Carotid Bruits Detected by Electronic Auscultation

    OpenAIRE

    Knapp, Arthur; Cetrullo, Violetta; Sillars, Brett A.; Lenzo, Nat; Davis, Wendy A; Davis, Timothy M. E.

    2014-01-01

    Background: Electronic auscultation appears superior to acoustic auscultation for identifying hemodynamic abnormalities. The aim of this study was to determine whether carotid bruits detected by electronic stethoscope in patients with diabetes are associated with stenoses and increased carotid intima-medial thickness (CIMT).

  6. Clinical experience of cerebral protection with balloon occlusion during carotid artery stenting; Zerebrale Protektion mit Ballonokklusion bei der Stentimplantation der A. carotis - Erste Erfahrungen

    Energy Technology Data Exchange (ETDEWEB)

    Jaeger, H.J.; Mathias, K.D.; Drescher, R.; Bockisch, G.; Hauth, E.; Demirel, E.; Gissler, H.M. [Staedtische Kliniken Dortmund (Germany). Radiologische Klinik; Witten/Herdecke Univ. (Germany). Lehrstuhl fuer Radiologie und Mikro-Therapie

    2001-02-01

    Purpose: To asses the technical feasibility and the results of cerebral protection with the GuardWire Plus Temporary Occlusion and Aspiration System during carotid artery stenting for high-grade stenosis. Patients and Methods: In 20 patients 20 carotid artery stenoses were treated with stent placement under cerebral protection. A contralateral carotid occlusion was an exclusion criteria for the use of the protection device. In all cases only aspiration, but no flushing was used before deflation of the occlusion balloon. In 17 of 20 patients diffusion-weighted (DW-)MRT imaging of the brain was performed before and 24 hours after the procedure. Results: The stent implantation was successfully performed in all patients. In 3 patients neurologic symptoms occurred during the occlusion time. In these 3 patients the symptoms immediately disappeared after deflation of the balloon. In one case there was dilatation of the internal carotid artery at the site of the balloon inflation. In 3 of the 17 DW-MR images new ipsilateral cerebral lesions, in one case a new contralateral lesion occurred after the procedure. Conclusions: The cerebral protection procedure is technically feasible. The occlusion of the internal carotid artery was not tolerated by all patients. The DW-MR imaging demonstrated cerebral lesions indicating the occurrence of cerebral microemboli during the procedure. Further investigations are necessary to determine if the use of the cerebral protection device will improve the results of the carotid artery stenting for high-grade stenoses. (orig.) [German] Ziel: Evaluation der Technik und der Ergebnisse der zerebralen Protektion mit dem temporaeren Okklusions- und Aspirationssystem GuardWire Plus bei der Stentimplantation der A. carotis bei hochgradigen Stenosen. Patienten und Methoden: Bei 20 Patienten wurden 20 Karotisstenosen mit Stentimplantation unter zerebraler Protektion behandelt. Ein kontralateraler Verschluss der A. carotis war ein Ausschlusskriterium

  7. Current Approaches for Carotid Endarterectomy

    Directory of Open Access Journals (Sweden)

    Cengiz Köksal

    2010-12-01

    Full Text Available Permanent neurologic injuries and death following stroke, necessitates more vigorous treatment of carotid disease. Carotid stenting and carotid endarterectomy are treatment options in many centers besides medical treatment. Whether the patient is symptomatic or asymtomatic, indications and management strategies for treatment remain controversial. Despite the debate, carotid endarterectomy is still accepted to be the most efficientintervention to decrease risk of stroke due to carotid artery stenosis.

  8. Intravascular ultrasound assessed incomplete stent apposition and stent fracture in stent thrombosis after bare metal versus drug-eluting stent treatment the Nordic Intravascular Ultrasound Study (NIVUS)

    DEFF Research Database (Denmark)

    Kosonen, Petteri; Vikman, Saila; Jensen, Lisette Okkels; Lassen, Jens Flensted; Harnek, Jan; Olivecrona, Göran K; Erglis, Andrejs; Fossum, Eigil; Niemelä, Matti; Kervinen, Kari; Ylitalo, Antti; Pietilä, Mikko; Aaroe, Jens; Kellerth, Thomas; Saunamäki, Kari; Thayssen, Per; Hellsten, Lars; Thuesen, Leif; Niemelä, Kari

    2012-01-01

    This prospective multicenter registry used intravascular ultrasound (IVUS) in patients with definite stent thrombosis (ST) to compare rates of incomplete stent apposition (ISA), stent fracture and stent expansion in patients treated with drug-eluting (DES) versus bare metal (BMS) stents. ST is a...

  9. A Comparative Study on the Efficacy of Covered Metal Stent and Plastic Stent in Unresectable Malignant Biliary Obstruction

    OpenAIRE

    Choi, Jae Myoung; Kim, Jin Hong; Kim, Soon Sun; Yu, Jun Hwan; Hwang, Jae Chul; Yoo, Byung Moo; Park, Sang Heum; Kim, Ho Gak; Lee, Dong Ki; Ko, Kang Hyun; Yoo, Kyo Sang; Park, Do Hyun

    2012-01-01

    Background/Aims The placement of self expandable metal stent (SEMS) is one of the palliative therapeutic options for patients with unresectable malignant biliary obstruction. The aim of this study was to compare the effectiveness of a covered SEMS versus the conventional plastic stent. Methods We retrospectively evaluated 44 patients with unresectable malignant biliary obstruction who were treated with a covered SEMS (21 patients) or a plastic stent (10 Fr, 23 patients). We analyzed the techn...

  10. Early carotid endarterectomy after a nondisabling stroke: a prospective study.

    Science.gov (United States)

    Ricco, J B; Illuminati, G; Bouin-Pineau, M H; Demarque, C; Camiade, C; Blecha, L; Neau, J P

    2000-01-01

    On the recommendation of several studies, carotid endarterectomy (CEA) should be delayed for at least 6 weeks in patients suffering an acute nondisabling stroke. Our objective was to determine if these patients could be safely operated on earlier, thus decreasing the risk of a recurrent stroke prior to surgery. This prospective study, carried out from January 1990 to December 1997, included 72 consecutive patients having a nondisabling hemispheric stroke with severe ipsilateral carotid stenosis (NASCET 70-99%). All patients underwent CEA within 15 days of stroke onset. Patients were considered to have a nondisabling hemispheric stroke if (1) symptoms of hemispheric ischemia persisted longer than 24 hr and (2) the resulting deficit caused no major impairment in their everyday activities. All patients were examined by a neurologist prior to carotid angiography and contrast CT scan. Hemorrhage seen on the initial CT scan eliminated the patient from the study. If the CT scan with contrast injection was negative, patients underwent magnetic resonance imaging. CEA was performed under general anesthesia with intraluminal shunting. All patients had a postoperative duplex scan and yearly follow-up by a neurologist and a surgeon, with a duplex scan of the carotid arteries. Mean follow-up was 53 months. Our study shows that CEA can be performed relatively safely within 15 days following an acute nondisabling stroke. The arbitrary 6-week delay for CEA may unnecessarily expose patients with high-grade stenosis to a recurrent stroke, which could be prevented by earlier surgery. PMID:10629271

  11. Silicon Carbide Coating Ñ A Semiconducting Hybrid Design of Coronary Stents Ñ A Feasibility Study.

    Science.gov (United States)

    Heublein; Pethig; Elsayed

    1998-06-01

    OBJECTIVE: To determine the rates of subacute and acute thrombotic stent occlusion in patients with normal and high risk for stent thrombosis and to assess the 6 month follow-up with respect to in-stent restenosis, using a new principle of semiconductor coating (active passivating as metallic hybrid design). DESIGN: Open, non-randomized, prospective, observational, feasibility study. PATIENTS: One hundred sixty-five patients (215 stents) were scheduled consecutively with respect to lesions suitable for slotted tube stent implantation. Two subgroups of patients (stents) were identified based on the local thrombotic risk (common indications for stent implantation Ñ group I; lesions with high(er) risk for stent implantation (group II). A closed clinical 3Ð12 (mean 6.5 +/- 2.3) months follow-up was done in 126 (92.6%) eligible patients [164 (97.6%) stents]. Angiographic and/or IVUS data were available in 96 of 136 eligible patients (70.6%) after stenting 6.0 +/- 2.1 months). STENT-MATERIAL/MEDICATION: Balloon expandable tantalum three segment slotted tube stents which were coated with silicon carbide, diameter ranged from 2.5 to 4.0 mm were used. Stent deployment was limited by inflation pressure (12Ð16 Bar). Apart from patients with acute myocardial infarction (n = 15 stents) patients received heparin loading dose during the procedure only, no oral anticoagulation except aspirin (300 mg p.d.) and ticlopidine (250Ð500mg p.d.) given over 1 month. RESULTS: Acute complications. No in-hospital mortality occurred, stent-related myocardial infarction was 1.9%; major bleedings 0.5% of implanted stents. Acute stent thrombosis 1.4%, subacute stent thrombosis occurred in 0.5% (no significant difference between group I and II). Late events: From 136 eligible patients (range 15 daysÐ14 months) (187 stents) 92 patients (67.6%) with 142 stents (75.9%) were event-free. In-stent restenosis. Thirty-six percent (biased group of patients with events) resp. 26.8% (including negative

  12. Dual-Design Expandable Colorectal Stent for a Malignant Colorectal Obstruction: Preliminary Prospective Study Using New 20 mm Diameter Stents

    International Nuclear Information System (INIS)

    To evaluate the safety and effectiveness of a 20-mm diameter dual-design expandable colorectal stent for malignant colorectal obstruction. The study series included 34 patients with malignant colorectal obstruction who underwent implantation of a 20-mm dual-design expandable colorectal stent in our department between March 2009 and June 2010. The 20-mm dual-design expandable colorectal stent was placed by using a 3.8-mm delivery system that had 28-mm diameter proximal and distal ends. Among the 34 patients, stent placement for palliation was performed in 20 patients, while stent placement for bridge to surgery was performed in 14 patients. A 97% (33 of 34) success rate was achieved for the stent placement. The perforation rate in the bridge to surgery group was 7% (1 of 14), compared to 0% (0 of 19) in palliative group. Migration occurred in one of 33 patients (3%) at 30 days after stent placement. The placement of a 20-mm diameter dual-design stent appears to be clinically safe and effective for the management of colorectal obstruction, with low perforation and migration rates.

  13. Identification of critical areas of carotid stent navigation by measurement of resistive forces in vitro, using silicone phantoms

    International Nuclear Information System (INIS)

    Manipulation of surgical tools in neuro-endovascular surgery presents problems that are unique to this procedure. Navigating tools through arterial complexities without appropriate visual or force feedback information often causes tool snagging, plaque dislocations and formation of thrombosis from the damage of the arterial wall by the tools. Identifying the critical areas in the vasculature during navigation of endovascular tools, will not only ensure safer surgical planning but also reduce risks of vessel damage. In the present research, resistive forces of stent navigation were measured in-vitro using silicone phantoms and clinically relevant surgical devices. The patterns of variation of the forces along the path of the stent movement were analyzed and mapped along the path of stent movement using a color code. It was observed that the forces changed along the length of the vessel, independent of the insertion length but based on the curvature of the vessel and the contact area of the device in the vessel lumen. (orig.)

  14. 颈动脉支架置入术对无症状重度颈动脉狭窄患者认知功能的影响%Effect of carotid artery stenting on cognitive function in patients with asymptomatic severe carotid artery stenosis

    Institute of Scientific and Technical Information of China (English)

    赵启媛; 金平; 吴章松; 张钧; 陈生; 汪凯

    2014-01-01

    Objective To investigate the effect of carotid artery stenting (CAS) on cognitive function in patients with asymptomatic severe carotid artery stenosis.Methods The patients with asymptomatic severe carotid stenosis (stenosis ≥ 70%) were enrolled in the study.The cognitive function evaluation was performed before CAS,1 and 3 months after procedure respectively with mini-mental status scale (MMSE),digital span (DS),Chinese auditory learning test (CALT),judgment of line orientation test (JLOT),and verbal fluency test (VFT),including attention,memory,visual spatial function,and frontal fluency function.Results A total of 26 patients with asymptomatic severe carotid artery stenosis who performed CAS were enrolled,18 were males and 8 were females (aged 52 to 79 years,mean 64.19 ±6.76 years),and the years of education was 9.84 ± 3.29 years.Eighteen patients had left carotid artery stenosis and 8 had contralateral carotid artery stenosis.CAS was performed successfully in all patients,and no complications occurred.Compared with the CAS before procedure,all the cognitive functions were improved significantly at 1 and 3 months after procedure (all P <0.01),however,there was no significant difference between 1 and 3 months after procedure (all P> 0.05).Conclusions CAS may improve cognitive function in patients with asymptomatic severe carotid artery stenosis,and it was more obvious in the early postoperative period.%目的 探讨颈动脉支架置入术(carotid artery stenosis,CAS)对无症状重度颈动脉狭窄患者认知功能的影响.方法 纳入行CAS的无症状重度颈动脉狭窄(狭窄程度≥70%)患者,分别于CAS术前、术后1个月和3个月采用简易智能状态检测量表(Mini-Mental Status Examination,MMSE)、数字广度测验(Digital Span,DS)、中文听觉词汇学习测验(Chinese Auditory Learning Test,CALT)、线段方向判定测验(Judgment of Line Orientation Test,JLOT)和语言流畅性测验(Verbal Fluency Test,VFT)进行认

  15. Endovascular treatment of experimentally induced aneurysms in rabbits using stents: a feasibility study

    International Nuclear Information System (INIS)

    Although Guglielmi detachable coil (GDC) systems have been generally accepted for treatment of intracranial aneurysms, primary stenting of aneurysms using porous stents or implantation of coils after stent placement remains experimental. Testing of these new methods requires an animal model which imitates human aneurysms in size, configuration and neck morphology. We assessed in detail the technical requirements of and steps for transfemoral stent treatment of experimentally induced aneurysms at the top of the brachiocephalic trunk in rabbits. We created aneurysms in ten rabbits by distal ligation and intraluminal digestion of the right common carotid artery with elastase. We treated five animals with porous stents alone, and five with stents plus coiling via the meshes of the stent, which permitted dense packing of coils. No complications related to the procedures occurred. In all animals, even in those treated solely with porous stents, total occlusion of the aneurysm was achieved. Our animal model can be suitable for testing the biocompatibility and occlusion rate of new methods and devices for the treatment of experimental aneurysms. (orig.)

  16. Retrievable IVC Square Stent Filter: Experimental Study

    International Nuclear Information System (INIS)

    Purpose: In vitro and in vivo evaluation of a new retrievable, home-made, inferior vena cava (IVC) Square stent filter (SSF) with two trapping levels. Methods: In vitro, the SSF was compared in a flow model with the stainless steel Greenfield filter (SGF) for emboli- trapping efficiency by serially passing 300 emboli of 3 and 6 mm in diameter and 15-30 mm in length in each type of filter. Nine swine were used for the in vivo testing of the SSF for deployment and retrievability, emboli-trapping efficiency, stability, and self-centering ability and two were used (total of 11 swine) for testing repositioning and retrievability of the SSF at 2 weeks and for gross and histologic IVC changes at 2 months. Results: In vitro, the SSF and SGF had similar efficiency in trapping large emboli but the SSF had significantly better efficiency than the SGF for trapping all sizes of emboli (91.7% vs 81%), medium size emboli (93% vs 80%), and small emboli (86% vs 69%). Efficiency decreased in both filters from the first to the fifth embolus in each series but was still significantly better for the SSF. With the SSF, 89% of emboli were caught at the primary and 11% at the secondary filtration level. In the nine animals used for acute studies, the SSF was easily placed in all 27 attempts, assumed a central position 26 times, and was easily retrieved in 21 of 22 attempts. One tilted filter needed additional manipulation for retrieval. During emboli injection in five swine, the SSF had 97.2% emboli-trapping efficiency and demonstrated good stability. In the two animals used for longer-term evaluation, the filters were easily retrieved 2 weeks after implantation. Histologic evaluation at 2 months showed neointimal proliferation around the SSF wires in contact with the IVC wall, which was otherwise normal. Conclusion: The SSF is a promising filter. It is easy to place and retrieve, is stable after placement, and has high efficiency for trapping emboli. Promising results justify further

  17. A CT study of the prevalence of carotid artery calcification in dental patients

    International Nuclear Information System (INIS)

    Stroke is one of the leading causes of death in Korea. Atherosclerotic disease in the carotid artery bifurcation is the most common cause of stroke. The carotid artery calcification is easily appreciated by CT(Computed tomography). CT is often taken in a dental hospital for the diagnosis of inflammation. injury, cyst or tumor on maxillofacial region. However, there was no report of carotid artery calcification on CT in dental patients. The presence of carotid artery calcification was evaluated by an experienced radiologist on CT scans of 287 patients (166 males, 121 females, average age 42, range 6 to 86 years) and the medical history of the patient and the interpretation of CT were reviewed. Carotid artery calcification was detected on CT scans of 57 patients (19.8%; 35 males, 22 females). All the male patients with carotid artery calcification were older than 50, and all the female patients with carotid artery calcification were older than 60. Among the 57 patients, 10 had Diabetes mellitus, 20 had cardiovascular disease, 3 had history of stroke and 3 underwent radiation therapy for head and neck cancer. Carotid artery calcification was not included in the interpretation of CT of dental patients except one patient. The prevalence of carotid artery calcification on CT of dental patients was about 20% in this study. Carotid artery calcification should be included in the interpretation of CT of dental patients

  18. A CT study of the prevalence of carotid artery calcification in dental patients

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Suk Ja; Lee, Jae Seo; Yoon, Woong [Chonnam National Univ. Medical School, Gwangju (Korea, Republic of)

    2006-09-15

    Stroke is one of the leading causes of death in Korea. Atherosclerotic disease in the carotid artery bifurcation is the most common cause of stroke. The carotid artery calcification is easily appreciated by CT(Computed tomography). CT is often taken in a dental hospital for the diagnosis of inflammation. injury, cyst or tumor on maxillofacial region. However, there was no report of carotid artery calcification on CT in dental patients. The presence of carotid artery calcification was evaluated by an experienced radiologist on CT scans of 287 patients (166 males, 121 females, average age 42, range 6 to 86 years) and the medical history of the patient and the interpretation of CT were reviewed. Carotid artery calcification was detected on CT scans of 57 patients (19.8%; 35 males, 22 females). All the male patients with carotid artery calcification were older than 50, and all the female patients with carotid artery calcification were older than 60. Among the 57 patients, 10 had Diabetes mellitus, 20 had cardiovascular disease, 3 had history of stroke and 3 underwent radiation therapy for head and neck cancer. Carotid artery calcification was not included in the interpretation of CT of dental patients except one patient. The prevalence of carotid artery calcification on CT of dental patients was about 20% in this study. Carotid artery calcification should be included in the interpretation of CT of dental patients.

  19. Association of carotid atherosclerotic plaque features with acute ischemic stroke: A magnetic resonance imaging study

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Huilin [Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127 (China); Zhao, Xihai [Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing 100084 (China); Liu, Xiaosheng; Cao, Ye [Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127 (China); Hippe, Daniel S.; Sun, Jie [Department of Radiology, University of Washington, Seattle, WA 98109 (United States); Li, Feiyu [Department of Radiology, Peking University First Hospital, Beijing 100034 (China); Xu, Jianrong, E-mail: renjixjr@yahoo.com.cn [Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127 (China); Yuan, Chun [Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing 100084 (China); Department of Radiology, University of Washington, Seattle, WA 98109 (United States)

    2013-09-15

    Background and purpose: It remains unclear whether direct vessel wall imaging can identify carotid high-risk lesions in symptomatic subjects and whether carotid plaque characteristics are more effective indicators for cerebral infarct severity than stenosis. This study sought to determine the associations of carotid plaque characteristics by MR imaging with stenosis and acute cerebral infarct (ACI) sizes on diffusion weighted imaging (DWI). Materials and methods: One hundred and fourteen symptomatic patients underwent carotid and brain MRI. ACI volume was determined from symptomatic internal carotid artery territory on DWI images. Ipsilateral carotid plaque morphological and compositional characteristics, and stenosis were also determined. The relationships between carotid plaque characteristics, stenosis and ACIs size were then evaluated. Results: In carotid arteries with 30–49% stenosis, 86.7% and 26.7% were found to have lipid-rich necrotic core (LRNC) and intraplaque hemorrhage, respectively. Furthermore, 45.8% of carotid arteries with 0–29% stenosis developed LRNCs. Carotid morphological measurements, such as % wall volume, and the LRNC size were significantly associated with ipsilateral ACIs volume before and after adjustment for significant demographic factors (age and LDL) or stenosis in patients with carotid plaque (all p < 0.05). Conclusions: A substantial number of high-risk plaques characterized by vessel wall imaging exist in carotid arteries with lower grade stenosis. In addition, carotid plaque characteristics, particularly the % wall volume and LRNC size, are independently associated with cerebral infarction as measured by DWI lesions. Our findings indicate that characterizing atherosclerotic plaque by MR vessel wall imaging might be useful for stratification of plaque risk and infarction severity.

  20. A STUDY OF ANATOMICAL VARIATIONS OF THE COMMON CAROTID ARTERIES: A CADAVERIC STUDY

    Directory of Open Access Journals (Sweden)

    Vatsala A R

    2014-03-01

    Full Text Available Background: Anatomical variations of carotid arterial system which are not infrequently encountered have a great impact on the surgical approaches of the neck. Although the described individual variations of the carotid arteries are well-known in the literature, the combination of anomalies reported in this study has not been, to the best of our knowledge, previously described. The carotid arteries show important variability and thus emphasise caution for clinicians during surgical procedures in the neck. Methods:The present study was undertaken on 80 common carotid arteries (40 left, 40 right of both sexes from embalmed adult human cadavers. The specimens were studied by detailed dissection method. Results: In the present study,fiftyone (63.8% bifurcations of common carotid arteries were high among which the most common levels of bifurcation was at the level of C 3 vertebral body (37.5%. The origin of the right common carotid artery was high and low in 10% and 2.6% of vessels respectively. Conclusion: The carotid arteries show important variability and thus emphasise caution for clinicians during surgical procedures in the neck.

  1. Reliability of digital panoramic radiographs in detecting calcified carotid artery atheromatous plaques: A clinical study

    OpenAIRE

    Neha Khambete; Rahul Kumar; Mukund Risbud; Anil Joshi

    2014-01-01

    Objectives: The objective of this study was to determine whether digital panoramic radiography is a reliable method to detect calcified carotid artery atheromatous plaques (CCAAP) as compared with ultrasonography. Study Design: Digital panoramic radiographs were obtained from 50 patients who also underwent carotid ultrasound examination. The images were interpreted by trained maxillofacial radiologist for the presence or absence of calcified atheromatous plaques. The extent of carotid cal...

  2. Hemodynamics of Stent Implantation Procedures in Coronary Bifurcations: an in vitro study

    CERN Document Server

    Brindise, Melissa C; Burzotta, Francesco; Migliavacca, Francesco; Vlachos, Pavlos P

    2016-01-01

    Stent implantation in coronary bifurcations presents unique challenges and currently there is no universally accepted stent deployment approach. Despite clinical and computational studies, to date, the effect of each stent implantation method on the coronary artery hemodynamics is not well understood. In this study the hemodynamics of stented coronary bifurcations under pulsatile flow conditions were investigated experimentally. Three implantation methods, provisional side branch (PSB), culotte (CUL), and crush (CRU), were investigated using time-resolved particle image velocimetry (PIV) to measure the velocity fields. Subsequently, hemodynamic parameters including wall shear stress (WSS), oscillatory shear index (OSI), and relative residence time (RRT) were calculated and the pressure field through the vessel was non-invasively quantified. The effects of each stented case were evaluated and compared against an un-stented case. CRU provided the lowest compliance mismatch, but demonstrated detrimental stent in...

  3. The normal internal carotid artery: a computed tomography angiographic study

    Energy Technology Data Exchange (ETDEWEB)

    Koskinen, Suvi Maaria; Valanne, Leena; Silvennoinen, Heli [Helsinki University Central Hospital and University of Helsinki, Department of Radiology, HUS Medical Imaging Center, Helsinki (Finland); Soinne, Lauri [Helsinki University Central Hospital, Department of Neurology, Helsinki (Finland)

    2014-09-15

    Systematic computed tomography angiographic (CTA) studies investigating variation in internal carotid artery (ICA) luminal diameters (LDs) are scarce. Knowledge of the normal intra-individual LD variability would provide a cut-off value for detection of more subtle collapses. In addition, low intra-individual variability would allow using contralateral LD as a reference for estimation of stenosis degree in cases where ipsilateral measurement is hampered. Therefore, our aim was to investigate intra-individual LD variation of normal ICA. We retrospectively collected multidetector high-speed CTAs of 104 patients younger than 40 years who were considered not to have carotid pathology. We carried out independent measurements of the common carotid artery (CCA) and ICA LDs bilaterally from axial source images by two observers, analysing side-to-side LD differences from averaged double measurements with a paired t test. We discovered no significant side-to-side LD differences. In the female group, the mean differences (mm) with 95 % confidence intervals were 0.08 (0.00, 0.17) for CCA and 0.03 (-0.04, 0.11) for ICA, with ICA LD standard deviation of 0.4 mm. In the male group, these were: 0.06 (-0.04, 0.17), 0.02 (-0.07, 0.11) and 0.4 mm, respectively. We detected no ICA agenesis. The intrinsic intra-individual variation of the LD of normal ICA is minimal. This uniformity may serve as the basis for detection of subtle grades of side-to-side variation caused by pathology. (orig.)

  4. Symptomatic stent cast.

    LENUS (Irish Health Repository)

    Keohane, John

    2012-02-03

    Biliary stent occlusion is a major complication of endoscopic stent insertion and results in repeat procedures. Various theories as to the etiology have been proposed, the most frequently studied is the attachment of gram negative bacteria within the stent. Several studies have shown prolongation of stent patency with antibiotic prophylaxis. We report the case of stent occlusion from a cast of a previously inserted straight biliary stent; a "stent cast" in an 86-year-old woman with obstructive jaundice. This was retrieved with the lithotrypter and she made an uneventful recovery. This is the first reported case of a biliary stent cast.

  5. Patient Dose During Carotid Artery Stenting With Embolic-Protection Devices: Evaluation With Radiochromic Films and Related Diagnostic Reference Levels According to Factors Influencing the Procedure

    International Nuclear Information System (INIS)

    To measure the maximum entrance skin dose (MESD) on patients undergoing carotid artery stenting (CAS) using embolic-protection devices, to analyze the dependence of dose and exposure parameters on anatomical, clinical, and technical factors affecting the procedure complexity, to obtain some local diagnostic reference levels (DRLs), and to evaluate whether overcoming DRLs is related to procedure complexity. MESD were evaluated with radiochromic films in 31 patients (mean age 72 ± 7 years). Five of 33 (15 %) procedures used proximal EPD, and 28 of 33 (85 %) procedures used distal EPD. Local DRLs were derived from the recorded exposure parameters in 93 patients (65 men and 28 women, mean age 73 ± 9 years) undergoing 96 CAS with proximal (33 %) or distal (67 %) EPD. Four bilateral lesions were included. MESD values (mean 0.96 ± 0.42 Gy) were FR) were 269 Gy cm2, 28 minutes, and 251, respectively. Only simultaneous bilateral treatment was associated with KAP (odds ratio [OR] 10.14, 95 % confidence interval [CI] 1–102.7, p FR overexposures (OR 10.8, 95 % CI 1.1–109.5, p FR overexposure (OR 2.8, 95 % CI 1.1–7.4, p = 0.040). At multivariable analysis, stenosis ≥ 90 % (OR 2.8, 95 % CI 1.1–7.4, p = 0.040) and bilateral treatment (OR 10.8, 95 % CI 1.1–109.5, p = 0.027) were associated with overexposure for two or more parameters. Skin doses are not problematic in CAS with EPD because these procedures rarely lead to doses >2 Gy.

  6. Computer simulation of the carotid artery

    OpenAIRE

    Santos, A.; Sousa, L. de; Tavares, J.; Santos, R.; Castro, P.; Azevedo, E.

    2012-01-01

    Background: Disturbed flow conditions at the bifurcation of common carotid artery and proximal internal carotid artery plays an important role in the development of local atherosclerotic plaques, which are important causes of stroke. Being able to build 3D models based on ultrasound imaging can improve diagnostic assessment and support interventions like endarterectomy or carotid stenting. Our aim was to describe a carotid segmentation algorithm to build these 3D models.Methods: We developed ...

  7. Study on the Prevalence and Corelation of Carotid Atherosclerosis in Stroke Patients

    Institute of Scientific and Technical Information of China (English)

    Wei Hua; Wang Yongjun; Yah Zhenying

    2000-01-01

    Objective To assess the prevalence and severity of carotid atherosclerosis in stroke patients and the risk factors of carotid atherosclerosis. Methods Two hundred fifty-one ischemic stroke patients,46 ccrcbral hemorrhagc patients and 96 control subjects were entercd into this study. Sonographic assessment of the extracranial carotid arteries was performed in all patients. Diametcr. IMT, plaques and percentage ratio of lumen stenosis were observcd. Results (1)The prevalence of carotid plaqucs was prominent in stroke patients than the control subjects(63.0%vs 36.5%). (2)The prevalencc of lumen stenosis>50% in ischemic stroke patients was higher than the cerebral hemorrhage patients and control subjects (15.6% vs 4.3%. 2.1%).(3) The prevalence of severe carotid artery stcnosis(>75%) was promincnt in aged 61~70 years old patients.(4)Our data revealed 30% of the cortical infarction subgroup, 17.5%of the subcortical infarction subgroup, 17% of the lacunar infarction subgroup,8% of the vcrtibral-basilar artery infarction subgroup.2.8% of thc CT normal subgroup possessed carotid stcnosis >50%. (5)Age, diabetes mellitus and ApoAl(inversely) were independent predictors of the extracranial carotid atherosclcrosis. Discusssion (Ⅰ)There is close relation between extracraniai carotid atherosclerosis and ischemic cerebrovascular disease.(2)The extent of serious carotid artery stcnosis in aged patients was lower.(3)Thc severity of extracranial carotid artery atherosclerosis was prominent in patients with conical infarction. Conclusion There is a high prevalence of extracranial carotid atherosclerosis in Chinese stroke patients.

  8. Endovascular treatment of peripheral arterial injury with covered stents: an experimental study in pigs

    Directory of Open Access Journals (Sweden)

    Sergio Belczak

    2011-01-01

    Full Text Available OBJECTIVE: To evaluate the feasibility of using endovascular repair to treat penetrating arterial injuries with covered stents. Feasibility was examined according to the circumferential extent of the injury. INTRODUCTION: Surgical trauma often increases the risk of major morbidity and mortality associated with vascular injury, and endovascular repair has many advantages in such situations. METHODS: Twenty white male domestic pigs weighing 28-38 kg with controlled vascular injuries were divided into four equal groups according to the circumferential extent of their vascular lesion (i.e., no lesion, lesion 50%, and complete lesion. The left common carotid artery was dissected with proximal and distal control, and this procedure was followed by controlled sectioning of the arterial wall. Local manual compression was applied for 10 min and was followed by endovascular repair with the placement of a 5x50 mm VIABHAN TM covered stent using the femoral approach. We also monitored additional variables, such as the duration of the procedures (the mean was 56.3 ± 19.1 min, ultrasound parameters (e.g., maximum arterial diameter, peak systolic and diastolic velocity, and resistance index, arteriography findings, and fluctuations in vital signs (e.g., cardiac output, arterial pressure, and central venous pressure. RESULTS: The experimental procedure was found to be feasible and reproducible. Repairs were successful in all animals in the control (no lesion and 50% group and in one pig in the complete lesion group. DISCUSSION: The endovascular repair of an arterial injury is possible, but success depends on the circumferential extent of the arterial lesion. The present experimental model, which involved endovascular techniques, highlighted important factors that must be considered in future studies involving similar animals and materials.

  9. Placement of Endovascular Stent across the Branching Arteries: Long-term Serial Evaluation of Stent-tissue Responses Overlying the Arterial Orifices in an Experimental Study

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Il; Chung, Jin Wook, E-mail: chungjw@snu.ac.kr [Seoul National University College of Medicine, Department of Radiology (Korea, Republic of); Kim, Hyun Beom [National Cancer Center of Korea, Department of Radiology and Center for Liver Cancer, Research Institute and Hospital (Korea, Republic of); Park, Jae Hyung [Seoul National University College of Medicine, Department of Radiology (Korea, Republic of); Seo, Jeong Wook [Seoul National University College of Medicine, Department of Pathology (Korea, Republic of); Kim, Hyo-Cheol; Jae, Hwan Jun; Lee, Whal [Seoul National University College of Medicine, Department of Radiology (Korea, Republic of)

    2012-10-15

    PurposeThis study was designed to investigate the effects of stenting across the branching arteries on the patency and stent-tissue responses over the branching arterial orifices. Methods: Thirteen dogs were observed after placing aortic stents across the celiac arteries (CA), superior mesenteric arteries (SMA), and renal arteries (RA). The animals were grouped according to stent types: large-cell group (n = 6) and small-cell group (n = 7). Angiography was performed to evaluate the branching artery patency at 2, 6, and 12 months after stent insertion, and the stent-tissue responses covering the orifices were evaluated on histopathologic examination. Results: All branching arteries were patent on follow-up angiography; however, three patterns of stent-tissue responses over the orifices were observed: neointimal layering, bridging septa, and papillary hyperplasia. Although neointimal layering and bridging septa were evenly observed, severe papillary hyperplasia was more frequent at SMA and CA than RA. Four RA showed less than 50% ostial patency, and localized infarct was observed in six kidneys (24%). The ostial patency tended to decrease with small-cell stent during the follow-up period. Conclusions: Various stent-tissue responses over the branching artery orifices are induced by the aortic stent covering the branching arteries and may not be easily detected by conventional angiography. Subclinical renal infarct also may occur despite patent renal angiography.

  10. Comparative analysis of conventional and eversion carotid endarterectomy: Prospective randomized study

    Directory of Open Access Journals (Sweden)

    Marković Dragan M.

    2008-01-01

    Full Text Available INTRODUCTION Studies completed in the last decade of the 20th century showed benefits of carotid endarterectomy in the prevention of stroke in patients with a high-grade stenosis of the internal carotid artery. OBJECTIVE The aim of this prospective, randomized study was the comparison of early and long-term results between the conventional and eversion carotid endarterectomy, and literature review. METHOD By the method of random choice, 103 patients were operated on using the eversion carotid endarterectomy and 98 patients using the conventional technique. Operative treatment was carried out under general anaesthesia. Following the clammping of the carotid artery, retrograde blood pressure was determined by a direct puncture of the internal carotid artery above the stenotic lesions. In patients with retrograde pressure below 20 mm Hg intraluminal shunting was routinely performed. Early results were estimated (during the first seven postoperative days based on mortality, central neurological complications (stroke, TIA and cranial or cervical nerve lesions. Long-term results were estimated (after at least two years based on long-term survival rate, central neurological complications (stroke, TIA and the incidence of haemodynamically significant restenosis of the carotid artery treated by endarterectomy. RESULTS The average time of clamming of the internal carotid artery in the eversion carotid anderectomy group was 5.36 minutes shorter than in the group treated by the conventional technique. Student's t-test showed a statistically highly significant difference in the time needed for clamming of the internal carotid artery between the two groups. The average duration of eversion endarterectomy (82 minutes was most often 19 minutes shorter than the duration of the conventional endarterectomy (101 minutes. Student's t-test showed a statistically highly significant difference in the average length of surgeries. The distal intimal fixation was more

  11. A historical prospective cohort study of carotid artery stenosis after radiotherapy for head and neck malignancies

    International Nuclear Information System (INIS)

    Purpose: To determine carotid artery stenosis incidence after radiotherapy for head-and-neck neoplasms. Methods and Materials: This historical prospective cohort study comprised 44 head-and-neck cancer survivors who received unilateral neck radiotherapy between 1974 and 1999. They underwent bilateral carotid duplex ultrasonography to detect carotid artery stenosis. Results: The incidence of significant carotid stenosis (8 of 44 [18%]) in the irradiated neck was higher than that in the contralateral unirradiated neck (3 of 44 [7%]), although this difference was not statistically significant (p = 0.13). The rate of significant carotid stenosis events increased as the time after radiotherapy increased. The risk of ipsilateral carotid artery stenosis was higher in patients who had undergone a neck dissection vs. those who had not. Patients with significant ipsilateral stenosis also tended to be older than those without significant stenosis. No other patient or treatment variables correlated with risk of carotid artery stenosis. Conclusions: For long-term survivors after neck dissection and irradiation, especially those who are symptomatic, ultrasonographic carotid artery screening should be considered

  12. Percutaneous valve stent insertion to correct the pulmonary regurgitation: an animal feasibility study

    Institute of Scientific and Technical Information of China (English)

    BAI Yuan; ZONG Gang-jun; JIANG Hai-bing; LI Wei-ping; WU Hong; ZHAO Xian-xian; QIN Yong-wen

    2010-01-01

    Background Pulmonary regurgitation leads to progressive right ventricular dysfunction, susceptibility to arrhythmias,and sudden cardiac death. Percutaneous valve replacement has been developed in recent years, providing patients with an alternative option. Percutaneous pulmonary valve replacement has been recently introduced into clinical practice. The goal of this study was to evaluate the feasibility of percutaneous valve stent insertion to correct the pulmonary regurgitation in sheep using a cup-shaped valve stent.Methods Pulmonary regurgitation was created by percutaneous cylindrical stent insertion in native pulmonary annulus of 8 sheep. One month after the initial procedure, the sheep with previous cylindrical stent implanted underwent the same implantation procedure of pulmonary valve stent. The valve stent consisted of a cup-shaped stent and pericardial valves.Hemodynamic assessments of the bioprosthetic pulmonary valve were obtained by echocardiography at immediately post-implant and at 2 months follow up.Results Successful transcatheter cylindrical stent insertion was performed in 7 sheep but failed in 1 sheep because the cylindrical stent was released to right ventricle outflow tract. After one month the 7 sheep with pulmonary regurgitation underwent valve stent implantation successfully. Echocardiography confirmed the stents were in desired position during the follow-up. No evidence of pulmonary valve insufficiency occurred in any animals. Echocardiography showed all heart function markers were normal.Conclusions Percutaneous cylindrical stent insertion to induce significant pulmonary regurgitation in sheep was feasible, simple and reproducible. Percutaneous pulmonary valve stent implantation can reduce pulmonary regurgitation in a sheep model. Further development of animal model and clinical trials are warranted.

  13. The usefulness of perfusion CT (p-CT) in the assessment of brain perfusion and autoregulation in patients with carotid stenosis before and after surgery or stenting: a preliminary report

    International Nuclear Information System (INIS)

    Improvement of brain perfusion and disappearance of neurological symptoms are the objective indicators of successful treatment of carotid stenosis. The perfusion CT technique is a component of a comprehensive evaluation of blood flow in cerebropetal arteries and brain perfusion. In the period of 2002-2004, perfusion CT exams were performed in 40 symptomatic patients being treated at our Surgery or Radiology Departments because of one-sided internal carotid stenosis (more than 70%). The exams were performed before and after the surgical procedure (23 patients) or stenting (17 patients). rCBV, rCBF, MTT, and TTP were evaluated. In a subgroup of 16 patients with carotid stenosis (less then 90%), a significant prolongation of MTT and a decrease in rCBF were observed in preoperative perfusion CT. In another subgroup of 24 patients with tight stenosis (more than 90%), changes in perfusion parameters ipsilateral to the stenosis were observed in every patient; MTT prolongation (by 35%) was the most profound change. In 14 patients in the critical stenosis subgroup which presented clinical symptoms (for at least 5 years), exams were performed after acetazolamide (Diamox) provocation to assess vascular autoregulation. The additional parameter of cerebrovascular reserve capacity (CRC) was introduced. In the evaluated group, 5 of the 14 patients presented complications, of which intracranial hemorrhage was the most severe. Mild symptoms of reperfusion syndrome in the subgroup of moderate stenosis occurred in one case only. Analysis of preoperative perfusion parameters revealed statistically significant increases in CBV and CBF as well as shortening of MTT and TTP ipsilaterally to the carotid stenosis. Perfusion CT is of significant importance in the evaluation of the effectiveness of procedures to restore carotid patency. Perfusion evaluation by means of autoregulation test (test with acetazolamide) enables prognosis of the course of the postoperative period in patients at risk

  14. Potential advantages and limitations of the Leo stent in endovascular treatment of complex cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lv Xianli; Li Youxiang; Jiang Chuhan; Yang Xinjian [Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan Xili, 100050 Hebei, Beijing (China); Wu Zhongxue, E-mail: ttyyzjb@sina.com [Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan Xili, 100050 Hebei, Beijing (China)

    2011-08-15

    Objective: The Leo self-expandable stent is a new retractable stent that is delivered via a conventional catheter. The aim of this study was to evaluate the use of this stent for endovascular treatment of complex aneurysms. Methods: Twenty-eight complex cerebral aneurysms (27 saccular and 1 fusiform) in 28 patients were treated electively. They were located at the internal carotid artery (17), basilar trunk (3), anterior cerebral artery (1), anterior communicating artery (3), vertebral artery (2) and middle cerebral artery (2). One aneurysm exhibited recanalization after primary endovascular treatment without stent. Clinical outcome was assessed with the modified Glasgow Outcome Scale. Results: Deployment of Leo stent was successful in 26 lesions, and difficulties in stent positioning due to tortuous cerebral circulation in 2 cases, which were treated with Neuroform stent. Additional coil embolization was performed in 26 lesions. No permanent neurological deficits were encountered consequent to endovascular procedure. Complete or partial occlusion immediately after stent deployment was achieved in all aneurysms. There was no immediate coil embolization was chosen in 3 cases because of subsequent reduced filling of the aneurysms with contrast agent on angiograms. There were 3 asymptomatic parent artery occlusion related to the deployment of the Leo stent, one stent migration. Follow-up revealed patent stents in the remaining cases. No angiographic recurrences arose. Conclusion: The Leo stent is very useful for endovascular treatment of complex cerebral aneurysms because it is easy to navigate and place precisely. A drawback is that in-stent thrombosis caused by stent placement and stiffer delivery catheters to place larger stents.

  15. Potential advantages and limitations of the Leo stent in endovascular treatment of complex cerebral aneurysms

    International Nuclear Information System (INIS)

    Objective: The Leo self-expandable stent is a new retractable stent that is delivered via a conventional catheter. The aim of this study was to evaluate the use of this stent for endovascular treatment of complex aneurysms. Methods: Twenty-eight complex cerebral aneurysms (27 saccular and 1 fusiform) in 28 patients were treated electively. They were located at the internal carotid artery (17), basilar trunk (3), anterior cerebral artery (1), anterior communicating artery (3), vertebral artery (2) and middle cerebral artery (2). One aneurysm exhibited recanalization after primary endovascular treatment without stent. Clinical outcome was assessed with the modified Glasgow Outcome Scale. Results: Deployment of Leo stent was successful in 26 lesions, and difficulties in stent positioning due to tortuous cerebral circulation in 2 cases, which were treated with Neuroform stent. Additional coil embolization was performed in 26 lesions. No permanent neurological deficits were encountered consequent to endovascular procedure. Complete or partial occlusion immediately after stent deployment was achieved in all aneurysms. There was no immediate coil embolization was chosen in 3 cases because of subsequent reduced filling of the aneurysms with contrast agent on angiograms. There were 3 asymptomatic parent artery occlusion related to the deployment of the Leo stent, one stent migration. Follow-up revealed patent stents in the remaining cases. No angiographic recurrences arose. Conclusion: The Leo stent is very useful for endovascular treatment of complex cerebral aneurysms because it is easy to navigate and place precisely. A drawback is that in-stent thrombosis caused by stent placement and stiffer delivery catheters to place larger stents.

  16. Long-term outcome of endovascular treatment versus medical care for carotid artery stenosis in patients not suitable for surgery and randomised in the Carotid and Vertebral Artery Transluminal Angioplasty study (CAVATAS).

    LENUS (Irish Health Repository)

    Ederle, Jörg

    2009-01-01

    Optimal treatment of carotid stenosis in patients not suitable for surgery is unclear. The Carotid and Vertebral Artery Transluminal Angioplasty study contained a trial comparing medical and endovascular treatment in patients not suitable for surgery.

  17. A gene-centric study of common carotid artery remodelling

    NARCIS (Netherlands)

    Harrison, Seamus C.; Zabaneh, Delilah; Asselbergs, Folkert W.; Drenos, Fotios; Jones, Gregory T.; Shah, Sonia; Gertow, Karl; Sennblad, Bengt; Strawbridge, Rona J.; Gigante, Bruna; Holewijn, Suzanne; De Graaf, Jacqueline; Vermeulen, Sita; Folkersen, Lasse; van Rij, Andre M.; Baldassarre, Damiano; Veglia, Fabrizio; Talmud, Philippa J.; Deanfield, John E.; Agu, Obi; Kivimaki, Mika; Kumari, Meena; Bown, Matthew J.; Nyyssonen, Kristiina; Rauramaa, Rainer; Smit, Andries J.; Franco-Cereceda, Anders; Giral, Philippe; Mannarino, Elmo; Silveira, Angela; Syvanen, Ann-Christine; de Borst, Gert J.; van der Graaf, Yolanda; de Faire, Ulf; Baas, Annette F.; Blankensteijn, Jan D.; Wareham, Nicholas J.; Fowkes, Gerry; Tzoulaki, Ionna; Price, Jacqueline F.; Tremoli, Elena; Hingorani, Aroon D.; Eriksson, Per; Hamsten, Anders; Humphries, Steve E.

    2013-01-01

    Background: Expansive remodelling is the process of compensatory arterial enlargement in response to atherosclerotic stimuli. The genetic determinants of this process are poorly characterized. Methods: Genetic association analyses of inter-adventitial common carotid artery diameter (ICCAD) in the IM

  18. Carotid revascularization: risks and benefits

    Directory of Open Access Journals (Sweden)

    O'Brien M

    2014-07-01

    Full Text Available Marlene O'Brien, Ankur Chandra Department of Surgery, Division of Vascular Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Abstract: Despite a decline during the recent decades in stroke-related death, the incidence of stroke has remained unchanged or slightly increased, and extracranial carotid artery stenosis is implicated in 20%–30% of all strokes. Medical therapy and risk factor modification are first-line therapies for all patients with carotid occlusive disease. Evidence for the treatment of patients with symptomatic carotid stenosis greater than 70% with either carotid artery stenting (CAS or carotid endarterectomy (CEA is compelling, and several trials have demonstrated a benefit to carotid revascularization in the symptomatic patient population. Asymptomatic carotid stenosis is more controversial, with the largest trials only demonstrating a 1% per year risk stroke reduction with CEA. Although there are sufficient data to advocate for aggressive medical therapy as the primary mode of treatment for asymptomatic carotid stenosis, there are also data to suggest that certain patient populations will benefit from a stroke risk reduction with carotid revascularization. In the United States, consensus and practice guidelines dictate that CEA is reasonable in patients with high-grade asymptomatic stenosis, a reasonable life expectancy, and perioperative risk of less than 3%. Regarding CAS versus CEA, the best-available evidence demonstrates no difference between the two procedures in early perioperative stroke, myocardial infarction, or death, and no difference in 4-year ipsilateral stroke risk. However, because of the higher perioperative risks of stroke in patients undergoing CAS, particularly in symptomatic, female, or elderly patients, it is difficult to recommend CAS over CEA except in populations with prohibitive cardiac risk, previous carotid surgery, or prior neck radiation. Current treatment

  19. Patient Dose During Carotid Artery Stenting With Embolic-Protection Devices: Evaluation With Radiochromic Films and Related Diagnostic Reference Levels According to Factors Influencing the Procedure

    Energy Technology Data Exchange (ETDEWEB)

    D' Ercole, Loredana, E-mail: l.dercole@smatteo.pv.it [Fondazione IRCCS Policlinico San Matteo, Department of Medical Physics (Italy); Quaretti, Pietro; Cionfoli, Nicola [Fondazione IRCCS Policlinico San Matteo, Department of Radiology (Italy); Klersy, Catherine [Fondazione IRCCS Policlinico San Matteo, Biometry and Clinical Epidemiology Service, Research Department, (Italy); Bocchiola, Milena [Fondazione IRCCS Policlinico San Matteo, Department of Medical Physics (Italy); Rodolico, Giuseppe; Azzaretti, Andrea [Fondazione IRCCS Policlinico San Matteo, Department of Radiology (Italy); Lisciandro, Francesco [Fondazione IRCCS Policlinico San Matteo, Department of Medical Physics (Italy); Cascella, Tommaso; Zappoli Thyrion, Federico [Fondazione IRCCS Policlinico San Matteo, Department of Radiology (Italy)

    2013-04-15

    To measure the maximum entrance skin dose (MESD) on patients undergoing carotid artery stenting (CAS) using embolic-protection devices, to analyze the dependence of dose and exposure parameters on anatomical, clinical, and technical factors affecting the procedure complexity, to obtain some local diagnostic reference levels (DRLs), and to evaluate whether overcoming DRLs is related to procedure complexity. MESD were evaluated with radiochromic films in 31 patients (mean age 72 {+-} 7 years). Five of 33 (15 %) procedures used proximal EPD, and 28 of 33 (85 %) procedures used distal EPD. Local DRLs were derived from the recorded exposure parameters in 93 patients (65 men and 28 women, mean age 73 {+-} 9 years) undergoing 96 CAS with proximal (33 %) or distal (67 %) EPD. Four bilateral lesions were included. MESD values (mean 0.96 {+-} 0.42 Gy) were <2 Gy without relevant dependence on procedure complexity. Local DRL values for kerma area product (KAP), fluoroscopy time (FT), and number of frames (N{sub FR}) were 269 Gy cm{sup 2}, 28 minutes, and 251, respectively. Only simultaneous bilateral treatment was associated with KAP (odds ratio [OR] 10.14, 95 % confidence interval [CI] 1-102.7, p < 0.05) and N{sub FR} overexposures (OR 10.8, 95 % CI 1.1-109.5, p < 0.05). Type I aortic arch decreased the risk of FT overexposure (OR 0.4, 95 % CI 0.1-0.9, p = 0.042), and stenosis {>=} 90 % increased the risk of N{sub FR} overexposure (OR 2.8, 95 % CI 1.1-7.4, p = 0.040). At multivariable analysis, stenosis {>=} 90 % (OR 2.8, 95 % CI 1.1-7.4, p = 0.040) and bilateral treatment (OR 10.8, 95 % CI 1.1-109.5, p = 0.027) were associated with overexposure for two or more parameters. Skin doses are not problematic in CAS with EPD because these procedures rarely lead to doses >2 Gy.

  20. Computational fluid dynamics study of commercially available stents inside an idealised curved coronary artery

    Science.gov (United States)

    Chen, Winson Xiao; Ooi, Andrew; Hutchins, Nicholas; Poon, Eric; Thondapu, Vikas; Barlis, Peter

    2015-11-01

    Stent placement restores blood flow in diseased coronary arteries and is the standard treatment for obstructive coronary atherosclerosis. Analysis of the hemodynamic characteristics of stented arteries is essential for better understanding of the relationship between key fluid dynamic variables and stent designs. Previous computational studies have been limited to idealised stents in curved arterial segments or more realistic stents in straight segments. In clinical practice, however, it is often necessary to place stents in geometrically complex arterial curvatures. Thus, numerical simulations of the incompressible Navier-Stokes equations are carried out to investigate the effects of curvature on hemodynamics using detailed, commercially available coronary stents. The computational domain is a 3mm curved coronary artery model and simulations are conducted using a physiologically realistic inlet condition. The averaged flow rate is about 80 mL/min, similar to the normal human resting condition. The examination of hemodynamic parameters will assess the performance of several commercially available stents in curved arteries and identify regions that may be at risk for restenosis. It is anticipated that this information will lead to improvements in future stent design and deployment.

  1. Association between Carotid Artery Stenosis and Cognitive Impairment in Stroke Patients: A Cross-Sectional Study.

    Directory of Open Access Journals (Sweden)

    Wei Yue

    Full Text Available To investigate potential associations between carotid artery stenosis and cognitive impairment among patients with acute ischemic stroke and to provide important clinical implications. We measured the degree of carotid artery stenosis and recorded the Mini-Mental State Examination score (MMSE at admission in 3116 acute ischemic stroke patients. The association between carotid stenosis and cognitive impairment assessed by MMSE was tested using multivariate regression analysis. Other clinical variables of interest were also studied. After adjusting for age, gender, education level, marriage, alcohol use, tobacco use, physical activity, hypertension, diabetes, hypercholesterolemia, atrial fibrillation, myocardial infarction and NIHSS (National Institutes of Health Stroke Scale score, we found that participants with high-grade stenosis of the carotid artery had a higher likelihood of cognitive impairment compared to those without carotid artery stenosis (OR = 1.49, 95%CI: 1.05-2.11, p<0.001. Left common carotid artery stenosis was associated with cognitive impairment in the univariate analysis, although this effect did not persist after adjustment for the NIHSS score. Cognitive impairment was associated with high-grade stenosis of the right carotid artery.

  2. Progression of carotid intima media thickness after radiotherapy: A long-term prospective cohort study

    International Nuclear Information System (INIS)

    Background and purpose: Carotid artery vasculopathy is a long-term complication of radiotherapy (RT) of the neck. We investigated the change in carotid intima media thickness (IMT) and the incidence of ischemic stroke in the first 7 years after radiotherapy (RT) of the neck. Materials and methods: A multicentre prospective cohort study among patients treated for Head and Neck Cancer (HNC) assessed carotid IMT at baseline (before RT) and after a median of 7 years follow-up. We also screened for cerebrovascular risk factors and events. Results: 48 patients underwent IMT measurement at baseline and follow-up (median age 61 years, range 29–87). Mean IMT of the irradiated common carotid arteries was 0.64 mm at baseline and 0.74 mm at follow-up (p = 0.002). Mean delta IMT in the irradiated and non-irradiated common carotid arteries were 0.11 and 0.02 mm (p = 0.03). Incidence rate of stroke in our cohort, compared to the Dutch population was 8.9 versus 1.5 per 1.000 person years. Conclusions: IMT in irradiated carotid arteries was significantly increased in the first 7 years after RT. The incidence rate of stroke was six fold increased. Patients treated with RT for HNC have sustained risk for developing atherosclerosis of the carotid arteries and future stroke

  3. A gene-centric study of common carotid artery remodelling

    Science.gov (United States)

    Harrison, Seamus C.; Zabaneh, Delilah; Asselbergs, Folkert W.; Drenos, Fotios; Jones, Gregory T.; Shah, Sonia; Gertow, Karl; Sennblad, Bengt; Strawbridge, Rona J.; Gigante, Bruna; Holewijn, Suzanne; De Graaf, Jacqueline; Vermeulen, Sita; Folkersen, Lasse; van Rij, Andre M.; Baldassarre, Damiano; Veglia, Fabrizio; Talmud, Philippa J.; Deanfield, John E.; Agu, Obi; Kivimaki, Mika; Kumari, Meena; Bown, Matthew J.; Nyyssönen, Kristiina; Rauramaa, Rainer; Smit, Andries J.; Franco-Cereceda, Anders; Giral, Philippe; Mannarino, Elmo; Silveira, Angela; Syvänen, Ann-Christine; de Borst, Gert J.; van der Graaf, Yolanda; de Faire, Ulf; Baas, Annette F.; Blankensteijn, Jan D.; Wareham, Nicholas J.; Fowkes, Gerry; Tzoulaki, Ionna; Price, Jacqueline F.; Tremoli, Elena; Hingorani, Aroon D.; Eriksson, Per; Hamsten, Anders; Humphries, Steve E.

    2013-01-01

    Background Expansive remodelling is the process of compensatory arterial enlargement in response to atherosclerotic stimuli. The genetic determinants of this process are poorly characterized. Methods Genetic association analyses of inter-adventitial common carotid artery diameter (ICCAD) in the IMPROVE study (n = 3427) using the Illumina 200k Metabochip was performed. Single nucleotide polymorphisms (SNPs) that met array-wide significance were taken forward for analysis in three further studies (n = 5704), and tested for association with Abdominal Aortic Aneurysm (AAA). Results rs3768445 on Chromosome 1q24.3, in a cluster of protein coding genes (DNM3, PIGC, C1orf105) was associated with larger ICCAD in the IMPROVE study. For each copy of the rare allele carried, ICCAD was on average 0.13 mm greater (95% CI 0.08–0.18 mm, P = 8.2 × 10−8). A proxy SNP (rs4916251, R2 = 0.99) did not, however, show association with ICCAD in three follow-up studies (P for replication = 0.29). There was evidence of interaction between carotid intima-media thickness (CIMT) and rs4916251 on ICCAD in two of the cohorts studies suggesting that it plays a role in the remodelling response to atherosclerosis. In meta-analysis of 5 case–control studies pooling data from 5007 cases and 43,630 controls, rs4916251 was associated with presence of AAA 1.10, 95% CI 1.03–1.17, p = 2.8 × 10−3, I2 = 18.8, Q = 0.30). A proxy SNP, rs4916251 was also associated with increased expression of PIGC in aortic tissue, suggesting that this may the mechanism by which this locus affects vascular remodelling. Conclusions Common variation at 1q24.3 is associated with expansive vascular remodelling and risk of AAA. These findings support a hypothesis that pathways involved in systemic vascular remodelling play a role in AAA development. PMID:23246012

  4. First-in-man (FIM) study of the Stentys™ bifurcation stent - 30 days results

    NARCIS (Netherlands)

    S. Verheye (Stefan); E. Grube (Eberhard); S. Ramcharitar (Steve); J. Schofer (Joachim); B. Witzenbichler (Bernhard); J. Kovac (Jan); K. Hauptmann (Karl); P. Agostoni (Pierfrancesco); M. Wiemer (Marcus); T. Lefèvre (Thierry); P.W.J.C. Serruys (Patrick); R.J.M. van Geuns (Robert Jan)

    2009-01-01

    textabstractAims: We report the acute and 30 day results of the OPEN I study, a multicentre prospective single arm study evaluating the safety and feasibility of the Stentys™ bifurcation stent. Methods and results: The Stentys™ stent is a provisional, self-expanding nitinol drug eluting or bare meta

  5. Incidental direct carotid-cavernous fistula in a patient with high-grade internal carotid artery stenosis

    International Nuclear Information System (INIS)

    The concurrent occurrence of internal carotid artery (ICA) stenosis and carotid-cavernous fistula (CCF) is infrequent. We report the case of a 59-year-old man with symptomatic high-grade stenosis of left ICA who was referred to our hospital for surgical treatment. An ipsilateral direct CCF was found incidentally during operation. Ultimately, the two lesions were successfully treated with a covered stent while the ICA was preserved. The result of our study may provide further insight into this rare combination of diseases. (author)

  6. Intra-aneurysmal thrombosis induced by stenting in the parent artery in rabbit. Hemodynamic consideration

    International Nuclear Information System (INIS)

    The indication of coil embolization for unruptured aneurysms is recently increasing. However, a safer procedure is required, since the patients are asymptomatic. We presumed that the manipulation in aneurysm can be avoided to prevent rupture if intra-aneurysmal thrombosis is induced with only stenting in the parent artery of aneurysm, and considered whether stenting is effective from a hemodynamic point of view. Neuroform2 is a self-expandable stent used in these experiments. The aneurysm is induced at the origin on the right common carotid artery in rabbits, and the stent introduced into the parent artery of an aneurysm. Aneurysm was also induced in another rabbit without stenting. Intra-aneurysmal partial thrombosis was induced and the volume increased in the term of observation with 3DCT-angiography every month in the stented rabbit. There was no intra-aneurysmal thrombosis in the rabbit without stenting. We also confirmed the decreased intra-aneurysmal velocity in the hemodynamic study using realistic silicon models. These results indicate that intra-aneurysmal partial thrombosis is induced by alteration of the hemodynamics with stenting. This procedure has the possibility for preventing rupture of the aneurysm. We also consider that improvement of the mesh design of the stent and double stenting would lead to complete thrombosis in the aneurysm. (author)

  7. A Retrospective Study of Combined Cardiac and Carotid Surgery

    Directory of Open Access Journals (Sweden)

    Fabrizio Sansone

    2012-08-01

    Full Text Available Introduction: A combined carotid endarterectomy (CEA and cardiac procedure has higher early risk of stroke than isolated CEA because of the widespread atherosclerosis in patients selected for simultaneous procedures. In this retrospective study, we review the results of combined coronary artery bypass grafting (CABG and carotid endarterectomy (CEA procedures. Materials and methods: Between January 2000 and December 2007, 91 patients with a mean age of 69.2+6.6 (24/67 female/male underwent combined operations (CEA-CABG on cardiopulmonary bypass (CPB as elective surgery. The study population was divided, as follows: Group A: 83 patients (91.2% had both venous and arterial revascularization; Group B: 8 patients (8.8% had total arterial revascularization. CEA was performed in case of stenosis more than 80% and always before cardiac operation. These techniques were used: standard procedure (54.8%, eversion (39.2%, patch enlargement (6%. Immediately after the vascular procedure, CABGs were performed through median sternotomy. The mean EUROscore was 6.9+2.5%. Results: All neurological complications were in the group who underwent both venous and arterial revascularization (Group A, where a proximal anastomosis was made. All complications and deaths were in group A. Six patients had stroke (6.6% and 2 had acute myocardial infarction (AMI (2.2%. There were 8 in-hospital deaths (8.8% and 1 late death (for stroke after five months. Conclusions: In our center, the incidence of stroke in simultaneous cardiovascular procedures was 5.5 times greater than in isolated cardiac or vascular procedures, which was probably related to the widespread vessels disease. An aortic cross clamp and surgical procedure on the ascending aorta are relevant risk factors for developing neurological events; much attention should be paid to aortic manipulation. In the sub-group who underwent total arterial revascularization with associated CEA procedures, we had no neurological

  8. The implantation of separating aortic stent-graft into the canine thoracic aorta: an experimental study

    International Nuclear Information System (INIS)

    Objective: to assess the technical feasibility of implanting separating stent-graft into the canine thoracic aorta and to study its biocompatibility. Methods: Twelve adult dogs were randomly and equally divided into three groups. The right femoral artery was cut open, through which the separating stent-graft was inserted and deployed in the canine thoracic aorta, with the proximal end of the graft being quite close to the origin of the left subclavian artery. the technical feasibility of the deployment process was assessed. Angiography was performed at 4, 8 and 12 weeks after stent-graft placement to evaluate the position and patency of the stent-graft. Then the dogs were sacrificed and the specimens were collected for pathologic study. Both gross and microscopic examinations were made to evaluate the fixation of the stent-graft with the vessel wall, the endothelialization of stent-graft surface and the pathologic changes of the vascular wall. Results: A total of ten separating stent-grafts were successfully deployed in the canine thoracic aorta, no migration or deformation occurred. One dog died of massive bleeding due to the rupture of the right femoral artery which occurred when the delivery system containing the inner bare stent was inserted through the right femoral artery. Death occurred in another dog as a result of the ascending aorta rupture caused by the migration of outer-layer stent-graft. Angiography was conducted at 4, 8 and 12 weeks after stent-graft placement. No migration, deformation, rupture or stenosis of the implanted stent-grafts were observed. The formation of intima on the inner surface of the bare stent appeared at 4 weeks, which became more and more obvious with the time passing, and at 12 weeks complete endothelialization of stent-graft surface was observed. Conclusion: Technically, it is feasible to deploy the separating aortic stent-graft into the canine thoracic aorta. Moreover, the separating aortic stent-graft carries excellent

  9. Temporary self-expanding cardia stents for the treatment of achalasia: an experimental study in dogs

    International Nuclear Information System (INIS)

    Objective: To assess the performance, efficiency and optimal removal time of a newly designed temporary retrievable cardia covered stent (TRC-CS) for the treatment of achalasia in a dog model. Methods: Eighty-four achalasia-like dog models were randomly divided into seven groups of 12, a control group (CG; no stent insertion), a standard stent control group (NSCG, standard esophageal stent) and five treatment groups (TG, TRC-CS). Stents were retrieved at 4 days after insertion in the NSCG and at 4 days (4 d-TG), 2 weeks (2 w-TG), 1 month (1 m-TG), 3 months (3 m-TG), and 6 months (6 m-TG) in the TGs. lower esophageal sphincter pressure (LESP) and a timed barium esophagram were assessed before stent insertion, after stent retrieval, and at 1-week, 1-, 3- and 6-month follow-up. Three dogs in NSCG and 4 d-TG were sacrificed for histological examination at each follow-up to investigate the inflammatory reaction after stent insertion. Results: Stent insertion/removal and the follow-up procedures were well tolerated. At 6-month follow-up, the 2 w-TG and 1 m-TG demonstrated an acceptable stent migration (n=2 in both TGs versus n=4 in NSCG, n=4 in 3 m-TG, and =6 in 6 m-TG), improved LESP compared to after BAC injection (P<0.05), and improved timed barium height (p=0.0144 and 0.0409). Mouse-proliferating cell nuclear antigen (PCNA) and α-smooth muscle actin staining revealed no inflammatory reaction difference between the NSCG and 4d-TG at each follow-up. Conclusion: The TRC-CS was effective in the treatment of achalasia in a dog model. LESP measurements, timed barium esophagram studies suggest an optimal stent retrieval time of between 2 w∼1 m. (authors)

  10. Experimental study of different nickel-titanium memory tracheal stents in dogs

    International Nuclear Information System (INIS)

    Objective: Since membrane -covered metal tracheal stent was applied successfully to treat the airway stenosis, it has been widely used and obtained satisfactory result during the past years. The purpose of our study was provide theoretical rational for treatment with membrane-covered tracheal stent by using animal experiment. Methods: The nickel- titanium memory stents of 22 mm in diameter and 6 cm in length were deployed in 18 dogs. The dogs were grouped into full- length membrane-covered group (n=6), partial-length membrane-covered group (membrane was covered for 4 cm in the medial part of the stent, n=6), and naked stent group (n=6). After the stent placement dysphagia or dysphonia was monitored daily. Twenty-four weeks later, the dogs were executed. Speiments were taken from the cephalic, medial, and caudal trachea under the stent. HE stain and proliferating cell nuclear antigen (PCNA) were evaluated. Results: After the stent placement, no dyspnea, dysphagia or dysphonia but cough was present in each dog. There was no significant difference in symptom between the three groups. Inflammation reaction, metaplasia from low columnar epithelium to spuamous epithelium, and mild granulation tissue hyperplasia in the underlying mucosa were present in each group. However, fibrosis and tracheal straitness were present only in the non-membrane-covered area, but not in the membrane-covered area. More PCNA expression was observed in the non-membrane -covered area than in the membrane-covered area. Conclusion: Both membrane-covered and non-membrane-covered stents can cause similar symptoms. However, the membrane -covered tracheal stent has good biological compatibility and would not induce tracheal straitness. The non-membrane -covered tracheal stent could induce a severe pathologic reaction and tracheal straitness. (authors)

  11. Atherosclerotic Calcification Detection: A Comparative Study of Carotid Ultrasound and Cone Beam CT

    OpenAIRE

    Fisnik Jashari; Pranvera Ibrahimi; Elias Johansson; Jan Ahlqvist; Conny Arnerlöv; Maria Garoff; Eva Levring Jäghagen; Per Wester; Michael Y. Henein

    2015-01-01

    BACKGROUND AND AIM: Arterial calcification is often detected on ultrasound examination but its diagnostic accuracy is not well validated. The aim of this study was to determine the accuracy of carotid ultrasound B mode findings in detecting atherosclerotic calcification quantified by cone beam computed tomography (CBCT). METHODS: We analyzed 94 carotid arteries, from 88 patients (mean age 70 ± 7 years, 33% females), who underwent pre-endarterectomy ultrasound examination. Plaques with high ec...

  12. Morphological changes of carotid bodies in acute respiratory distress syndrome: a morphometric study in humans

    OpenAIRE

    E.N.G. Vinhaes; Dolhnikoff, M; Saldiva, P. H. N.

    2002-01-01

    Carotid bodies are chemoreceptors sensitive to a fall of partial oxygen pressure in blood (hypoxia). The morphological alterations of these organs in patients with chronic obstructive pulmonary disease (COPD) and in people living at high altitude are well known. However, it is not known whether the histological profile of human carotid bodies is changed in acute clinical conditions such as acute respiratory distress syndrome (ARDS). The objective of the present study was to perform a quantita...

  13. Drug eluting stents: are human and animal studies comparable?

    OpenAIRE

    Virmani, R; Kolodgie, F D; Farb, A.; Lafont, A

    2003-01-01

    Animal models of stenting probably predict human responses as the stages of healing are remarkably similar. What is characteristically different is the temporal response to healing, which is substantially prolonged in humans. The prevention of restenosis in recent clinical trials of drug eluting stents may represent a near absent or incomplete phase of intimal healing. Continued long term follow up of patients with drug eluting stents for major adverse cardiac events and angiographic restenos...

  14. A novel biodegradable frontal sinus stent (MgNd2): a long-term animal study.

    Science.gov (United States)

    Durisin, M; Seitz, J M; Reifenrath, J; Weber, C M; Eifler, R; Maier, H J; Lenarz, T; Klose, C

    2016-06-01

    The frontal sinus recess consists of anatomically narrow passages that are prone to stenosis in endonasal frontal sinus surgery for chronic sinus disease. Over the past 100 years, diverse frontal sinus stents have been developed and evaluated in clinical and animal studies. However, superinfection, formation of granulations tissue, stent dislocation and late stenosis of the duct have remained challenges and subject of debate in the literature. Currently developed biodegradable materials, including rare earth-containing magnesium alloys are promising candidates for application as temporary implant materials. The Mg 2 % wt Nd alloy (MgNd2) was used to design a nasal stent that fit the porcine anatomy. In the current study, we evaluate biocompatibility, biodegradation and functionality of a frontal sinus stent in 16 minipigs over 6 months. Intraoperative endoscopy revealed free stent lumen in all cases. Blood examination and clinical examinations indicated no systematic or local inflammation signs. The histopathology and elements analysis showed a very good biocompatibility. The μ-computed tomography-based volumetric analysis showed substantial stent degradation within 6 months. Our MgNd2 based stent appears to be a promising, solid basis for the development of a frontal sinus stent for clinical use. PMID:26341887

  15. A study on the carotid artery ultrasonography for the metabolic syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Kong, Hye Jung; Cho, Pyong Kon [Dept. of Radiological Science, Catholic University of Daegu, Daegu (Korea, Republic of); Kang, Young Han [Dept. of Radiology, Catholic University Hospital of Daegu, Daegu (Korea, Republic of)

    2013-09-15

    The primary goal of this study was to ascertain the primary factors to the affect for the carotid artery intima-media thickness (IMT), the prevalence of metabolic syndrome and other risks can possibly influence the carotid artery IMT. All patients data (total specimens: 289, male: 197, female: 92) including the carotid artery ultrasonography examination. The all data were analyzed by the use of SPSS software, version 21.0 (SPSS, Chicago, IL USA), with the descriptive statistics method. The Results of this study was found to be highly increased in the males than the females. The prevalence of metabolic syndrome in all of the participants was 30.5 percentages. The carotid artery IMT in the subjects with metabolic syndrome was significantly high in both genders, compared to the rest, who were without metabolic syndrome. The Pearsons correlation coefficient of metabolic syndrome and CIMT was 0.378(p<0.01). In conclusions, the present study also supports the association between the carotid artery IMT and the metabolic syndromes with cardiovascular risk factors. Usage of B-mode ultrasonography to measure the carotid artery IMT was found to be highly effective in the current analysis.

  16. A study on the carotid artery ultrasonography for the metabolic syndrome

    International Nuclear Information System (INIS)

    The primary goal of this study was to ascertain the primary factors to the affect for the carotid artery intima-media thickness (IMT), the prevalence of metabolic syndrome and other risks can possibly influence the carotid artery IMT. All patients data (total specimens: 289, male: 197, female: 92) including the carotid artery ultrasonography examination. The all data were analyzed by the use of SPSS software, version 21.0 (SPSS, Chicago, IL USA), with the descriptive statistics method. The Results of this study was found to be highly increased in the males than the females. The prevalence of metabolic syndrome in all of the participants was 30.5 percentages. The carotid artery IMT in the subjects with metabolic syndrome was significantly high in both genders, compared to the rest, who were without metabolic syndrome. The Pearsons correlation coefficient of metabolic syndrome and CIMT was 0.378(p<0.01). In conclusions, the present study also supports the association between the carotid artery IMT and the metabolic syndromes with cardiovascular risk factors. Usage of B-mode ultrasonography to measure the carotid artery IMT was found to be highly effective in the current analysis

  17. Carotid angioplasty with cerebral protection

    International Nuclear Information System (INIS)

    Background. Carotid endarterectomy (CEA) is widely used in the management of high-grade carotid stenosis. It is a surgical procedure requiring general anaesthesia and is suitable only for lesions located at or close to the carotid bifurcation. It may develop complications, such as stroke, death, cranial nerve palsies, wound haematoma and cardiac complications. The risk of complications is increased in patients with recurrent carotid artery stenosis following CEA, in subjects undergoing radiotherapy to the neck, and in patients with cardiopulmonary disease. The drawbacks of CEA have led physicians to search for alternative treatment options. Carotid angioplasty and stenting (CAS) is less invasive than CEA. The method is particularly suitable for the treatment of recurrent stenosis after previous CEA and distal internal artery stenosis, which is inaccessible for CEA. CAS does not cause cranial nerve palsies. Moreover, it does not require general anaesthesia and causes lower morbidity and mortality in patients with severe cardiopulmonary disease. The complications of CAS include stroke due to distal immobilisation of a plaque or thrombus dislodged during the procedure, abrupt vessel occlusion due to thrombosis, dissection or vasospasm, and restenosis due to intimal hyperplasia. CAS is a relatively new procedure; therefore, it is essential to establish its efficacy and safety before it is introduced widely into clinical practice. Patients and methods. In Slovenia, we have also started with carotid angioplasty by the study: Slovenian Carotid Angioplasty Study (SCAS). We performed CAS in 17 patients (12 males and 5 females) aged from 69 to 82 years. All patients were symptomatic with stenosis greater than 70 %. 10 patients suffered transient ischemic attacks, 4 patients minor strokes and 3 patients amaurosis fugax. Results. Technical success (< 30 % residual stenosis) was achieved in all cases. In 14 patients, no residual stenosis was found, in 2 patients a 15 % residual

  18. Shared and discrepant susceptibility for carotid artery and aortic arch calcification: A genetic association study.

    Science.gov (United States)

    Zhang, Yumeng; Wang, Li; Zhang, Zhizhong; Zhang, Zongjun; Zhou, Shuyu; Cao, Liping; Cai, Biyang; Liu, Keting; Bai, Wen; Xie, Xia; Fan, Wenping; Liu, Xinfeng; Lu, Guangming; Xu, Gelin

    2015-08-01

    Genome-wide association studies (GWASs) have identified several risk loci for coronary artery calcification. Four single-nucleotide polymorphisms (SNPs, rs1537370, rs1333049, rs2026458 and rs9349379) were associated with coronary artery calcification with P values less than 5 × 10(-8) in GWASs. It is unclear if these associations exist in other vascular beds. Thus, we evaluated the impacts of these four SNPs on carotid artery and aortic arch calcification in this study. Computed tomography was applied to quantify the calcification of carotid artery and aortic arch. 860 patients with stroke completed calcification quantification and genotype testing were included in data analysis. Each SNP was evaluated for the association with carotid artery calcification, and with aortic arch calcification using generalized linear model. Among the four tested SNPs, rs2026458 was associated with calcification in both carotid artery (β = 0.31, 95% confidence interval [CI] 0.10-0.52, P = 0.003) and aortic arch (β = 0.32, 95% CI 0.10-0.54, P = 0.004), while rs1333049 was only associated with carotid artery calcification (β = 0.28, 95% CI 0.06-0.50, P = 0.011). In gender-stratified analyses, rs2026458 had significant impacts on carotid artery (P = 0.003) and aortic arch calcification (P = 0.008) in male, but not in female patients; while rs1537370 was significantly associated with carotid artery calcification in female (P = 0.013), but not in male patients. In conclusion, SNPs associated with coronary artery calcification may also increase the risk of calcification in other arteries such as carotid artery and aortic arch. PMID:26071660

  19. Indications and Problems of Intracranial Stenting: Report of Two Cases

    OpenAIRE

    Deguchi, J.; Kuroiwa, T; Nagasawa, S; Satoh, G.; T. Ohta

    2000-01-01

    There have been few reports of stenting in the intracranial arteries. We used coronary stents in the chronically occluded intracranial vertebral artery and stenosis of internal carotid artery by the external force, and good blood flow were resumed. Stenosis in the intracranial arteries is also a good indication for stent placement when it is due to chronic total occlusion or artery compression by external force. But stent placement in the intracranial arteries has some problems. Stent placeme...

  20. Changes of nitric oxide and endothelin serum level after carotid balloon denudation or stent assisted angioplasty: an experimental and clinical observation%颈动脉球囊扩张与支架置入术后血清一氧化氮和内皮素变化的实验与临床观察

    Institute of Scientific and Technical Information of China (English)

    刘加春; 王大明; 钱江南; 李雅国; 王利军; 姜学丽; 翟乐乐; 陆军; 祁鹏

    2009-01-01

    Objective To observe the changes of nitric oxide (NO) and endothelin (ET) serum level in the Guangxi BA-MA minipigs whose carotid arteries were injured by balloon denudation and in the patients with catotid stent assisted angioplasty. Methods Twelve Guangxi BA-MA minipigs were choosen. High fat/cholesterol feeding and endovascular balloon denudation were used to create a carotid artery atherosclerotic stenosis animal model. Blood samples were collected from peripheral veins before starting the procedure, and again, at 2 and 3 weeks after the procedure, respectively. Serum NO and ET concentrations of blood samples were tested. Nineteen patients with carotid artery stenosis who underwent stent assisted angioplasty were randomly selected, and their serum NO and ET were tested using the same methods as above. Results In the animal group, there was a significant decrease of mean NO concentration at 2 weeks after carotid injury (t-test, P<0.05 ), however, no significant change of ET was observed. A very significant increase of ET was observed at 3 weeks after the procedure (t-test, P <0.01 ). In the patient group, there were no significant differences among serum NO or ET concentration of peripheral vein blood before, immediately after, and 6 h after the endovascular treatment. Conclusions In this study, a decrease of NO concentration and an increase of ET concentration of peripheral vein blood are found in BA-MA minipigs after carotid arteries are injured by balloon denudation, which might be a cue for the formation of atherosclerosis. However, no significant changes are observed in this group of patients who underwet carotid angioplasty treatment. Therefore, further studies are needed.%目的:观察小型猪颈动脉球囊扩张前后和颈动脉狭窄患者狭窄扩张、支架置入术前后血清一氧化氮(NO)和内皮素(ET)的变化.方法:选取12头广西巴马小型猪,分别于颈动脉球囊损伤前、损伤后2周和3周检测静脉血血清中NO

  1. Tolerance of the carotid-sheath contents to brachytherapy: an experimental study

    Energy Technology Data Exchange (ETDEWEB)

    Werber, J.L.; Sood, B.; Alfieri, A.; McCormick, S.A.; Vikram, B. (Department of Otolaryngology--Head and Neck Surgery, New York Medical College, Beth Israel (USA))

    1991-06-01

    Tumor invasion of the carotid artery is a potential indication for brachytherapy, which delivers a high dose of irradiation to residual tumor while limiting the dose to adjacent healthy tissues. The tolerance of carotid-sheath contents to varying doses of brachytherapy, however, has not been clearly established. In order to evaluate brachytherapy effects on carotid-sheath contents, after-loading catheters were implanted bilaterally in 3 groups of 6 rabbits each (18 rabbits). Iridium 192 brachytherapy doses of either 5000 cGy (rad), 9000 cGy, or 13,000 cGy were delivered unilaterally, with the contralateral neck serving as a nonirradiated control in each animal. There were no carotid ruptures and wound healing was normal. Two animals from each group were killed at 6, 20, and 48 weeks. Even at the highest dose (13,000 cGy), nerve conduction studies performed on the vagus nerve prior to sacrifice revealed no increased latency, histologic changes were minimal, and carotid arteries were patent. These observations suggest that the carotid-sheath contents in healthy rabbits could tolerate high doses (up to 13,000 cGy) of low-dose-rate interstitial brachytherapy without complications.

  2. Tolerance of the carotid-sheath contents to brachytherapy: an experimental study

    International Nuclear Information System (INIS)

    Tumor invasion of the carotid artery is a potential indication for brachytherapy, which delivers a high dose of irradiation to residual tumor while limiting the dose to adjacent healthy tissues. The tolerance of carotid-sheath contents to varying doses of brachytherapy, however, has not been clearly established. In order to evaluate brachytherapy effects on carotid-sheath contents, after-loading catheters were implanted bilaterally in 3 groups of 6 rabbits each (18 rabbits). Iridium 192 brachytherapy doses of either 5000 cGy (rad), 9000 cGy, or 13,000 cGy were delivered unilaterally, with the contralateral neck serving as a nonirradiated control in each animal. There were no carotid ruptures and wound healing was normal. Two animals from each group were killed at 6, 20, and 48 weeks. Even at the highest dose (13,000 cGy), nerve conduction studies performed on the vagus nerve prior to sacrifice revealed no increased latency, histologic changes were minimal, and carotid arteries were patent. These observations suggest that the carotid-sheath contents in healthy rabbits could tolerate high doses (up to 13,000 cGy) of low-dose-rate interstitial brachytherapy without complications

  3. Does the principle of minimum work apply at the carotid bifurcation: a retrospective cohort study

    International Nuclear Information System (INIS)

    There is recent interest in the role of carotid bifurcation anatomy, geometry and hemodynamic factors in the pathogenesis of carotid artery atherosclerosis. Certain anatomical and geometric configurations at the carotid bifurcation have been linked to disturbed flow. It has been proposed that vascular dimensions are selected to minimize energy required to maintain blood flow, and that this occurs when an exponent of 3 relates the radii of parent and daughter arteries. We evaluate whether the dimensions of bifurcation of the extracranial carotid artery follow this principle of minimum work. This study involved subjects who had computed tomographic angiography (CTA) at our institution between 2006 and 2007. Radii of the common, internal and external carotid arteries were determined. The exponent was determined for individual bifurcations using numerical methods and for the sample using nonlinear regression. Mean age for 45 participants was 56.9 ± 16.5 years with 26 males. Prevalence of vascular risk factors was: hypertension-48%, smoking-23%, diabetes-16.7%, hyperlipidemia-51%, ischemic heart disease-18.7%. The value of the exponent ranged from 1.3 to 1.6, depending on estimation methodology. The principle of minimum work (defined by an exponent of 3) may not apply at the carotid bifurcation. Additional factors may play a role in the relationship between the radii of the parent and daughter vessels

  4. Using Flat-Panel Perfusion Imaging to Measure Cerebral Hemodynamics: A Pilot Feasibility Study in Patients With Carotid Stenosis.

    Science.gov (United States)

    Lin, Chung-Jung; Guo, Wan-Yuo; Chang, Feng-Chi; Hung, Sheng-Che; Chen, Ko-Kung; Yu, Deuerling-Zheng; Wu, Chun-Hsien Frank; Liou, Jy-Kang Adrian

    2016-05-01

    Flat-detector CT perfusion (FD-CTP) imaging has demonstrated efficacy in qualitatively accessing the penumbra in acute stroke equivalent to that of magnetic resonance perfusion (MRP). The aim of our study was to evaluate the feasibility of quantifying oligemia in the brain in patients with carotid stenosis.Ten patients with unilateral carotid stenosis of >70% were included. All MRPs and FD-CTPs were performed before stenting. Region-of-interests (ROIs) including middle cerebral artery territory at basal ganglia level on both stenotic and contralateral sides were used for quantitative analysis. Relative time to peak (rTTP) was defined as TTP of the stenotic side divided by TTP of the contralateral side, and so as relative cerebral blood volume (rCBV), relative mean transit time (rMTT), and relative cerebral blood flow (rCBF). Absolute and relative TTP, CBV, MTT, CBF between two modalities were compared.For absolute quantitative analysis, the correlation of TTP was highest (r = 0.56), followed by CBV (r = 0.47), MTT (r = 0.47), and CBF (r = 0.43); for relative quantitative analysis, rCBF was the highest (r = 0.79), followed by rTTP (r = 0.75) and rCBV (r = 0.50).We confirmed that relative quantitative assessment of FD-CTP is feasible in chronic ischemic disease. Absolute quantitative measurements between MRP and FD-CTP only expressed moderate correlations. Optimization of acquisitions and algorithms is warranted to achieve better quantification. PMID:27196456

  5. Invasive treatment for carotid fibromuscular dysplasia

    OpenAIRE

    Tekieli, Łukasz M.; Maciejewski, Damian R.; Dzierwa, Karolina; Kabłak-Ziembicka, Anna; Michalski, Michał; Wójcik-Pędziwiatr, Magdalena; Brzychczy, Andrzej; Moczulski, Zbigniew; Żmudka, Krzysztof; Pieniążek, Piotr

    2015-01-01

    Introduction Fibromuscular dysplasia (FMD) is an infrequent non-inflamatory disease of unknown etiology that affects mainly medium-size arteries. The prevalence of FMD among patients scheduled for endovascular treatment of carotid artery stenosis is unknown. Aim To evaluate the prevalence and treatment options of carotid FMD in patients scheduled for carotid artery stenting (CAS). Material and methods Between Jan 2001 and Dec 2013, 2012 CAS procedures were performed in 1809 patients (66.1% me...

  6. In Vivo Study of Polyurethane-Coated Gianturco-Rosch Biliary Z-Stents

    International Nuclear Information System (INIS)

    Purpose: Prototypes of Gianturco-Rosch Z-stents coated with polycarbonate urethane (PCU) were placed in the biliary tree of pigs, in order to test their biomechanical behavior, stability, and biocompatibility. Methods: The stents were surgically implanted in the common bile duct of three pairs of pigs, which were killed after 1, 3, and 6 months respectively. Explanted livers from pigs of the same race, age, and size were used to provide comparative data. The bile ducts were radiologically and histopathologically examined; the stents were processed and examined by scanning electron microscopy. Results: No complications occurred and the animals showed a normal weight gain. The main bile duct appeared radiologically and macroscopically dilated, but the stents proved to be in place. Histologically, the bile duct epithelium was destroyed, but neither hyperplastic nor inflammatory fibrotic reactions of the wall were evident. Both the metallic structure and the polymeric coating of the stents were intact. A layer of organic material with a maximum thickness of approximately 3 μm was evident on the inner surface of the stents. Conclusion: The present in vivo study demonstrates the biocompatibility, efficacy, and stability of PCU-coated Gianturco-Rosch stents in the biliary environment

  7. Multilink stent promotes less platelet and leukocyte adhesion than a traditional stainless steel stent : An in vitro experimental study

    NARCIS (Netherlands)

    Amoroso, G; van Boven, AJ; Volkers, C; Crijns, HJGM; van Oeveren, W

    2001-01-01

    Background: Platelet and Leukocyte deposition onto metallic struts can be a crucial factor in the outcome of a coronary stenting procedure. By means of an in vitro, closed-loop circulation model, me aimed to assess blood-stent interaction patterns for a new stainless steel stent (MultiLink, Guidant

  8. Modelling Simple Experimental Platform for In Vitro Study of Drug Elution from Drug Eluting Stents (DES)

    Science.gov (United States)

    Kalachev, L. V.

    2016-06-01

    We present a simple model of experimental setup for in vitro study of drug release from drug eluting stents and drug propagation in artificial tissue samples representing blood vessels. The model is further reduced using the assumption on vastly different characteristic diffusion times in the stent coating and in the artificial tissue. The model is used to derive a relationship between the times at which the measurements have to be taken for two experimental platforms, with corresponding artificial tissue samples made of different materials with different drug diffusion coefficients, to properly compare the drug release characteristics of drug eluting stents.

  9. Associations between bicycling and carotid arterial stiffness in adolescents: The European Youth Hearts Study.

    Science.gov (United States)

    Ried-Larsen, M; Grøntved, A; Østergaard, L; Cooper, A R; Froberg, K; Andersen, L B; Møller, N C

    2015-10-01

    The aim of the study was to investigate the associations between bicycling and carotid arterial stiffness, independent of objectively measured moderate-and-vigorous physical activity. This cross-sectional study included 375 adolescents (age 15.7 ± 0.4 years) from the Danish site of the European Youth Heart Study. Total frequency of bicycle usage was assessed by self-report, and carotid arterial stiffness was assessed using B-mode ultrasound. After adjusting for pubertal status, body height, and objectively measured physical activity and other personal lifestyle and demographic factors, boys using their bicycle every day of the week displayed a higher carotid arterial compliance {standard beta 0.47 [95% confidence interval (CI) 0.07-0.87]} and distension [standard beta 0.38 (95% CI -0.04 to 0.81)]. Boys using their bicycle every day of the week furthermore displayed a lower Young's elastic modulus [standard beta -0.48 (95% CI -0.91 to -0.06)]. Similar trends were observed when investigating the association between commuter bicycling and carotid arterial stiffness. These associations were not observed in girls. Our observations suggest that increasing bicycling in adolescence may be beneficial to carotid arterial health among boys. PMID:25156494

  10. Ketoprofen-eluting biodegradable ureteral stents by CO2 impregnation: In vitro study.

    Science.gov (United States)

    Barros, Alexandre A; Oliveira, Carlos; Reis, Rui L; Lima, Estevão; Duarte, Ana Rita C

    2015-11-30

    Ureteral stents are indispensable tools in urologic practice. The main complications associated with ureteral stents are dislocation, infection, pain and encrustation. Biodegradable ureteral stents are one of the most attractive designs with the potential to eliminate several complications associated with the stenting procedure. In this work we hypothesize the impregnation of ketoprofen, by CO2-impregnation in a patented biodegradable ureteral stent previously developed in our group. The biodegradable ureteral stents with each formulation: alginate-based, gellan gum-based were impregnated with ketoprofen and the impregnation conditions tested were 100 bar, 2 h and three different temperatures (35 °C, 40 °C and 50 °C). The impregnation was confirmed by FTIR and DSC demonstrated the amorphization of the drug upon impregnation. The in vitro elution profile in artificial urine solution (AUS) during degradation of a biodegradable ureteral stent loaded with ketoprofen was evaluated. According to the kinetics results these systems have shown to be very promising for the release ketoprofen in the first 72 h, which is the necessary time for anti-inflammatory delivery after the surgical procedure. The in vitro release studied revealed an influence of the temperature on the impregnation yield, with a higher impregnation yield at 40 °C. Higher yields were also obtained for gellan gum-based stents. The non-cytotoxicity characteristic of the developed ketoprofen-eluting biodegradable ureteral stents was evaluated in L929 cell line by MTS assay which demonstrated the feasibility of this product as a medical device. PMID:26392243

  11. Serum ferritin levels are associated with carotid atherosclerosis in Chinese postmenopausal women: the Shanghai Changfeng Study.

    Science.gov (United States)

    Ma, Hui; Lin, Huandong; Hu, Yu; Li, Xiaoming; He, Wanyuan; Jin, Xuejuan; Gao, Jian; Zhao, Naiqing; Song, Binbin; Pan, Boshen; Gao, Xin

    2015-10-14

    Postmenopausal women are at increased risk of CVD: the increased serum ferritin level may be involved in the pathogenesis. The aim of the present study is to investigate the relationship of ferritin and carotid atherosclerosis in postmenopausal women. A total of 1178 postmenopausal women (mean age, 60·8 years) were enrolled from the Changfeng Study. A standard interview, anthropometric measurements and laboratory analyses were performed for each participant. Bilateral CIMT (carotid intima-media thickness) were measured using ultrasonography, and the presence of carotid plaques was assessed. Serum ferritin was measured using electrochemiluminescence immunoassay. The results showed that serum ferritin was 181·9 (sd 65·8) ng/ml in the postmenopausal women. Multivariate, linear, stepwise regression analysis demonstrated that age (standardised β = 0·233, PCVD risk factors, Hb, leucocytes, log urine albumin:creatinine ratio and liver function, the ferritin level of postmenopausal women in the fourth quartile had a 1·587-fold increased risk of carotid plaques relative to those in the lowest quartile. In conclusion, these results suggest that serum ferritin is independently and positively associated with carotid atherosclerosis in postmenopausal women and that ferritin may be implicated in atherosclerosis. PMID:26395322

  12. Feasibility studies of Bragg probe for noninvasive carotid pulse waveform assessment

    Science.gov (United States)

    Leitão, Cátia; Bilro, Lúcia; Alberto, Nélia; Antunes, Paulo; Lima, Hugo; André, Paulo S.; Nogueira, Rogério; Pinto, João L.

    2013-01-01

    The arterial stiffness evaluation is largely reported as an independent predictor of cardiovascular diseases. The central pulse waveform can provide important data about arterial health and has been studied in patients with several pathologies, such as diabetes mellitus, coronary artery disease and hypertension. The implementation and feasibility studies of a fiber Bragg grating probe for noninvasive monitoring of the carotid pulse are described based on fiber Bragg grating technology. Assessment tests were carried out in carotids of different volunteers and it was possible to detect the carotid pulse waveform in all subjects. In one of the subjects, the sensor was also tested in terms of repeatability. Although further tests will be required for clinical investigation, the first studies suggest that the developed sensor can be a valid alternative to electromechanical tonometers.

  13. Carotid endarterectomy for atherosclerotic carotid artery stenosis

    International Nuclear Information System (INIS)

    Several randomized controlled trials (RCTs) have demonstrated carotid endarterectomy (CEA) to be more beneficial for the prevention of recurrent or first-ever ischemic stroke than treatment with antiplatelet agents in patients with moderate-severe stenosis of the cervical internal carotid artery. CEA is the standard treatment for such lesions; however, other RCTs have demonstrated carotid artery stenting (CAS) with a protective device to be comparable to CEA in patients with or without radiological or medical high-risks for CEA, although the selection criteria among these treatments have not yet been established in clinical practice. This review compares the results of RCTs valuating the superiority of CEA over medical treatment or CAS, preoperative examination, procedures of CEA, perioperative management and complications, long-term results, and indications for CEA based on the currently available evidence-based publications. A preoperative evaluation of the patients' medical condition, including atherosclerosis, is therefore important to minimize the perioperative complications of CEA, because myocardial infarction during the perioperative period is frequently observed in patients undergoing CEA. A through radiological examination such as plaque imaging is essential for selecting appropriate treatment strategies involving revascularization or medical treatment for atherosclerotic carotid artery stenosis. In addition, the surgical indications, particularly for asymptomatic lesions, should be carefully considered in light of the recent improvements in medical treatments including antihypertensive agents and statins. (author)

  14. In vitro study on the feasibility of magnetic stent hyperthermia for the treatment of cardiovascular restenosis

    OpenAIRE

    LI Li; Wang, Rui; Shi, Huan-Huan; Xie, Le; LI, JING-DING-SHA; KONG, WEI-CHAO; Tang, Jin-Tian; KE, DA-NIAN; ZHAO, LING-YUN

    2013-01-01

    Thermal treatment or hyperthermia has received considerable attention in recent years due to its high efficiency, safety and relatively few side-effects. In this study, we investigated whether it was possible to utilize targeted thermal or instent thermal treatments for the treatment of restenosis following percutaneous transluminal coronary angioplasty (PTCA) through magnetic stent hyperthermia (MSH). A 316L stainless steel stent and rabbit vascular smooth muscle cells (VSMCs) were used in t...

  15. Vergleich aktiv und passiv beschichteter Stents im Hinblick auf Restenoseprophylaxe - eine vergleichende tierexperimentelle Studie

    OpenAIRE

    Reinke, Julia Margaretha

    2011-01-01

    Zusammenfassend kann aus dieser Studie entnommen werden, dass der getestete Ramapycin-Stent (+ Camouflage® Nanocoating) in der Lage ist die Neointimaproliferation und damit die Gefahr der Restenose signifikant zu senken. Weiterhin scheint dieser Stent durch seine antithrombogene Beschichtung in der Lage zu sein die Einheilung in die Gefäßwand zu verbessern, was möglicherweise durch die verbesserte vaskuläre Einheilung zu weniger ...

  16. Prophylactic Pancreatic Stent Placement for Endoscopic Duodenal Ampullectomy: A Single-Center Retrospective Study

    OpenAIRE

    Chang, Woo Ik; Min, Yang Won; Yun, Hwan Sic; Lee, Kwang Hyuck; Lee, Jong Kyun; Lee, Kyu Taek; Rhee, Poong-Lyul

    2013-01-01

    Background/Aims We investigated the efficacy of prophylactic pancreatic stent placement for preventing postprocedure pancreatitis in patients undergoing endoscopic papillectomy. Methods This retrospective study included 82 consecutive patients who underwent endoscopic papillectomy for benign ampullary neoplasm at Samsung Medical Center between August 2002 and June 2011. The patients were subdivided into two groups, namely, those who received prophylactic pancreatic stent placement and those w...

  17. A comprehensive study of stent visualization enhancement in X-ray images by image processing means

    OpenAIRE

    Bismuth, Vincent; Vaillant, Régis; Funck, François; Guillard, Niels; Najman, Laurent

    2011-01-01

    In this work we propose a comprehensive study of Digital Stent Enhancement (DSE), from the analysis of requirements to the validation of the proposed solution. First, we derive the stent visualization requirements in the context of the clinical application and workflow. Then, we propose a DSE algorithm combining automatic detection, tracking, registration and contrast enhancement. The most original parts of our solution: landmark segmentation and non-linear image registration are detailed. Fi...

  18. Noninvasive carotid plaque characterization by black blood MRI

    International Nuclear Information System (INIS)

    Management of atherosclerotic carotid arteries requires both plaque characterization and determination of the degree of stenosis, especially when carotid stenting (GAS) is being considered for severe carotid stenosis. Recent studies have demonstrated that high-resolution MRI can identify plaque components, such as the lipid-rich necrotic core, intraplaque hemorrhage, fibrous tissue, and the calcification present in human carotid atherosclerosis. The purpose of this study was to assess the feasibility of black blood MRI (BB-MRI) for accurately identifying the plaque components in vivo. Twenty-six consecutive patients scheduled for carotid endarterectomy (CEA) underwent a BB-MRI examination within 2 weeks before the surgical procedure using a 1.5-T Philips scanner with a protocol that generated 2 contrast weightings (T1 and T2). The MR images were acquired using cardiac gating to minimize motion artifact and fat suppression to reduce MR signals from subcutaneous fatty tissue. The plaque evaluations obtained by BB-MRI were compared with the intra-operative video recordings, the excised specimens, and the histological sections. With BB-MRI, the combination of the signal intensities in the T1- and T2- weighted images for each component (lipid deposits, intra-plaque hemorrhage, fibrous plaque, and calcification) showed findings that corresponded with the excised specimens. Complex morphological features could also be assessed by BB-MRI. BB-MRI is a useful method for noninvasively imaging and characterizing atherosclerotic carotid arteries. This MRI technique can provide valuable information that can be used to decide whether to perform a CEA or a GAS in patients with severe carotid stenosis. Furthermore, BB-MRI appears to be a useful tool for the investigation of the pathogenesis and natural history of carotid atherosclerosis. (author)

  19. Carotid plaque is a new risk factor for peripheral vestibular disorder: a retrospective cohort study

    Science.gov (United States)

    Wada, Masaoki; Takeshima, Taro; Nakamura, Yosikazu; Nagasaka, Shoichiro; Kamesaki, Toyomi; Kajii, Eiji

    2016-01-01

    Abstract Many chronic diseases are associated with dizziness or vertigo, as is peripheral vestibular disorder (PVD). Although carotid plaque development is linked to atherosclerosis, it is unclear whether such plaques can lead to the development of PVD. We therefore conducted this study to investigate the presence of an association between carotid plaque and new PVD events. In this retrospective study, we consecutively enrolled 393 patients ≥20 years old who had been treated for chronic diseases such as hypertension, dyslipidemia, and diabetes mellitus for ≥6 months at a primary care clinic (Oki Clinic, Japan) between November 2011 and March 2013. Carotid plaque presence was measured with high-resolution ultrasonography for all patients. During a 1-year follow-up period, an otorhinolaryngologist diagnosed and reported any new PVD events (the main end point). Hazard ratios (HRs) and 95% confidence intervals (CIs) for new PVD occurrence were estimated using the Cox proportional hazard regression model. The mean age of the participants was 65.5 years; 33.8% were men, and 12.7%, 82.4%, and 93.1% had diabetes mellitus, hypertension, and dyslipidemia, respectively. There were 76 new PVD events; patients with carotid plaque had a greater risk of such events (crude HR: 3.25; 95% CI: 1.62–6.52) compared to those without carotid plaque. This risk was even higher after adjusting for traditional risk factors for atherosclerosis (adjusted HR: 4.41; 95% CI: 1.75–11.14). Carotid plaques are associated with an increased risk of new PVD events. PMID:27495105

  20. Carotid plaque is a new risk factor for peripheral vestibular disorder: a retrospective cohort study.

    Science.gov (United States)

    Wada, Masaoki; Takeshima, Taro; Nakamura, Yosikazu; Nagasaka, Shoichiro; Kamesaki, Toyomi; Kajii, Eiji

    2016-08-01

    Many chronic diseases are associated with dizziness or vertigo, as is peripheral vestibular disorder (PVD). Although carotid plaque development is linked to atherosclerosis, it is unclear whether such plaques can lead to the development of PVD. We therefore conducted this study to investigate the presence of an association between carotid plaque and new PVD events.In this retrospective study, we consecutively enrolled 393 patients ≥20 years old who had been treated for chronic diseases such as hypertension, dyslipidemia, and diabetes mellitus for ≥6 months at a primary care clinic (Oki Clinic, Japan) between November 2011 and March 2013. Carotid plaque presence was measured with high-resolution ultrasonography for all patients. During a 1-year follow-up period, an otorhinolaryngologist diagnosed and reported any new PVD events (the main end point). Hazard ratios (HRs) and 95% confidence intervals (CIs) for new PVD occurrence were estimated using the Cox proportional hazard regression model.The mean age of the participants was 65.5 years; 33.8% were men, and 12.7%, 82.4%, and 93.1% had diabetes mellitus, hypertension, and dyslipidemia, respectively. There were 76 new PVD events; patients with carotid plaque had a greater risk of such events (crude HR: 3.25; 95% CI: 1.62-6.52) compared to those without carotid plaque. This risk was even higher after adjusting for traditional risk factors for atherosclerosis (adjusted HR: 4.41; 95% CI: 1.75-11.14).Carotid plaques are associated with an increased risk of new PVD events. PMID:27495105

  1. Cerebral haemodynamic and metabolic changes in carotid artery occlusion: a PET study

    International Nuclear Information System (INIS)

    Using the positron emission tomography, with the O15 inhalation technique, the cerebral blood flow (CBF), the oxygen extraction fraction (OEF) and the cerebral metabolic rate of oxygen (CMRO2) were studied in 37 patients with internal carotid artery (ICA) occlusion. In the territory of the occluded ICA, two pattern of focal anomaly have been observed: a CBF decrease with a ''compensatory'' OEF increase or a matched CBF and CMRO2 decrease. On the other hand, as compared to age matched control values, CMRO2 is significantly decreased in the territory of the occluded carotid only in patients with extensive neck vessels obstructive disease

  2. Brachytherapy and percutaneous stenting in the treatment of cholangiocarcinoma: A prospective randomised study

    International Nuclear Information System (INIS)

    Purpose: To evaluate the effect of radiation therapy including intraluminal brachyterapy with iridium-192 on survival of patients with malignant biliary strictures (cholangiocarcinoma, histologically improved) treated with metallic stent in a prospective randomised study. Method and materials: In the prospective randomised study, 21 patients with cholangiocarcinoma were treated with implantation of percutaneous stents followed with intraluminal Ir-192 brachytherapy (mean dose 30 Gy) and external radiotherapy (mean dose 50 Gy) and 21 patients were treated only with stents insertion. We did not find any statistically significant differences in age and tumor localization between these two groups of patients. Results: All the patients died. In the group of patients treated with brachytherapy and with stent implantation, the mean survival time was 387.9 days. In the group of patients treated only with stent insertion the mean survival was 298 days. In effort to eliminate possible effect of external radiotherapy we treated the control group of eight patients with cholangiocarcinoma by stent insertion and brachyterapy only. Conclusion: Our results show that combined radiation therapy could extend the survival in the patients with cholangiocarcinoma obstruction

  3. Clinicians' contributions to the development of coronary artery stents: a qualitative study of transformative device innovation.

    Directory of Open Access Journals (Sweden)

    Aaron S Kesselheim

    Full Text Available BACKGROUND: Medical device innovation remains poorly understood, and policymakers disagree over how to incentivize early development. We sought to elucidate the components of transformative health care innovation by conducting an in-depth case study of development of a key medical device: coronary artery stents. METHODS AND FINDINGS: We conducted semi-structured interviews with the innovators whose work contributed to the development of coronary artery stents who we identified based on a review of the regulatory, patent, and medical literature. Semi-structured interviews with each participant covered the interviewee's personal involvement in coronary artery stent development, the roles of institutions and other individuals in the development process, the interplay of funding and intellectual property in the interviewee's contribution, and finally reflections on lessons arising from the experience. Transcripts were analyzed using standard coding techniques and the constant comparative method of qualitative data analysis. CONCLUSIONS: We found that the first coronary artery stents emerged from three teams: Julio Palmaz and Richard Schatz, Cesare Gianturco and Gary Roubin, and Ulrich Sigwart. First, these individual physician-inventors saw the need for coronary artery stents in their clinical practice. In response, they developed prototypes with the support of academic medical centers leading to early validation studies. Larger companies entered afterwards with engineering support. Patents became paramount once the technology diffused. The case of coronary stents suggests that innovation policy should focus on supporting early physician-inventors at academic centers.

  4. Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study

    DEFF Research Database (Denmark)

    Erglis, Andrejs; Kumsars, Indulis; Niemelä, Matti;

    2009-01-01

    BACKGROUND: In a number of coronary bifurcation lesions, both the main vessel and the side branch need stent coverage. Using sirolimus eluting stents, we compared 2 dedicated bifurcation stent techniques, the crush and the culotte techniques in a randomized trial with separate clinical and...... angiographic end-points. METHODS AND RESULTS: A total of 424 patients with a bifurcation lesion were randomized to crush (n=209) and culotte (n=215) stenting. The primary end point was major adverse cardiac events; cardiac death, myocardial infarction, target vessel revascularization, or stent thrombosis after...... 6 months. At 6 months there were no significant differences in major adverse cardiac event rates between the groups; crush 4.3%, culotte 3.7% (P=0.87). Procedure and fluoroscopy times and contrast volumes were similar in the 2 groups. The rates of procedure-related increase in biomarkers of...

  5. Sirolimus-eluting cobalt-chromium stents: two-year clinical results from first-in-man study on the Firebird 2TM stent

    Institute of Scientific and Technical Information of China (English)

    Xu Bo; LI Jian-ping; CHEN Ji-lin; HUO Yong; GAO Run-lin; SHEN Wei-feng; ZHANG Qi; YANG Yue-jin; QIAO Shu-bin; ZHANG Rui-yan; ZHANG Jian-sheng; HU Jian; QIN Xue-wen; HONG Tao

    2008-01-01

    Background Drug-eluting stents(DES)have been shown to significantly reduce clinical events and angiographic restenosis in the treatment of coronary artery disease(CAD).This study was conducted to assess the long-term efficacy and safety of the polymer-based sirolimus-eluting cobalt-chromium Firebird 2TM stents in the treatment of patients with CAD.Methods This first-in-man study using the Firebird 2TM stent is a prospective,historically-controlled multicenter clinical study,which enrolled 67 patients with CAD who were treated with the sirolimus-eluting cobalt-chromium stent(Firebird 2TM,Microport Shanghai,Firebird 2 group),compared to another 49 patients treated with a bare cobalt alloy stent(Driver,Medtronic,control group).Continued 2-year clinical follow-up was performed after getting the initial 6-month angiographic and 1-year clinical follow-up.The incidence of major adverse cardiac events(MACE)including cardiac death,reinfarction and target lesion revascularization(TLR)and stent thrombosis were compared between the two groups.Results All patients in the Firebird 2 group(100.0%)and 48 patients in the control group(98.O%)completed the 2-year clinical follow-up.At the 1-year follow-up the use of the Firebird 2 stent was highly effective,resulting in a significant 94% decrease of TLR (26.5%in the control group and 1.5%in the Firebird 2 group,P<0.0001).A significant difference in TLR was maintained at 2-year follow-up,Firebird 2 group 1.5%and the control group 31.3%(P<0.0001).Between 1-and 2-year post-stenting.no more TLR occurred in the Firebird 2 group compared with two cases in the control group (P>0.05).There was a 1.5%incidence of MACE at 1-and 2-year follow-up in the Firebird 2 group,compared with 26.5% and 33.3%in the control group,respectively(all P<0.0001).The cumulative 1-and 2-year MACE free survival rates were 98.5%in the Firebird 2 group vs 73.5%and 66.7% in the control group (log rank P<0.0001).No case of stent thrombosis occurred during 2

  6. Stroke prevention-surgical and interventional approaches to carotid stenosis

    Directory of Open Access Journals (Sweden)

    Kumar Rajamani

    2013-01-01

    Full Text Available Extra cranial carotid artery stenosis is an important cause of stroke, which often needs treatment with carotid revascularization. To prevent stroke recurrence, carotid endarterectomy (CEA has been well-established for several decades for symptomatic high and moderate grade stenosis. Carotid stenting is a less invasive alternative to CEA and several recent trials have compared the efficacy of the 2 procedures in patients with carotid stenosis. Carotid artery stenting has emerged as a potential mode of therapy for high surgical risk patients with symptomatic high-grade stenosis. This review focuses on the current data available that will enable the clinician to decide optimal treatment strategies for patients with carotid stenosis.

  7. Stent Thrombosis is the Primary Cause of ST-Segment Elevation Myocardial Infarction following Coronary Stent Implantation: A Five Year Follow-Up of the SORT OUT II Study

    DEFF Research Database (Denmark)

    Kristensen, S. L.; Galloe, A. M.; Thuesen, L.;

    2014-01-01

    Background: The widespread use of coronary stents has exposed a growing population to the risk of stent thrombosis, but the importance in terms of risk of ST-segment elevation myocardial infarctions (STEMIs) remains unclear. Methods: We studied five years follow-up data for 2,098 all-comer patients...... treated with coronary stents in the randomized SORT OUT II trial (mean age 63.6 yrs. 74.8% men). Patients who following stent implantation were readmitted with STEMI were included and each patient was categorized ranging from definite-to ruled-out stent thrombosis according to the Academic Research...... Consortium definitions. Multivariate logistic regression was performed on selected covariates to assess odds ratios (ORs) for definite stent thrombosis. Results: 85 patients (4.1%), mean age 62.7 years, 77.1% men, were admitted with a total of 96 STEMIs, of whom 60 (62.5%) had definite stent thrombosis...

  8. Serum soluble RAGE levels and carotid atherosclerosis: the Northern Manhattan Study (NOMAS)

    Science.gov (United States)

    Hudson, Barry I; Gardener, Hannah; Liu-Mares, Wen; Dong, Chuanhui; Cheung, Ken; Elkind, Mitchell SV; Wright, Clinton B; Sacco, Ralph L; Rundek, Tatjana

    2016-01-01

    Background Recent cohort studies suggested that serum levels of soluble Receptor for Advanced Glycation End-products (sRAGE) are associated with the risk of cardiovascular disease. We hypothesized that sRAGE levels are associated with subclinical atherosclerosis in a racially and ethnically diverse population. Methods and results 828 stroke-free participants from the Northern Manhattan Study (mean age 71.1±8.7yrs; 64% Hispanic, 19% black, and 17% white) underwent high-resolution carotid B-mode ultrasound to measure carotid plaque (present in 62% of subjects) and intima-media thickness (IMT) (mean Total= 0.96±0.10 mm). Serum sRAGE was measured by ELISA and associations tested between sRAGE with IMT and plaque presence. Soluble RAGE levels were not associated with plaque presence or IMT after adjusting for sociodemographic, vascular risk factors and medication use. Stratification by race-ethnicity did not reveal any associations with carotid IMT or plaque. Conclusion In the present study, sRAGE levels were not associated with carotid atherosclerosis. PMID:25744702

  9. Longitudinal assessment of carotid atherosclerosis after Radiation Therapy using Computed Tomography: A case control Study

    Energy Technology Data Exchange (ETDEWEB)

    Anzidei, Michele [Rome Univ. ' ' La Sapienza' ' (Italy). Dept. of Radiology; Suri, Jasjit S.; Piga, Mario [AtheroPoint TM LLC, Roseville, CA (United States). Monitoring and Diagnostic Div.; Global Biomedical Technologies, Inc., CA (United States). Point of Care Devices; Idaho Univ., Moscow, ID (United States). Electrical Engineering Dept.; Saba, Luca [Azienda Ospedaliero Universitaria (A.O.U.), Cagliari (Italy). Dept. of Radiology; Sanfilippo, Roberto; Montisci, Roberto [Azienda Ospedaliero Universitaria (A.O.U.), Cagliari (Italy). Dept. of Vascular Surgery; Laddeo, Giancarlo [New York Univ. Langone Medical Center, New York, NY (United States). Dept. of Radiology; Argiolas, Giovanni Maria [Azienda Ospedaliera Brotzu, Cagliari (Italy). Dept. of Radiology; Raz, Eytan [Rome Univ. ' ' La Sapienza' ' (Italy). Dept. of Radiology; New York Univ. Langone Medical Center, New York, NY (United States). Dept. of Radiology

    2016-01-15

    To study the carotid artery plaque composition and its volume changes in a group of patients at baseline and 2 years after head and neck radiation therapy treatment (HNXRT). In this retrospective study, 62 patients (41 males; mean age 63 years; range 52-81) who underwent HNXRT and 40 patients (24 males; mean age 65) who underwent surgical resection of neoplasm and did not undergo HNXRT were assessed, with 2-year follow-up. The carotid artery plaque volumes, as well as the volume of the sub-components (fatty-mixed-calcified), were semiautomatically quantified. Mann-Whitney and Wilcoxon tests were used to test the hypothesis. In the HNXRT group, there was a statistically significant increase in the total volume of the carotid artery plaques (from 533 to 746 mm{sup 3}; p = 0.001), in the fatty plaques (103 vs. 202 mm{sup 3}; p = 0.001) and mixed plaque component volume (328 vs. 419 mm{sup 3}; p = 0.034). A statistically significant variation (from 21.8 % to 27.6 %) in the percentage of the fatty tissue was found. of this preliminary study suggest that HNXRT promotes increased carotid artery plaque volume, particularly the fatty plaque component. (orig.)

  10. Acute effects of liver vein occlusion by stent-graft placed in transjugular intrahepatic portosystemic shunt channel: An experimental study

    OpenAIRE

    Keussen, Inger; Bergqvist, Lennart; Rissler, Pehr; Cwikiel, W

    2006-01-01

    The purpose of this study was to evaluate the effects of hepatic vein occlusion by stent-graft used in transjugular intrahepatic portosystemic shunt (TIPS). The experiments were performed in six healthy pigs under general anesthesia. Following percutaneous transhepatic implantation of a port-a-cath in the right hepatic vein, TIPS was created with a stent-graft (Viatorr; W L Gore, Flagstaff, AZ, USA). The outflow from the hepatic vein, blocked by the stent-graft was documented by injection of ...

  11. Influence of high-porosity mesh stent on hemodynamics of intracranial aneu- rysm:A computational study

    Institute of Scientific and Technical Information of China (English)

    邱晓宁; 费智敏; 张珏; 曹兆敏

    2013-01-01

    This paper studies the influence of a High-Porosity Mesh (HPM) stent on the hemodynamic characteristics in the intracra- nial aneurysm based on the Computational Fluid Dynamics (CFD). An idealized basilar tip aneurysm model and a HPM stent model are built. The pulsating blood flow in a cardiac cycle is computationally simulated for non-stented and stented models, to provide a wealth of information of the spatio-temporally varying blood flow field. The influence of the stent placement on the hemodynamic characteristics is analyzed in terms of distributions of velocity, pressure, Wall Shear Stress (WSS) and Energy Loss (EL), which are believed to play an important role in the development and rupture of the aneurysm. The numerical results clearly show that the velo- city, pressure, WSS and EL of the blood flow in the aneurysm are reduced by 30%-40% when the HPM stent is implanted. These computational results may provide valuable hemodynamic information for clinical neurosurgeon.

  12. Morphology characterization and biocompatibility study of PLLA (Poly-L-Llactid-Acid) coating chitosan as stent for coronary heart disease

    Science.gov (United States)

    Widiyanti, Prihartini; Paramadini, Adanti W.; Jabbar, Hajria; Fatimah, Inas; Nisak, Fadila N. K.; Puspitasari, Rahma A.

    2016-03-01

    Cardiovascular disease is a global disease with high urgency. In the severe case of coronary heart disease while a blockage in the coronary arteries reach 75% or more, the patient required stent implantation. Stents are made of metal which has many limitations that can lead to blood clots and stent incompatibility toward the size of the blood vessels. There is a metal stent replacement solution that made from polymer material which is biocompatible. PLLA also has biocompatibility and good mechanical strength. PLLA stent will be coated with chitosan as a candidate for drug-coated stents which is able to work as a drug carrier. The aim of this study is to know the morphology information and biocompability status of PLLA coating chitosan as candidate of heart stent. Morphological results using SEM showed a smooth surface structure which reinforced clinical standard of stent material. Results of cytotoxicity test by MTT Assay method showed that the result of four samples in this experiment living cells is reached 90% which is non toxic and safe to use in the human body. %). The conclusion of this study is PLLA is polymer has potency to be used as stent material.

  13. Endovascular Treatment of Peripheral Artery Disease with Expanded PTFE-Covered Nitinol Stents: Interim Analysis from a Prospective Controlled Study

    International Nuclear Information System (INIS)

    Purpose: Current covered peripheral stent designs have significant drawbacks in terms of stent delivery characteristics and flexibility. The aim of this study was to analyze the technical performance, safety and initial clinical efficacy of expanded polytetrafluoroethylene (PTFE)-covered nitinol stents for arteriosclerotic peripheral artery disease. Methods:Eighty-two patients underwent implantation of PTFE-covered nitinol stents for iliac and/or femoral obstructions. The study was conducted prospectively in seven European centers and one Canadian center. Patients were controlled clinically and by duplex ultrasound follow-up. Data up to discharge were collected in 79 patients. Seventy-four patients have thus far received 1 month follow-up and 32 patients, 6 month follow-up examinations. Results: The average lesion length measured 47 mm for the common and external iliac arteries and 50 mm for the femoral arteries. The mean severity of the stenoses was reduced from 94% to 4% in the iliac arteries and from 98% to 7% in the femoral arteries after stent placement and dilatation. One device deviation (inadvertent stent misplacement) and one puncture-related severe adverse event with formation of a pseudoaneurysm occurred. There were occlusions of the stent in five patients. No infections were noticed. Conclusion: The interim analysis of this trial using PTFE-covered nitinol stents indicates that a strategy using primary implantation of this stent type is technically feasible, has an acceptable safety profile and is effective from a short-term perspective

  14. Detailing radio frequency heating induced by coronary stents: a 7.0 Tesla magnetic resonance study.

    Directory of Open Access Journals (Sweden)

    Davide Santoro

    Full Text Available The sensitivity gain of ultrahigh field Magnetic Resonance (UHF-MR holds the promise to enhance spatial and temporal resolution. Such improvements could be beneficial for cardiovascular MR. However, intracoronary stents used for treatment of coronary artery disease are currently considered to be contra-indications for UHF-MR. The antenna effect induced by a stent together with RF wavelength shortening could increase local radiofrequency (RF power deposition at 7.0 T and bears the potential to induce local heating, which might cause tissue damage. Realizing these constraints, this work examines RF heating effects of stents using electro-magnetic field (EMF simulations and phantoms with properties that mimic myocardium. For this purpose, RF power deposition that exceeds the clinical limits was induced by a dedicated birdcage coil. Fiber optic probes and MR thermometry were applied for temperature monitoring using agarose phantoms containing copper tubes or coronary stents. The results demonstrate an agreement between RF heating induced temperature changes derived from EMF simulations versus MR thermometry. The birdcage coil tailored for RF heating was capable of irradiating power exceeding the specific-absorption rate (SAR limits defined by the IEC guidelines by a factor of three. This setup afforded RF induced temperature changes up to +27 K in a reference phantom. The maximum extra temperature increase, induced by a copper tube or a coronary stent was less than 3 K. The coronary stents examined showed an RF heating behavior similar to a copper tube. Our results suggest that, if IEC guidelines for local/global SAR are followed, the extra RF heating induced in myocardial tissue by stents may not be significant versus the baseline heating induced by the energy deposited by a tailored cardiac transmit RF coil at 7.0 T, and may be smaller if not insignificant than the extra RF heating observed under the circumstances used in this study.

  15. Transluminal radio-frequency thermal ablation using a stent-type electrode: an experimental study

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Sun; Rhim, Hyun Chul [Hanyang University College of Medicine, Seoul (Korea, Republic of); Song, Ho Young [Asan Medical Center, Seoul (Korea, Republic of)] [and others

    2003-06-01

    To assess the feasibility of transluminal radiofrequency thermal ablation using a stent-type electrode and to determine, by means of in-vivo and in-vivo animal studies, the appropriate parameters. In-vivo: the radiofrequency electrode used was a self-expandable nitinol stent with 1cm insulated ends. A stent was placed in the portal vein of bovine liver, and ablations at target temperatures of 70, 80, 90, and 100 .deg. C were performed. Ablated sizes were measured longitudinally. In vivo: four mongrel dogs were anesthetized, and a stent was inserted in the common bile duct under fluoroscopic guidance through an ultrasound-guided gall bladder puncture site. The ablation temperature was set at 80 .deg. C, and each dog underwent proximal and distal esophageal ablations lasting 12 minutes. They were sacrificed immediately. In-vivo: ablated sizes showed significant correlation with target temperatures (r>0.04; p<0.05). Although most lesions were fusiform, dumbbell-shaped lesions with central thinning were found in two cases in the 70 .deg. C group. In all cases in the 70 .deg. C and 80 .deg. C group, the length of the insulated segment was less than 1cm. In-vivo: at microscopy, tissues at the center of the biliary stent showed more prominent pathological change than those at the periphery while those remote from the stent showed minimal or no change. In esophageal ablations, the mean highest temperature was 48.6 .deg. C. Microscopy demonstrated the destruction and shedding of mucosa, edema, and coagulation necrosis of submucosa, but in muscle layers no abnormalities were apparent. Transluminal radio-frequency thermal ablation using a stent-type electrode may be useful for elongating patency. The appropriate target temperature for biliary ablation is 80 .deg. C.

  16. The accuracy of noninvasive imaging techniques in diagnosis of carotid plaque morphology

    International Nuclear Information System (INIS)

    The stroke is leading cause of death and severe disability worldwide. Atherosclerosis is responsible for over 30% of all ischemic strokes. It has been recently discovered that plaque morphology may help predict the clinical behavior of carotid atherosclerosis and determine the risk of stroke. The noninvasive imaging techniques have been developed to evaluate the vascular wall in an attempt to identify 'vulnerable plaques'. The purpose of the study is to investigate the diagnostic accuracy of ultrasound, multidetector computed tomography and magnetic resonance imaging in the identification of plaque components associated with plaque vulnerability. One hundred patients were admitted for carotid endarterectomy for high grade carotid stenosis. We defined the diagnostic value of B-mode ultrasound of carotid plaque in a half, and the accuracy of multidetector computed tomography and magnetic resonance imaging, in the other group, for detection of unstable carotid plaque. The reference standard was histology. Sensitivity of ultrasound, multidetector computed tomography and magnetic resonance imaging is 94%, 83% and 100%, and the specificity is 93%, 73% and 89% for detection of unstable carotid plaque. The ultrasound has high accuracy for diagnostics of carotid plaque morphology, magnetic resonance imaging has high potential for tissue differentiation and multidetector computed tomography determines precisely degree of stenosis and presence of ulceration and calcifications. The three noninvasive imaging modalities are complementary for optimal evaluation of the morphology of carotid plaque. This will help to determine the risk of stroke and to decide on the best treatment - carotid endarterectomy or carotid stenting. (authors) Key words: STROKE. NONINVASiVE IMAGING. VULNERABLE PLAQUE

  17. ENDOSCOPIC DCR A COMPARATIVE STUDY BETWEEN CONVENTIONAL MUCOSAL FLAP, MITOMYCIN C APPLICATION AND SILICONE STENTING

    Directory of Open Access Journals (Sweden)

    Nishtha

    2015-03-01

    Full Text Available BACKGROUND/OBJECTIVES: Recurrent stenosis and closure of neostium is considered a major factor for surgical failure in endoscopic dacryocystorhinostomy (Endo DCR. The main objective of this study is to evaluate the role of mitomycin c and silicone stent in maintaining the patency of the neostium. MATERIALS AND METHODS: Endo DCR were done in 180 patients. Group A included 40 patients where only mucosal flap was created, group B included 40 patients where silicon tube stents were used. Group C 40 included those in whom mitomycin c was applied to the neo ostium. Group D 40 included those in whom stenting along with mitomycin c was used. All the surgeries were done under general anaesthesia. RESULTS: In our study, 90% success in syringing patency was seen in group A, 85% success in syringing patency was seen in group B at 6 months of follow - up. 95% success was seen in group C. 100% success rate was seen in patients with mitomycin c application and stenting. Significant difference in success rate was seen group D. CONCLUSION: Significant difference in EDCR success rates were seen with the use of mitomycin c along with stenting in our study.

  18. Atherosclerotic Calcification Detection: A Comparative Study of Carotid Ultrasound and Cone Beam CT

    Directory of Open Access Journals (Sweden)

    Fisnik Jashari

    2015-08-01

    Full Text Available Background and Aim: Arterial calcification is often detected on ultrasound examination but its diagnostic accuracy is not well validated. The aim of this study was to determine the accuracy of carotid ultrasound B mode findings in detecting atherosclerotic calcification quantified by cone beam computed tomography (CBCT. Methods: We analyzed 94 carotid arteries, from 88 patients (mean age 70 ± 7 years, 33% females, who underwent pre-endarterectomy ultrasound examination. Plaques with high echogenic nodules and posterior shadowing were considered calcified. After surgery, the excised plaques were examined using CBCT, from which the calcification volume (mm3 was calculated. In cases with multiple calcifications the largest calcification nodule volume was used to represent the plaque. Carotid artery calcification by the two imaging techniques was compared using conventional correlations. Results: Carotid ultrasound was highly accurate in detecting the presence of calcification; with a sensitivity of 88.2%. Based on the quartile ranges of calcification volumes measured by CBCT we have divided plaque calcification into four groups: <8; 8–35; 36–70 and >70 mm3. Calcification volumes ≥8 were accurately detectable by ultrasound with a sensitivity of 96%. Of the 21 plaques with <8 mm3 calcification volume; only 13 were detected by ultrasound; resulting in a sensitivity of 62%. There was no difference in the volume of calcification between symptomatic and asymptomatic patients. Conclusion: Carotid ultrasound is highly accurate in detecting the presence of calcified atherosclerotic lesions of volume ≥8 mm3; but less accurate in detecting smaller volume calcified plaques. Further development of ultrasound techniques should allow better detection of early arterial calcification.

  19. Atherosclerotic Calcification Detection: A Comparative Study of Carotid Ultrasound and Cone Beam CT

    Science.gov (United States)

    Jashari, Fisnik; Ibrahimi, Pranvera; Johansson, Elias; Ahlqvist, Jan; Arnerlöv, Conny; Garoff, Maria; Levring Jäghagen, Eva; Wester, Per; Henein, Michael Y.

    2015-01-01

    Background and Aim: Arterial calcification is often detected on ultrasound examination but its diagnostic accuracy is not well validated. The aim of this study was to determine the accuracy of carotid ultrasound B mode findings in detecting atherosclerotic calcification quantified by cone beam computed tomography (CBCT). Methods: We analyzed 94 carotid arteries, from 88 patients (mean age 70 ± 7 years, 33% females), who underwent pre-endarterectomy ultrasound examination. Plaques with high echogenic nodules and posterior shadowing were considered calcified. After surgery, the excised plaques were examined using CBCT, from which the calcification volume (mm3) was calculated. In cases with multiple calcifications the largest calcification nodule volume was used to represent the plaque. Carotid artery calcification by the two imaging techniques was compared using conventional correlations. Results: Carotid ultrasound was highly accurate in detecting the presence of calcification; with a sensitivity of 88.2%. Based on the quartile ranges of calcification volumes measured by CBCT we have divided plaque calcification into four groups: 70 mm3. Calcification volumes ≥8 were accurately detectable by ultrasound with a sensitivity of 96%. Of the 21 plaques with <8 mm3 calcification volume; only 13 were detected by ultrasound; resulting in a sensitivity of 62%. There was no difference in the volume of calcification between symptomatic and asymptomatic patients. Conclusion: Carotid ultrasound is highly accurate in detecting the presence of calcified atherosclerotic lesions of volume ≥8 mm3; but less accurate in detecting smaller volume calcified plaques. Further development of ultrasound techniques should allow better detection of early arterial calcification. PMID:26307978

  20. Surgical treatment of internal carotid artery restenosis following eversion endarterectomy

    Directory of Open Access Journals (Sweden)

    Radak Đorđe

    2012-01-01

    Full Text Available Introduction. Carotid angioplasty and internal carotid artery stenting is the therapeutic method of choice in the treatment of carotid restenosis, but when it is not technically feasible (expressed tortuosity of supraaortic branches, calcifications, presence of pathological elongation of very long lesions a redo surgery is indicated. Objective. The aim of our study was to examine the benefits and risks of redo surgery in patients with symptomatic and asymptomatic significant internal carotid artery restenosis and its impact on early and late morbidity and mortality. Methods. The study included 45 patients who were surgically treated for a hemodynamically significant internal carotid artery restenosis from January 2000 to December 2009. Surgical techniques included redo endarterectomy with direct suture, redo anderectomy with a patch plastic and resection with Dacron tubular graft interposition. The patients were followed for postoperative neurological ischemic events (transient ischemic attack (TIA, stroke, local surgical complications and lethal outcome after one month, six months, one year and after two years. Results. In the early postoperative period (up to 30 days there were no lethal outcomes. TIA was diagnosed in four patients (8.8%, minor stroke in one patient (2.2% and one patient (2.2% also had cranial nerve injury. After two years two patients died (4.4% due to fatal myocardial infarction, three patients (6.5% had ipsilateral stroke and one patient developed graft occlusion (2%. Conclusion. In the case of symptomatic and asymptomatic carotid restenosis that cannot be treated by carotid percutaneous angioplasty, redo surgical treatment is therapeutic option with an acceptable rate of early and late postoperative complications.

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

    LENUS (Irish Health Repository)

    Bonati, Leo H

    2009-10-01

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

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

    International Nuclear Information System (INIS)

    Purpose: This study was designed to investigate a novel device that was developed to direct emboli away from the internal carotid artery to the external carotid artery to prevent embolic stroke while avoiding the necessity for anticoagulation with warfarin. Methods: A stent-like, self-expandable filter was developed consisting of fine cobalt alloy mesh. After promising preclinical animal testing, the device was implanted into the common carotid artery extending into the external carotid artery in three patients with atrial fibrillation, each of whom were at high-risk for cerebral emboli and were suboptimal candidates for anticoagulation. Follow-up was performed clinically and with carotid duplex ultrasound. Results: The implantation was successful in all three patients. Unrestricted flow through the filter was demonstrated in each patient at 6 months by duplex sonography. However, at 7 months ultrasound demonstrated occlusion of the internal carotid artery filter in one patient, which was subsequently confirmed by angiography. Subtotal filter occlusion occurred in a second patient at 14 months. Neither patient had clinical symptoms. Both internal carotid arteries were successfully recanalized using standard angioplasty techniques without complication. The third patient had completely normal carotid blood flow at 29 months follow-up. 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.

  3. Stenting:84 Cases of Clinical Application

    Institute of Scientific and Technical Information of China (English)

    GUANG Yongsong

    2002-01-01

    Objective To evaluate clinical application of therapeutic stenting. Methods 84 cases were managed with stents clinically, 136 procedures of intervention in all. The cases were suffering from portal hypertension of cirrhosis, stricture of inferior vana cava, superior vana cava syndrome, post- operative esophageal stricture, narrowig of femoral, common carotid, renal, superior mesentery arteries and biliary tract, etc. Results Therapeutic stenting achieves clinical effects completely different from conventional intemal medicine and surgery. Conclusion Therapeutic stenting is clinically unique, dramatically effective, with minor risks and worthy promoting.

  4. Study on Relationship Between Intima Medial Thickness and the Plaque in Stroke Patients on Carotid Artery Sonography

    International Nuclear Information System (INIS)

    The carotid intima-media thickness (IMT) is an early structural marker of the atherosclerotic process and is the only non-invasive test that is currently recommended by the American Heart Association for evaluation of the risk. However, use of this parameter has a limitation because it assumes uniform thickness throughout the blood vessel, whereas atherosclerosis is a focal phenomenon that is confined to intima. In fact, plaque can be found along the atherosclerotic blood vessels even though its value is unknown. The aim of this study is to analyze the carotid plaque and IMT in the stroke patients. We investigated the patients with ischemic stroke, who were admitted to the department of neurology at the Stroke Special Hospital from January to March 2008. After the carotid IMT and plaque were assessed by B-mode ultrasonography, IMT and carotid plaque to risk variables (age, sex) were analyzed. The distribution of CCA IMT was significantly different in terms of age (p = 0.004). Likewise, the distribution of carotid plaque was also significantly different in terms of age (p = 0.006). Carotid plaque was 69 and 92% in normal and abnormal CCA IMTs respectively. The results showed that the CCA IMT was closely associated with carotid plaque.

  5. Coil Migration through a Neuroform 3 Stent during Endovascular Coiling. A Case Report.

    LENUS (Irish Health Repository)

    O'Hare, A

    2009-07-29

    Summary: A 43-year-old woman attended for stent assisted coiling. A Neuroform 30 x 4.5 mm stent had been successfully placed over the left periophthalmic aneurysm. During the coiling the first coil migrated through the crowns in the stent, lodging at the MCA bifurcation. We believe that the coil herniated through the overlying stent due to the carotid siphon curvature and the open cell design. Furthermore the distal markers of the stent impeded coil extraction with a MERCI device.

  6. Endoluminal placement of stent-graft for the treatment of peripheral saccular aneurysm

    International Nuclear Information System (INIS)

    To determine the therapeutic effect of stent grafting in the treatment of saccular aneurysms of the peripheral artery. Eight patients (M:F=7:1 ; age:22-72(mean, 47) years) with ten saccular aneurysms of the peripheral artery who underwent stent grafting were included in this study. The etiologies of the aneurysms were Behcet's disease in four patients, atherosclerosis in two, trauma in one and'undcertain' in one; they were located at the common iliac artery in three cases, the renal artery in two, the subclavian artery in two, the anterior tibial artery in one, and at both the proximal and distal anastomotic sites of the common carotid-internal carotid bypass graft. In two cases, stent grafting and coils were used to embolize collateral vessels. Post-procedural evaluations involved the use of computerd tomography, Doppler sonography and magnetic resonance imaging. The mean follow-up period was 14.7 (range, 4-36) monthes. The saccular aneurysms were successfully excluded in all cases. Post-procedural angiography revealed minor leakage in two cases, but at follow-up these showed complete exclusion. Follow-up evaluation also revealed complete resolution in five cases and complete thrombosis accompanied by size reduction in three. In patients with aneurysms of the proximal and distal ends of a common carotid-internal carotid bypass graft, total occlusion occurred in the stent graft. Percutaneous stent-graft insertion is an effective and convenient method for the treatment of peripheral arterial aneurysms, and is an alternative to vascular surgery

  7. Mechanical characteristics of self-expandable metallic stents: in vitro study with three types of stress

    International Nuclear Information System (INIS)

    To obtain objective and comparable data for mechanical characteristics of self-expandable metallic stents widely used in the treatment of biliary obstruction. The stents tested were the 6 and 8 mm-band Hanaro spiral stent, Gianturco-Rosch Z stent, Wallstent, Ultraflex stent, and Memotherm stent. Each was subjected to three types of load:point, area, and circular. We analyzed their mechanical characteristics (resistance force, expansile force, and elasticity) according to these three types of stress. With regard to point loads, the Memotherm stent showed the highest resistance force and expansile force. The 8 mm-band Hanaro stent showed the lowest resistance force and the Gianturco-Rosch Z stent and Ultraflex stent showed lower expansile force. With regard to area loads, the Ultraflex stent showed the highest resistance force. The 6 mm-band Hanaro stent, Gianturco-Rosch Z stent, and Ultraflex stent showed higher expansile force. The 8 mm-band Hanaro stent showed the lowest value in both resistance force and expansile force. For circular loads, the Memotherm stent showed the highest resistance force and the Ultraflex stent and Wallstent showed lower value. Under all types of stress, the Hanaro stent and Memotherm stent were completely elastic, and the Ultraflex stent and Wallstent showed a wide gap between resistance force and expansile force. In clinical practice, awareness of the mechanical characteristics of each stent might help in choosing the one which is most suitable, according to type of biliary obstruction. =20

  8. Increased platelet activation in early symptomatic versus asymptomatic carotid stenosis and relationship with microembolic status: Results from the Platelets And Carotid Stenosis (PACS) Study.

    LENUS (Irish Health Repository)

    Kinsella, Ja

    2013-04-26

    BACKGROUND: Cerebral microembolic signals (MES) may predict increased stroke risk in carotid stenosis. However, the relationship between platelet counts or platelet activation status and MES in symptomatic versus asymptomatic carotid stenosis has not been comprehensively assessed. SETTING: University teaching hospitals. METHODS: This prospective, pilot observational study assessed platelet counts and platelet activation status, and the relationship between platelet activation and MES in asymptomatic versus early (≤4 weeks after TIA\\/stroke) and late phase (≥3 months) symptomatic moderate or severe (≥50%) carotid stenosis patients. Full blood count measurements were performed, and whole blood flow cytometry was used to quantify platelet surface activation marker expression (CD62P and CD63) and circulating leucocyte-platelet complexes. Bilateral simultaneous transcranial Doppler ultrasound monitoring of the middle cerebral arteries was performed for 1 hour to classify patients as MES-positive or MES-negative. RESULTS: Data from 31 asymptomatic patients were compared with 46 symptomatic patients in the early phase, and 35 of these patients followed up to the late phase after symptom onset. The median platelet count (211 vs. 200 x 10(9) \\/L; p=0.03) and the median% lymphocyte-platelet complexes were higher in early symptomatic than asymptomatic patients (2.8 vs. 2.4%, p=0.001). The% lymphocyte-platelet complexes was higher in early symptomatic than asymptomatic patients with ≥70% carotid stenosis (p=0.0005), and in symptomatic patients recruited within 7 days of symptom onset (p=0.028). Complete TCD data were available in 25 asymptomatic and 31 early phase symptomatic, and 27 late phase symptomatic patients. 12% of asymptomatic versus 32% of early phase symptomatic (p=0.02) and 19% of late phase symptomatic patients (p=0.2) were MES-positive. Early symptomatic MES-negative patients had a higher% lymphocyte-platelet complexes than asymptomatic MES

  9. CHILDHOOD FAMILY PSYCHOSOCIAL ENVIRONMENT AND CAROTID INTIMA MEDIA THICKNESS: THE CARDIA STUDY

    OpenAIRE

    Loucks, Eric B.; Taylor, Shelley E.; Polak, Joseph F.; Wilhelm, Aude; Kalra, Preety; Karen A. Matthews

    2013-01-01

    Little is known about whether the childhood family psychosocial environment (characterized by cold, unaffectionate interactions, conflict, aggression, neglect and/or low nurturance) affects coronary heart disease (CHD) risk. Objectives were to evaluate associations of childhood family psychosocial environment with carotid intima media thickness (IMT), a subclinical measure of atherosclerosis. The study population included 2,659 CARDIA study participants, aged 37-52 years. Childhood family psy...

  10. Surgery efficacy assessment at carotid artery stenosis using ultrasound duplex scanning

    International Nuclear Information System (INIS)

    Sixty-two patients aged 43-84 with high-grade carotid stenosis who in 2003-2011 were performed carotid angioplasty and stent grafting (CAS), of them in 5 with carotid endarterectomy, were investigated. According to the protocol, ultrasound investigation was performed one week before the surgery, during week 1 after CAS and 6-8 months later

  11. Influence of a dexamethasone-eluting covered stent on tissue reaction: an experimental study in a canine bronchial model

    International Nuclear Information System (INIS)

    This study was designed to evaluate the feasibility and efficacy of a dexamethasone (DXM)-eluting, covered, self-expanding metallic stent to reduce tissue reaction following stent placement in a canine bronchial model. We placed a DXM-eluting, polyurethane-covered, self-expanding metallic stent (drug stent, DS) and a polyurethane-covered, self-expanding metallic stent (control stent, CS) alternately in each left main bronchus and left lower lobe bronchus in 12 dogs. The stents were 20 mm in diameter and length when fully expanded. The dose of DXM was approximately 36.7 mg in each DS, but was absent in the CS. The dogs were euthanased 1 week (n=4), 2 weeks (n=4) or 4 weeks (n=4) after stent placement. Histologic findings, such as epithelial erosion/ulcer or granulation tissue thickness, were obtained from the mid-portion of the bronchus, where the stent had been placed, and evaluated between DS and CS. There were no procedure-related complications or malpositioning of any of the bronchial stents. Stent migration was detected in one dog just before euthanasia 1 week following stent placement. Stent patency was maintained until euthanasia in all dogs. Epithelial erosion/ulcer (%) was significantly less in the DS (mean±standard deviation, 46.88±23.75) than in the CS (73.75±14.08) (P=0.026) for all time-points. There was a decrease in epithelial erosion/ulcer as the follow-up period increased in both DS and CS. The granulation tissue thickness (mm) was less in DS (2.63±2.05) than in CS (3.49±2.95), although the difference was not significant (P=0.751) for all time-points. There was a tendency toward an increase in granulation tissue thickness and chronic lymphocytic infiltration as the follow-up period increased in both DS and CS. In conclusion, DXM-eluting, covered, self-expanding metallic stent seems to be effective in reducing tissue reaction secondary to stent placement in a canine bronchial model. (orig.)

  12. Influence of a dexamethasone-eluting covered stent on tissue reaction: an experimental study in a canine bronchial model

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ji Hoon; Song, Ho-Young; Choi, Gi Bok; Kim, Tae-Hyung; Suh, Ji-Yeon [University of Ulsan College of Medicine, Department of Radiology, Asan Medical Center, Seoul (Korea); Seo, Tae-Seok [Gachon Medical School, Department of Radiology, Gil Medical Center, Inchon (Korea); Yuk, Soon Hong [Hannam University, Department of Polymer Science and Engineering, College of Engineering, Daejeon (Korea); Kim, Young-Hwa [Soonchunhyang University Chonan Hospital, Department of Radiology, Chonan (Korea); Cho, Yong-Mee [University of Ulsan College of Medicine, Department of Pathology, Asan Medical Center, Seoul (Korea)

    2005-06-01

    This study was designed to evaluate the feasibility and efficacy of a dexamethasone (DXM)-eluting, covered, self-expanding metallic stent to reduce tissue reaction following stent placement in a canine bronchial model. We placed a DXM-eluting, polyurethane-covered, self-expanding metallic stent (drug stent, DS) and a polyurethane-covered, self-expanding metallic stent (control stent, CS) alternately in each left main bronchus and left lower lobe bronchus in 12 dogs. The stents were 20 mm in diameter and length when fully expanded. The dose of DXM was approximately 36.7 mg in each DS, but was absent in the CS. The dogs were euthanased 1 week (n=4), 2 weeks (n=4) or 4 weeks (n=4) after stent placement. Histologic findings, such as epithelial erosion/ulcer or granulation tissue thickness, were obtained from the mid-portion of the bronchus, where the stent had been placed, and evaluated between DS and CS. There were no procedure-related complications or malpositioning of any of the bronchial stents. Stent migration was detected in one dog just before euthanasia 1 week following stent placement. Stent patency was maintained until euthanasia in all dogs. Epithelial erosion/ulcer (%) was significantly less in the DS (mean{+-}standard deviation, 46.88{+-}23.75) than in the CS (73.75{+-}14.08) (P=0.026) for all time-points. There was a decrease in epithelial erosion/ulcer as the follow-up period increased in both DS and CS. The granulation tissue thickness (mm) was less in DS (2.63{+-}2.05) than in CS (3.49{+-}2.95), although the difference was not significant (P=0.751) for all time-points. There was a tendency toward an increase in granulation tissue thickness and chronic lymphocytic infiltration as the follow-up period increased in both DS and CS. In conclusion, DXM-eluting, covered, self-expanding metallic stent seems to be effective in reducing tissue reaction secondary to stent placement in a canine bronchial model. (orig.)

  13. Relationship of Carotid Distensibility and Thoracic Aorta Calcification: Multi-Ethnic Study of Atherosclerosis (MESA)

    OpenAIRE

    Blaha, Michael J.; Budoff, Matthew J.; Rivera, Juan J.; Katz, Ronit; O'Leary, Daniel H.; Polak, Joseph F.; Takasu, Junichiro; Blumenthal, Roger S.; Nasir, Khurram

    2009-01-01

    Stiffening of the central elastic arteries is one of the earliest detectable manifestations of adverse change within the vessel wall. While an association between carotid artery stiffness and adverse events has been demonstrated, little is known about the relationship between stiffness and atherosclerosis. Even less is known about the impact of age, gender, and race on this association. To elucidate this question, we used baseline data from the Multi-Ethnic Study of Atherosclerosis (MESA, 200...

  14. Transient Ischemic Attack in the Setting of Carotid Atheromatous Disease with a Persistent Primitive Hypoglossal Artery Successfully Treated with Stenting: A Case Report.

    Science.gov (United States)

    Huang, Meng; Moisi, Marc; Zwillman, Michael E; Volpi, John J; Diaz, Orlando; Klucznik, Richard

    2016-01-01

    Fetal brain perfusion is supplied by the primitive dorsal aorta anteriorly, longitudinal neural arteries posteriorly, and anastomotic transverse segmentals. Most notable of these connections are the primitive trigeminal, otic, hypoglossal, and proatlantal arteries. With cranial-cervical circulatory maturation and development of the posterior communicating segments and vertebro-basilar system, these primitive segmental anastomoses normally regress. Anomalous neurovascular development can result in persistence of these anastomoses. Due to its territory of perfusion, the persistent primitive hypoglossal artery (PPHA) is associated with vertebral artery and posterior communicating artery hypoplasia or aplasia. As a consequence, primary blood supply to the hindbrain comes chiefly from this single artery. Although usually clinically silent, PPHA is susceptible to common cerebrovascular disorders including athero-ischemic disease and saccular aneurysmal dilation to name a few. We present a case of transient ischemic attack in a patient with a PPHA and proximal atherosclerotic disease treated by endovascular stenting. PMID:26929891

  15. Current recommendations for the study of carotid stenosis by doppler ultrasound and other imaging techniques

    International Nuclear Information System (INIS)

    Ischemic cerebrovascular disease has been one of the most frequent causes of death from chronic disease, as well as cause of long-term disabilities, in both the United States, and in Latin American countries during recent years. It is therefore, important to know about it. An updated review of international recommendations to the Costa Rican health system is performed for carotid imaging study in patients at risk of accidents and ischemic cerebrovascular disease; with special emphasis on carotid Doppler ultrasonography, due to its wide availability in the medical field Costa Rican. Furthermore, certain relevant concepts of other imaging techniques currently available are listed to determine the appropriate choice of each method according to the individual patient's condition, such as conventional angiography and tomographic angiography

  16. Covered stent implantation for the treatment of intracranial arterial disorders

    International Nuclear Information System (INIS)

    The coronary covered s tents have been more and more used to treat intracranial arterial diseases for recent years, and the hot point in study has gradually changed from clinical application of coronary covered stents to the fundamental and clinical trial of specially-designed intracranial covered stents. The covered stents are mainly employed for the treatment of intracranial arterial disorders, including giant, wide-necked or minute cerebral aneurysms, intracranial pseudoaneurysms caused by a variety of reasons, fusiform or dissecting aneurysms of vertebral-basic artery, and internal carotid cavernous fistula, etc. It is very difficult for current surgical or endovascular treatment, both materially and technically, to deal with the above mentioned intracranial disorders. The covered stent can restore the anatomic shape of artery by direct sealing the aneurysmal neck and the fistula. The complications of covered stent treatment include defect of cranial nerves, occlusion of parent artery or branches. This article aims to review the related medical literature published both at home and abroad, to make a retrospective analysis of the therapeutic results, and to put forward some issues of common interest. (authors)

  17. Animal experimental studies on the influence of flow restriction on thrombogenicity of the Palmaz stent via 111indium marked thrombocytes

    International Nuclear Information System (INIS)

    The purpose of this experimental study in dogs is to evaluate the influence of restricted flow on the thrombogenicity of balloon-expandable intravascular stents (Palmaz type). We implanted 24 Palmaz stents in the femoral artery of mongrel dogs. 12 dogs experienced a 75% flow restriction by means of an artificial stenosis distal to the start in the outflow tract. We used 111In labelled thrombocytes as a marker for thrombus detection within the stent. The results presented demonstrate that there is no considerable risk of thrombus formation if the stent is implanted into vessels with good outflow tracts and therefore high blood flow velocities within the stent. Under conditions of highly impaired flow, a 68% rate of stent occlusion occur if no anticoagulation therapy is performed. After i.v. administration of 100 IU/kg body weight of heparin the occlusion rade drops to zero. It can be concluded that even under low-flow conditions as a result of a restricted outflow tract situation the Palmaz stent can be implanted without any risk of stent occlusion as long a sufficient anticoagulation protocol is maintained. (orig.)

  18. High-Resolution CT and Angiographic Evaluation of NexStent Wall Adaptation

    International Nuclear Information System (INIS)

    Carotid stenting is a minimally invasive treatment for extracranial carotid artery stenosis. Stent design may affect technical success and complications in a certain subgroup of patients. We examined the wall adaptability of a new closed-cell carotid stent (NexStent), which has a unique rolled sheet design. Forty-one patients had 42 carotid arteries treated with angioplasty and stenting for internal carotid artery stenosis. The mean patient age was 65 ± 10 years. All patients underwent high-resolution computed tomographic angiography after the stent implantation. Data analysis included pre- and postprocedural stenosis, procedure complications, plaque calcification, and stent apposition. We reviewed the angiographic and computed tomographic images for plaque coverage and stent expansion. All procedures were technically successful. Mean stenosis was reduced from 84 ± 8% before the procedure to 15.7 ± 7% after stenting. Two patients experienced transient ischemic attack; one patient had bradycardia and hypotension. Stent induced kinking was observed in one case. Good plaque coverage and proper overlapping of the rolled sheet was achieved in all cases. There was weak correlation between the residual stenosis and the amount of calcification. The stent provides adequate expansion and adaptation to the tapering anatomy of the bifurcation.

  19. Endothelial dysfunction is associated with carotid plaque: a cross-sectional study from the population based Northern Manhattan Study

    Directory of Open Access Journals (Sweden)

    Boden-Albala Bernadette

    2006-08-01

    Full Text Available Abstract Background Impaired vascular function occurs early in atherogenesis. Brachial flow mediated dilatation (FMD is a non-invasive measure of vascular function and may be an important marker of preclinical atherosclerosis. Data on the association between FMD and carotid plaque in multi-ethnic populations are limited. The objective of this study was to determine whether endothelial dysfunction is independently associated with carotid plaque in a community of northern Manhattan. Methods In the population-based Northern Manhattan Study (NOMAS, high-resolution B-mode ultrasound images of the brachial and carotid arteries were obtained in 643 stroke-free subjects (mean age 66 years; 55% women; 65% Caribbean-Hispanic, 17% African-American, 16% Caucasian. Brachial FMD was measured during reactive hyperemia. Maximum carotid plaque thickness (MCPT was measured at the peak plaque prominence. Results The mean brachial FMD was 5.78 ± 3.83 %. Carotid plaque was present in 339 (53% subjects. The mean MCPT was 1.68 ± 0.82 mm, and the 75th percentile was 2.0 mm. Reduced FMD was significantly associated with increased MCPT. After adjusting for demographics, vascular risk factors, and education, each percent of FMD decrease was associated with a significant 0.02 mm increase in MCPT (p = 0.028. In a dichotomous adjusted model, blunted FMD was associated with an increased risk of MCPT ≥ 2.0 mm (OR, 1.11 for every 1% decrease in FMD; 95% CI, 1.03–1.19. Conclusion Decreased brachial FMD is independently associated with carotid plaque. Non-invasive evaluation of endothelial dysfunction may be a useful marker of preclinical atherosclerosis and help to individualize cardiovascular risk assessment beyond traditional risk factors.

  20. Morphological changes of carotid bodies in acute respiratory distress syndrome: a morphometric study in humans

    Directory of Open Access Journals (Sweden)

    Vinhaes E.N.G.

    2002-01-01

    Full Text Available Carotid bodies are chemoreceptors sensitive to a fall of partial oxygen pressure in blood (hypoxia. The morphological alterations of these organs in patients with chronic obstructive pulmonary disease (COPD and in people living at high altitude are well known. However, it is not known whether the histological profile of human carotid bodies is changed in acute clinical conditions such as acute respiratory distress syndrome (ARDS. The objective of the present study was to perform a quantitative analysis of the histology of carotid bodies collected from patients who died of ARDS. A morphometric study of carotid bodies collected during routine autopsies was carried out on three groups: patients that died of non-respiratory diseases (controls, N = 8, patients that presented COPD and died of its complications or associated diseases (N = 7, and patients that died of ARDS (N = 7. Morphometric measurements of the volume fraction of clusters of chief cells were performed in five fields on each slide at 40X magnification. The numerical proportion of the four main histological cell types (light, dark, progenitor and sustentacular cells was determined analyzing 10 fields on each slide at 400X magnification. The proportion of dark cells was 0.22 in ARDS patients, 0.12 in controls (P<0.001, and 0.08 in the COPD group. The proportion of light cells was 0.33 (ARDS, 0.44 (controls (P<0.001, and 0.36 (COPD. These findings suggest that chronic and acute hypoxia have different effects on the histology of glomic tissue.

  1. Serum Osteoprotegerin Is Associated With Calcified Carotid Plaque: A Strobe-Compliant Observational Study.

    Science.gov (United States)

    Kwon, Ami; Choi, Yun-Seok; Choi, Yong-Won; Chung, Woo-Baek; Park, Chul-Soo; Chung, Wook-Sung; Lee, Man-Young; Youn, Ho-Joong

    2016-04-01

    Osteoprotegerin (OPG) is a kind of tumor necrosis factor, which is related to bone metabolism and vascular calcification. The increase of Osteoprotegerin concentration in serum is related to cardiovascular diseases in humans. The purpose of this study was to figure out the relevance between osteoprotegerin in serum and carotid calcification.Serum OPG concentrations were compared in 145 patients who underwent carotid sonography (average age: 68 ± 9 years old, male: female = 81:64). A calcified plaque (CP) (37 people [27%]), a noncalcified plaque (NCP) (54 people [37%]), and a nonplaque (NP) (54 people [37%]) were classified for this study.No significant differences among 3 groups were demonstrated in the distribution of age, diabetes, high blood pressure, and hyperlipidemia. Serum osteoprotegerin concentrations were significantly increased in CP group rather than NCP group or NP group; (median [interquartile range], 4016 [1410] vs 3210 [1802] pg/mL, P calcification in carotid artery disease had an increased serum OPG concentration, so it could consider that OPG plays an important function on calcification related to arteriosclerosis. PMID:27082605

  2. [A Case of Carotid Free-Floating Thrombus Treated by Carotid Ultrasonography-Guided Endovascular Approach].

    Science.gov (United States)

    Otawa, Masato; Kinkori, Takeshi; Watanabe, Kenichi; Ando, Ryo; Tambara, Masao; Arima, Toru

    2016-06-01

    We experienced a case of carotid free-floating thrombus treated by carotid ultrasonography-guided endovascular approach. A 63-year-old man was brought to our hospital with the chief complaint of sudden onset left hemiplegia. MRI revealed acute infarction of the right MCA territory due to the right M1 occlusion. Carotid ultrasonography showed a pedunculated, polypoid mobile plaque floating with the cardiac beat. We attempted ultrasonography-guided endovascular treatment. Under proximal balloon protection, the floating plaque was successfully aspirated into the Penumbra aspiration catheter. Carotid stent was also placed to stabilize the residual pedicle of the plaque. Aspirated plaque was identified as fresh thrombus by pathological examination. Carotid ultrasonography-guided endovascular approach was effective for getting the picture of real-time dynamics of the carotid FFT. PMID:27270147

  3. Development of a New Hanging-Type Esophageal Stent for Preventing Migration: A Preliminary Study in an Animal Model of Esophagotracheal Fistula

    Energy Technology Data Exchange (ETDEWEB)

    Endo, Masayuki, E-mail: masay010@yahoo.co.jp; Kaminou, Toshio, E-mail: kaminout@med.tottori-u.ac.jp; Ohuchi, Yasufumi, E-mail: oyasu@med.tottori-u.ac.jp [Tottori University, Department of Radiology, Faculty of Medicine (Japan); Sugiura, Kimihiko, E-mail: kimihikosugiura@gmail.com [Yonago Medical Center, Department of Radiology (Japan); Yata, Shinsaku, E-mail: yata-s@med.tottori-u.ac.jp; Adachi, Akira, E-mail: july1st@med.tottori-u.ac.jp; Kawai, Tsuyoshi, E-mail: prgr-xxio@kuc.biglobe.ne.jp; Takasugi, Syohei, E-mail: stakasugi@med.tottori-u.ac.jp; Yamamoto, Shuichi, E-mail: yamamotoshu@med.tottori-u.ac.jp; Matsumoto, Kensuke, E-mail: matsumoto-k@v103.vaio.ne.jp [Tottori University, Department of Radiology, Faculty of Medicine (Japan); Hashimoto, Masayuki, E-mail: hashimotom@pref.tottori.jp [Tottori Prefectural Kosei Hospital, Department of Radiology (Japan); Ihaya, Takashi, E-mail: iahaya@orange.ocn.ne.jp [Sanin Rosai Hospital, Department of Radiology (Japan); Ogawa, Toshihide, E-mail: ogawa@med.tottori-u.ac.jp [Tottori University, Department of Radiology, Faculty of Medicine (Japan)

    2012-10-15

    Purpose: Covered, self-expandable metallic stents (SEMS) have been enthusiastically adopted for the treatment of esophagotracheal fistula, but problems with stent migration have yet to be resolved. To overcome this problem, we have developed a new hanging-type esophageal stent designed to prevent migration, and we conducted an animal study to assess the efficacy of our method. Methods: A total of six female pigs were used in this study. The main characteristic of our stent was the presence of a string tied to the proximal edge of the stent for fixation under the skin of the neck. The first experiment was performed to confirm technical feasibility in three pigs with esophagotracheal fistula. The second experiment was performed to evaluate stent migration and esophagotracheal fistula in three pigs. Results: Creation of the esophagotracheal fistula and stent placement were technically successful in all pigs. In the first experiment, esophagotracheal fistula was sealed by stent placement. In the second experiment, no stent migration was seen 11 or 12 days after stent placement. Gross findings showed no fistulas on the esophageal or tracheal wall. Conclusions: Our new hanging-type esophageal stent seems to offer a feasible method for preventing stent migration.

  4. Development of a New Hanging-Type Esophageal Stent for Preventing Migration: A Preliminary Study in an Animal Model of Esophagotracheal Fistula

    International Nuclear Information System (INIS)

    Purpose: Covered, self-expandable metallic stents (SEMS) have been enthusiastically adopted for the treatment of esophagotracheal fistula, but problems with stent migration have yet to be resolved. To overcome this problem, we have developed a new hanging-type esophageal stent designed to prevent migration, and we conducted an animal study to assess the efficacy of our method. Methods: A total of six female pigs were used in this study. The main characteristic of our stent was the presence of a string tied to the proximal edge of the stent for fixation under the skin of the neck. The first experiment was performed to confirm technical feasibility in three pigs with esophagotracheal fistula. The second experiment was performed to evaluate stent migration and esophagotracheal fistula in three pigs. Results: Creation of the esophagotracheal fistula and stent placement were technically successful in all pigs. In the first experiment, esophagotracheal fistula was sealed by stent placement. In the second experiment, no stent migration was seen 11 or 12 days after stent placement. Gross findings showed no fistulas on the esophageal or tracheal wall. Conclusions: Our new hanging-type esophageal stent seems to offer a feasible method for preventing stent migration.

  5. Preliminary Study of Hemodynamics in Human Carotid Bifurcation by Computational Fluid Dynamics Combined with Magnetic Resonance Angiography

    International Nuclear Information System (INIS)

    Background: A longstanding hypothesis that correlates fluid dynamic forces and atherosclerotic disease has led to numerous analytical, numerical, and experimental studies over the years because it is very difficult to measure the hemodynamic variables of blood in vivo. Purpose: To investigate the technique of visualization and quantitation of hemodynamic variables at carotid artery bifurcation in vivo by combining computational fluid dynamics (CFD) and vascular imaging. Material and Methods: Twenty-six healthy volunteers underwent magnetic resonance (MR) angiography of the bilateral carotid artery by a 3.0T whole-body scanner. Hemodynamic variables at these carotid bifurcations were calculated and visualized by combining vascular imaging post-processing and CFD. Results: The average velocity of the carotid bifurcation in the systolic phase and the diastolic phase was 0.46±0.24 m/s and 0.23±0.05 m/s, respectively. Eddy current and back flows were observed at bifurcation and the lateral part of the proximal internal carotid arteries (ICA) and external carotid arteries (ECA), and the shapes of them changed with phases of the cardiac cycle, which were significant at the middle of the systolic phase and faded out quickly downstream of the ICA and ECA. The average range of wall shear stress (WSS) at the bifurcation was 4.36±1.32 Pa, and the maximum WSS was 18.02±4.11 Pa. The WSS map revealed a large region of low WSS at the carotid bulb and extended to the outer wall in the proximal end of the ICA (the lowest value was below 0.5 Pa), and there was also a small region of low WSS at the outer wall in the proximal end of the ECA. Conclusion: CFD combined with vascular imaging can calculate and visualize hemodynamic variables at carotid bifurcation in vivo individually

  6. A newly-designed temporary cardia stent for the treatment of achalasia:an experimental study in canine models

    International Nuclear Information System (INIS)

    Objective: To assess the efficacy and safety of a newly-designed temporary covered cardia stent for the treatment of achalasia in canine models and to investigate the histopathological changes at different points of follow-up time after the stent was removed. Methods: The canine achalasia model was created by injecting benzyl-dimethyl-tetradecyl ammonium chloride (BAC) circumferentially into the lower esophageal sphincter (LES) of the dogs. Twenty-four dogs with achalasia were randomly and equally divided into two groups with 12 dogs in each group: control group (using routine esophageal stents) and study group (using newly-designed temporary covered cardia stents). Under fluoroscopic guidance stents were implanted in the esophagus and were taken away from the esophagus 4 days after stent insertion in experimental dogs of both groups. LES pressures and timed barium esophagography (TBE) were performed in all dogs before and immediately after the stenting procedure, as well as at one week, 3 and 6 months after the stent was removed. Every three dogs were sacrificed each time at one week, 3 and 6 months after the stent was removed. The esophageal cardia was excised and sent for pathological examination. Results: All animals well tolerated the stent insertion / removal and the follow-up procedures. No severe complications such as esophageal perforation occurred. Comparison between two groups showed that stent migration occurrence was much lower in study group (n = 1) than that in control group (n = 5). The reduction of LES pressures in study group was more significant in comparison with control group (at 6-month follow-up, P = 0.027). The difference in barium column product (height x width) between 0-min and 5-min TBE was statistically significant in study group (at 3-month follow-up, P = 0.009). Integrated analysis of multi-comparison for LES pressures among subgroups of each group revealed that the dogs in study group exhibited better outcomes than the dogs in

  7. Colonic stenting as bridge to surgery versus emergency surgery for management of acute left-sided malignant colonic obstruction: a multicenter randomized trial (Stent-in 2 study

    Directory of Open Access Journals (Sweden)

    Scholten Pieter

    2007-07-01

    Full Text Available Abstract Background Acute left-sided colonic obstruction is most often caused by malignancy and the surgical treatment is associated with a high mortality and morbidity rate. Moreover, these operated patients end up with a temporary or permanent stoma. Initial insertion of an enteral stent to decompress the obstructed colon, allowing for surgery to be performed electively, is gaining popularity. In uncontrolled studies stent placement before elective surgery has been suggested to decrease mortality, morbidity and number of colostomies. However stent perforation can lead to peritoneal tumor spill, changing a potentially curable disease in an incurable one. Therefore it is of paramount importance to compare the outcomes of colonic stenting followed by elective surgery with emergency surgery for the management of acute left-sided malignant colonic obstruction in a randomized multicenter fashion. Methods/design Patients with acute left-sided malignant colonic obstruction eligible for this study will be randomized to either emergency surgery (current standard treatment or colonic stenting as bridge to elective surgery. Outcome measurements are effectiveness and costs of both strategies. Effectiveness will be evaluated in terms of quality of life, morbidity and mortality. Quality of life will be measured with standardized questionnaires (EORTC QLQ-C30, EORTC QLQ-CR38, EQ-5D and EQ-VAS. Morbidity is defined as every event leading to hospital admission or prolonging hospital stay. Mortality will be analyzed as total mortality as well as procedure-related mortality. The total costs of treatment will be evaluated by counting volumes and calculating unit prices. Including 120 patients on a 1:1 basis will have 80% power to detect an effect size of 0.5 on the EORTC QLQ-C30 global health scale, using a two group t-test with a 0.05 two-sided significance level. Differences in quality of life and morbidity will be analyzed using mixed-models repeated measures

  8. Transcatheter aortic value implantation with self-expandable nitinol valved stent: an experimental study in sheep

    International Nuclear Information System (INIS)

    Objective: to determine the feasibility and safety of transcatheter aortic valve implantation with domestic self-expandable nitinol valved stent in experimental sheep. Methods: A fresh pig pericardium was cross-linked with a 0.6% glutaraldehyde solution for 36 hours and then sutured on a nitinol self-expandable stent. Ten healthy sheep of (46.00±2.60) kg body weight were chosen for the study. Under general anesthesia, the device was delivered through catheter into the native aortic valve of the sheep via the femoral artery or abdominal aorta. The animals were followed up for three months. Results: Six devices were successfully delivered at the desired position in six sheep with no occurrence of complications. Angiographic and hemodynamic studies confirmed that the stents were fixed at correct position with competent valve function immediately and 90 days after the procedure. Technical failure or fatal complications occurred in the remaining four sheep. Conclusion: Implantation of a domestic nitinol self-expandable stent at the aortic valve position through a transcatheter approach is feasible in experimental sheep. (authors)

  9. DISCOVER: Dutch Iliac Stent trial: COVERed balloon-expandable versus uncovered balloon-expandable stents in the common iliac artery: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bekken Joost A

    2012-11-01

    Full Text Available Abstract Background Iliac artery atherosclerotic disease may cause intermittent claudication and critical limb ischemia. It can lead to serious complications such as infection, amputation and even death. Revascularization relieves symptoms and prevents these complications. Historically, open surgical repair, in the form of endarterectomy or bypass, was used. Over the last decade, endovascular repair has become the first choice of treatment for iliac arterial occlusive disease. No definitive consensus has emerged about the best endovascular strategy and which type of stent, if any, to use. However, in more advanced disease, that is, long or multiple stenoses or occlusions, literature is most supportive of primary stenting with a balloon-expandable stent in the common iliac artery (Jongkind V et al., J Vasc Surg 52:1376-1383,2010. Recently, a PTFE-covered balloon-expandable stent (Advanta V12, Atrium Medical Inc., Hudson, NH, USA has been introduced for the iliac artery. Covering stents with PTFE has been shown to lead to less neo-intimal hyperplasia and this might lower restenosis rates (Dolmatch B et al. J Vasc Interv Radiol 18:527-534,2007, Marin ML et al. J Vasc Interv Radiol 7:651-656,1996, Virmani R et al. J Vasc Interv Radiol 10:445-456,1999. However, only one RCT, of mediocre quality has been published on this stent in the common iliac artery (Mwipatayi BP et al. J Vasc Surg 54:1561-1570,2011, Bekken JA et al. J Vasc Surg 55:1545-1546,2012. Our hypothesis is that covered balloon-expandable stents lead to better results when compared to uncovered balloon-expandable stents. Methods/Design This is a prospective, randomized, controlled, double-blind, multi-center trial. The study population consists of human volunteers aged over 18 years, with symptomatic advanced atherosclerotic disease of the common iliac artery, defined as stenoses longer than 3 cm and occlusions. A total of 174 patients will be included. The control group will undergo

  10. Feasibility and Safety of Transradial Arterial Approach for Simultaneous Right and Left Vertebral Artery Angiographic Studies and Stenting

    International Nuclear Information System (INIS)

    Objectives. This study investigated whether the transradial artery (TRA) approach using a 6-French (F) Kimny guiding catheter for right vertebral artery (VA) angiographic study and stenting is safe and effective for patients with significant VA stenosis. Background. The TRA approach is commonly performed worldwide for both diagnostic cardiac catheterization and catheter-based coronary intervention. However, to our knowledge, the safety and feasibility of left and right VA angiographic study and stenting, in the same procedure, using the TRA approach for patients with brain ischemia have not been reported. Methods. The study included 24 consecutive patients (22 male, 2 female; age, 63-78 years). Indications for VA angiographic study and stenting were (1) prior stroke or symptoms related to vertebrobasilar ischemia and (2) an asymptomatic but vertebral angiographic finding of severe stenosis (>70%). A combination of the ipsilateral and retrograde-engagement technique, which involved a looping 6-F Kimny guiding catheter, was utilized for VA angiographic study. For VA stenting, an ipsilateral TRA approach with either a Kimny guiding catheter or a left internal mammary artery guiding catheter was utilized in 22 patients and retrograde-engagement technique in 2 patients. Results. A technically successful procedure was achieved in all patients, including left VA stenting in 15 patients and right VA stenting in 9 patients. The mean time for stenting (from engagement to stent deployment) was 12.7 min. There were no vascular complications or mortality. However, one patient suffered from a transient ischemic attack that resolved within 3 h. Conclusion. We conclude that TRA access for both VA angiographic study and VA stenting is safe and effective, and provides a simple and useful clinical tool for patients unsuited for femoral arterial access

  11. Mechanisms of Biliary Plastic Stent Occlusion and Efforts at Prevention.

    Science.gov (United States)

    Kwon, Chang-Il; Lehman, Glen A

    2016-03-01

    Biliary stenting via endoscopic retrograde cholangiopancreatography has greatly improved the quality of patient care over the last 30 years. Plastic stent occlusion limits the life span of such stents. Attempts to improve plastic stent patency duration have mostly failed. Metal stents (self-expandable metal stents [SEMSs]) have therefore replaced plastic stents, especially for malignant biliary strictures. SEMS are at least 10 times more expensive than plastic stents. In this focused review, we will discuss basic mechanisms of plastic stent occlusion, along with a systematic summary of previous efforts and related studies to improve stent patency and potential new techniques to overcome existing limitations. PMID:27000422

  12. Mechanism and animal model study of low-dose radioactive stents for prevention of restenosis

    International Nuclear Information System (INIS)

    Objective: To explore the effects and the mechanism of radionuclide on smooth muscle cells proliferation and apoptosis, and to investigate the effects of radioactive stents on prevention of restenosis. Methods: The effects and mechanism of radionuclide on the proliferation, apoptosis, and mutation of HPRT gene exon 7/8 in cultured smooth muscle cells were studied by cellular and molecular technique, and the prevention effects of radioactive stents on restenosis were investigated in animal model. Results: The proliferation of smooth muscle cells cultured in vitro could be inhibited markedly by β-particle radiation from radionuclide 188Re, proliferation inhibition rate: [(100.0% vs 34.1%, t = 2.500, P 2 vs (0.60 +- 0.29) mm2, t = 2.466, P < 0.05], and percent area of stenosis [(16.84 +- 6.61)% vs (10.05 +- 4.27)%, t = 2.448, P < 0.05] compared with non-radioactive stents in animal restenosis model. Conclusion: Endovascular radiotherapy in low-dose and low-dose rate was an ideal therapy selection for prevention of restenosis, which could inhibit cell proliferation significantly, but did not ruin the vessel structure. Radioactive stents could inhibit the restenosis in the animal model, and it is safe and feasible for prevention of restenosis

  13. Hemodynamics in Idealized Stented Coronary Arteries: Important Stent Design Considerations

    OpenAIRE

    Beier, Susann; Ormiston, John; Webster, Mark; Cater, John; Norris, Stuart; Medrano-Gracia, Pau; Young, Alistair; Cowan, Brett

    2015-01-01

    Stent induced hemodynamic changes in the coronary arteries are associated with higher risk of adverse clinical outcome. The purpose of this study was to evaluate the impact of stent design on wall shear stress (WSS), time average WSS, and WSS gradient (WSSG), in idealized stent geometries using computational fluid dynamics. Strut spacing, thickness, luminal protrusion, and malapposition were systematically investigated and a comparison made between two commercially available stents (Omega and...

  14. In vitro study on the feasibility of magnetic stent hyperthermia for the treatment of cardiovascular restenosis.

    Science.gov (United States)

    Li, Li; Wang, Rui; Shi, Huan-Huan; Xie, LE; Li, Jing-Ding-Sha; Kong, Wei-Chao; Tang, Jin-Tian; Ke, DA-Nian; Zhao, Ling-Yun

    2013-08-01

    Thermal treatment or hyperthermia has received considerable attention in recent years due to its high efficiency, safety and relatively few side-effects. In this study, we investigated whether it was possible to utilize targeted thermal or instent thermal treatments for the treatment of restenosis following percutaneous transluminal coronary angioplasty (PTCA) through magnetic stent hyperthermia (MSH). A 316L stainless steel stent and rabbit vascular smooth muscle cells (VSMCs) were used in the present study, in which the inductive heating characteristics of the stent under alternative magnetic field (AMF) exposure, as well as the effect of MSH on the proliferation, apoptosis, cell cycle and proliferating cell nuclear antigen (PCNA) expression of the rabbit VSMCs, were evaluated. The results demonstrated that 316L stainless steel coronary stents possess ideal inductive heating characteristics under 300 kHz AMF exposure. The heating properties were shown to be affected by the field intensity of the AMF, as well as the orientation the stent axis. MSH had a significant effect on the proliferation and apoptosis of VSMCs, and the effect was temperature-dependent. While a mild temperature of 43°C demonstrated negligible effects on the growth of VSMCs, MSH treatment above 47°C effectively inhibited the VSMC proliferation and induced apoptosis. Furthermore, a 47°C treatment exhibited a significant and long-term inhibitory effect on VSMC migration. The results strongly suggested that MSH may be potentially applied in the clinic as an alternative approach for the prevention and treatment of restenosis. PMID:24137187

  15. Hemodynamic Alterations after Stent Implantation in 15 Cases of Intracranial Aneurysms

    Science.gov (United States)

    Wang, Chao; Tian, Zhongbin; Liu, Jian; Jing, Linkai; Paliwal, Nikhil; Wang, Shengzhang; Zhang, Ying; Xiang, Jianping; Siddiqui, Adnan H; Meng, Hui; Yang, Xinjian

    2016-01-01

    Background Stent-assisted coiling technology has been widely used in the treatment of intracranial aneurysms. In current study, we investigated the intra-aneurysmal hemodynamic alterations after stent implantation and its association with aneurysm location. Methods We first retrospectively studied 15 aneurysm cases (8 internal carotid artery-ophthalmic artery (ICA-OphA) aneurysms and 7 posterior communicating artery (PcoA) aneurysms) treated with Enterprise stents and coils. Then based on patient-specific geometries before and after stenting, we built virtual stenting computational fluid dynamics (CFD) simulation models. Results Before and after stent deployment, the average Wall Shear Stress (WSS) on the aneurysmal sac at systolic peak changed from 7.04 Pa (4.14 Pa, 15.77 Pa) to 6.04 Pa (3.86 Pa, 11.13 Pa), P = 0.001; and the spatially averaged value of flow velocity in the perpendicular plane of aneurysm dropped from 0.5 m/s (0.28 m/s, 0.7 m/s) to 0.33 m/s (0.25 m/s, 0.49 m/s), P = 0.001, respectively. Post-stent implantation, WSS in ICA-OphA aneurysms and PcoA aneurysms decreased by 14.4% (P = 0.012) and 16.6% (P = 0.018) respectively, and flow velocity also reduced by 10.3% (P = 0.029) and 10.5% (P = 0.013), respectively. Changes in WSS, flow velocity, and pressure were not significantly different between ICA-OphA aneurysms and PcoA aneurysms (P > 0.05). Stent implantation did not significantly change the peak systolic pressure in both aneurysm types. Conclusion After stent implantation, intra-aneurysmal flow velocity and WSS decreased independent of aneurysm type (ICA-OphA and PcoA). Little change was observed on peak systolic pressure. PMID:26746828

  16. Optimal scanning protocols of 64-slice CT angiography in coronary artery stents: An in vitro phantom study

    International Nuclear Information System (INIS)

    Purpose: The purpose of the study was to investigate the optimal scanning protocol of 64-slice CT angiography for assessment of coronary artery stents based on a phantom study. Materials and methods: Coronary stents with a diameter of 2.5 mm was implanted in thin plastic tubes with an inner diameter of 3.0 mm to simulate a coronary artery. The tubes were filled with iodinated contrast medium diluted to 178 HU, closed at both ends and positioned in a plastic container filled with vegetable oil (-70 to -100 HU). A series of scans were performed with a 64-slice CT scanner with the following protocols: section thickness: 0.67 mm, 1.0 mm, 1.5 mm, 2.0 mm, pitch value: 0.2, 0.3, 0.5 and reconstruction interval of 50% overlap of the section thickness. 2D axial and multiplanar reformatted images were generated to assess the visibility of stent lumen, while virtual intravascular endoscopy (VIE) was reconstructed to evaluate the artery wall and stent surface. Results: Our results showed that a scanning protocol of 1.0 mm slice thickness with a pitch of 0.3 produced acceptable images with best demonstration of the intrastent lumen and stent surface with minimal image noise or artifacts. In contrast, submillimeter scans with 0.67 mm resulted in moderate artifacts which affected visualization of the coronary lumen, in addition to the increased noise. When the section thickness increased to 1.5 mm and 2.0 mm, visualization of the artery wall and stent surface was compromised, although the intrastent lumen was still visible. Conclusion: Our in vitro study suggested that a scanning protocol of 1.0 mm section thickness with pitch of 0.3 is the optimal protocol for evaluation of coronary artery stents as it allows generation of acceptable images with better visualization of stent lumen, stent surface and coronary artery wall.

  17. Optimal scanning protocols of 64-slice CT angiography in coronary artery stents: An in vitro phantom study

    Energy Technology Data Exchange (ETDEWEB)

    Almutairi, Abdulrahman Marzouq [Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University of Technology, Perth, Western Australia (Australia); Sun Zhonghua [Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University of Technology, Perth, Western Australia (Australia)], E-mail: z.sun@curtin.edu.au; Ng, Curtise [Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University of Technology, Perth, Western Australia (Australia); Al-Safran, Zakariya A.; Al-Mulla, Abeer A.; Al-Jamaan, Abdulaziz I. [Department of Medical Imaging, King Fahad Specialist Hospital, Dammam (Saudi Arabia)

    2010-04-15

    Purpose: The purpose of the study was to investigate the optimal scanning protocol of 64-slice CT angiography for assessment of coronary artery stents based on a phantom study. Materials and methods: Coronary stents with a diameter of 2.5 mm was implanted in thin plastic tubes with an inner diameter of 3.0 mm to simulate a coronary artery. The tubes were filled with iodinated contrast medium diluted to 178 HU, closed at both ends and positioned in a plastic container filled with vegetable oil (-70 to -100 HU). A series of scans were performed with a 64-slice CT scanner with the following protocols: section thickness: 0.67 mm, 1.0 mm, 1.5 mm, 2.0 mm, pitch value: 0.2, 0.3, 0.5 and reconstruction interval of 50% overlap of the section thickness. 2D axial and multiplanar reformatted images were generated to assess the visibility of stent lumen, while virtual intravascular endoscopy (VIE) was reconstructed to evaluate the artery wall and stent surface. Results: Our results showed that a scanning protocol of 1.0 mm slice thickness with a pitch of 0.3 produced acceptable images with best demonstration of the intrastent lumen and stent surface with minimal image noise or artifacts. In contrast, submillimeter scans with 0.67 mm resulted in moderate artifacts which affected visualization of the coronary lumen, in addition to the increased noise. When the section thickness increased to 1.5 mm and 2.0 mm, visualization of the artery wall and stent surface was compromised, although the intrastent lumen was still visible. Conclusion: Our in vitro study suggested that a scanning protocol of 1.0 mm section thickness with pitch of 0.3 is the optimal protocol for evaluation of coronary artery stents as it allows generation of acceptable images with better visualization of stent lumen, stent surface and coronary artery wall.

  18. Contemporary carotid imaging: from degree of stenosis to plaque vulnerability.

    Science.gov (United States)

    Brinjikji, Waleed; Huston, John; Rabinstein, Alejandro A; Kim, Gyeong-Moon; Lerman, Amir; Lanzino, Giuseppe

    2016-01-01

    limited in sensitivity and specificity for detecting LRNC, plaque hemorrhage, and ulceration compared with MRI. Also summarized is how these advanced imaging techniques are being used in clinical practice to risk stratify patients with low- and high-grade carotid artery stenosis. For example, identification of IPH on MRI in patients with low-grade carotid artery stenosis is a risk factor for failure of medical therapy, and studies have shown that such patients may fair better with carotid endarterectomy (CEA). MR plaque imaging has also been found to be useful in identifying revascularization candidates who would be better candidates for CEA than carotid artery stenting (CAS), as high intraplaque signal on time of flight imaging is associated with vulnerable plaque and increased rates of adverse events in patients undergoing CAS but not CEA. PMID:26230478

  19. Biocompatibility of a new device of self-expandable covered and non-covered tracheal stent: comparative study in rats

    Directory of Open Access Journals (Sweden)

    Olavo Ribeiro Rodrigues

    2013-01-01

    Full Text Available PURPOSE: To investigate the compatibility of a new model of self-expandable tracheal stent in rats. METHODS: A new device of polyurethane covered and non - covered stent was placed in the trachea of Wistar rats. Animals were distributed in two groups: the polyurethane covered and non-covered group. Macroscopic parameters included position within the tracheal lumen, adherence to the mucosa, degree of dilatation, permeability and internal diameter. Microscopic findings evaluated were: incorporation, inflammatory activity, granulation tissue and epithelial revetment injuries. The observation follow-up was six weeks. All parameters were quantified based on determined score values. Incorporation of the stents was evaluated based on the observation if the stent was fixed into the trachea or if it could be removed. Degree of dilatation was performed by external diameter measurements. Granulation tissue was evaluated by measurements of height of the tissue growing into the tracheal lumen. RESULTS: 100% of non-covered stents had total attachment to mucosa and 100% of polyurethane covered type had adherence only. Regarding dilatation, granulation tissue, inflammatory activity and internal diameter measurements, there were no significant differences between the groups. Pathological tracheal wall injuries were present in both groups. CONCLUSION: Both models of stent demonstrated biocompatibility with the trachea. Rats are suitable for an experimental model of tracheal stent study.

  20. The Potential Role of Optical Coherence Tomography in the Evaluation of Vulnerable Carotid Atheromatous Plaques: A Pilot Study

    International Nuclear Information System (INIS)

    Purpose. The decision to intervene surgically in patients with carotid artery disease is based on the presence of symptoms, along with the severity of carotid artery stenosis as assessed by ultrasound or X-ray computed tomography (CT). Optical coherence tomography (OCT) is a relatively new imaging technique that offers potential in the identification of, as well as the distinction between, stable and unstable atherosclerotic plaques. The purpose of our study was to evaluate whether OCT can be used as a noninvasive diagnostic tool to reveal the morphology of carotid stenosis from the adventitial surface of the carotid artery. To achieve this aim, excised atheromatous plaques were scanned by OCT from the external surface. Methods. Plaques removed at carotid endarterectomy were scanned by OCT from the external surface within 72 hr of surgery and then examined histologically. The images of the histologic slides and the scans were then compared. Results. We examined 10 carotid endarterectomy specimens and were able to identify calcification, cholesterol crystal clefts, and lipid deposits in the OCT images with histologic correlation. The strong light scattering from the calcified tissue and cholesterol crystal clefts limited the depth of light penetration, making observation of the intimal surface and the detail of the fibrous cap difficult. However, we were able to confidently identify the absence of an atherosclerotic plaque by OCT scans even from the external surface. Conclusion. The results of this pilot study demonstrate that OCT can reveal the main features of carotid stenosis but that plaque vulnerability cannot be reliably and precisely assessed if scanned from the external surface with OCT in its present form

  1. An experimental study on the changes of the doppler patterns in the common carotid artery after clamping of the internal carotid artery

    International Nuclear Information System (INIS)

    Recently, duplex sonography has been used as a screening test for the evaluation of carotid arterial disease. If an occlusion of atherosclerosis is located at the bifurcation of the common carotid artery or the lower portion of the internal carotid artery, the luminal change may be directly visualized on high-resolution B-mode sonography or color-Doppler images. But when the lesion is located at the high cervical, petrous or cavernous protion of the internal carotid artery, it is difficult to directly visualize the lesion with the sonography. The purpose of this paper is to evaluate the indirect changes on the Doppler patterns of both common carotid arteries with clamping of an internal carotid artery. Thirty common carotid arteries in fifteen normal rabbits were examined with duplex ultrasonography using high-resolution real-time imaging and 7.5MHz pulsed-wave Doppler flow measurements with velocity waveform analysis. Systolic velocity (SV) was 45.4 ± 8.4cm/sec, end-diastolic velocity (EDV) 15.3 ± 4.9cm/sec and resistative index (RI) 0.66 ± 0.08 in the common carotid artery before clamping of the internal carotid artery. SV was 26.3 ± 7.8cm/sec, EDV 6.0 ± 5.2cm/sec and RI 0.78 ± 0.18 in the ipsilateral common carotid artery and SV was 56.6 ± 13.0cm/sec, EDV 22.3 ± 8.2cm/sec and RI 0.61 ± 0.10 in the contralateral common carotid artery after clamping of the internal carotid artery. During clamping of the internal carotid artery, the difference between SV of bilateral common carotid arteries was 30.3 ± 13.8cm/sec and EDV 16.3 ± 9.2cm/sec. There was no difference of the velocity patterns of the common carotid artery between preclamping and declamping of the internal carotid artery. In conclusion, lower SV and EDV in a common carotid artery than that in contralateral side on Doppler patterns strongly suggests an occlusion of ipsilateral internal carotid artery

  2. Radioactive metallic stent for palliative treatment of esopageal cancer using Ho-166: an experimental study in canine model

    International Nuclear Information System (INIS)

    Self-expandable metallic stents are widely used for palliative treatment of esophageal cancer, however, tumor overgrowth and short survaval limit its long-term effect. The purpose of this study is to evaluate tissue response of the radiation effect in normal canine esophagus whether metallic stents coated with radioactive H-166 is effective for patients survival and preservation of stent patency longer than stents without radioactive materials. Ho-166 was incorporated within polyurethan (50μ) and coated over the outer surface of self-expandable metallic stents. Metallic stents with radioactivity of 4.0-7.8mCi (Group A), 1.0-1.8 mCi (Group B) and 0.5-0.7mCi (Group C) were placed in normal mid-esophagus in twelve dogs (Group A), five (Group B) and another five dogs (Group C) respectively, and the stents were tightly anchored by surgery to prevent migration. Estimated radiation dose was 6-70 Gy in Group C. Fluoroscopy confirmed stents in esophagus without migration for at least two days. The dogs were sacrified at two or three months later and histopathologic examinations were performed. In group A, mid-esophagus stricture, mucosal ulceration were found in all specimens. Severe fibrosis and degeneration of muscular propria, upper one half were found in three and complete fibrosis of esophageal wall, however, esophageal perforation was found but muscular layer was intact. In group C, no histological changes was demonstrated in three but submucosal inflammation with intact mucosa in two. In therapeutic dose level (group B), radioactive metallic stent showed radiation effect within esophageal wall without complication which might give additional palliative effect in malignant espohageal stricture

  3. Efficacy of a dexamethasone-eluting nitinol stent on the inhibition of pseudointimal hyperplasia in a transjugular intrahepatic portosystemic shunt: an experimental study in a swine model

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Tae Seok [Korea University Guro Hospital, Seoul (Korea, Republic of); Oh, Joo Hyeogn; Park, Young Koo [Kyung Hee University Hospital, Seoul (Korea, Republic of); Song, Ho Young [University of Ulsan, College of Medicine, Seoul (Korea, Republic of); Park, Sang Joon [Hallym University, College of Medicine, Seoul (Korea, Republic of); Yuk, Sun Hong [Hannam University, Daejeon (Korea, Republic of)

    2005-12-15

    We wanted to evaluate the feasibility and efficacy of using a dexamethasone (DM)-eluting nitinol stent to inhibit the pseudointimal hyperplasia following stent placement in the transjugular intrahepatic portosystemic shunt tract (TIPS) of a swine. Fifteen stents were constructed using 0.15 mm-thick nitinol wire; they were 60 mm in length and 10 mm in diameter. The metallic stents were then classified into three types; type 1 and 2 was coated with the mixture of 12% and 20%, respectively, of DM solution and polyurethane (PU), while type 3 was a bare stent that was used for control study. In fifteen swine, each type of stent was implanted in the TIPS tract of 5 swine, and each animal was sacrificed 2 weeks after TIPS creation. The proliferation of the pseudointima was evaluated both on follow-up portogram and pathologic examination. One TIPS case, using the type 1 stent, and two TIPS cases, using the type 2 stent, maintained their luminal patency while the others were all occluded. On the histopathologic analysis, the mean of the maximum pseudointimal hyperplasia was expressed as the percentage of the stent radius that was patent, and these values were 51.2%, 50% and 76% for the type 1, 2, and 3 stents, respectively. The DM-eluting stent showed a tendency to reduce the development of pseudointimal hyperplasia in the TIPS tract of a swine model with induced-portal hypertension.

  4. Are Aortic Stent Grafts Safe in Pregnancy?

    OpenAIRE

    Nader Khandanpour; Mehta, Tapan A.; Adiseshiah, M; Meyer, Felicity J.

    2015-01-01

    Aortic stent grafts are increasingly used to treat aortic aneurysms and also other aortic pathologies. The safety of aortic stent grafts in pregnancy has never been studied or reported. We report on two cases of aortic stent grafts in pregnant women and discuss the effect of pregnancy on these aortic stent grafts.

  5. A STUDY OF MORPHOLOGY, MORPHOMETRY, SYMMETRY AND DEVELOPMENT OF EXTERNAL OPENING OF CAROTID CANAL WITH COMPARISON IN MALE, FEMALE AND FOETUS

    Directory of Open Access Journals (Sweden)

    Vaseemraja G. Shaikh

    2014-12-01

    Full Text Available Introduction: The Carotid Canal is an important structure at the base of skull as it conveys the internal carotid artery, along with a sympathetic nerve plexus and a venous plexus. Previous researches done on carotid canal suggest that abnormalities to this canal, such as fractures of carotid canal and carotid sympathetic plexus schwannoma have their effect on the internal carotid artery and the structures passing through it. Cases of absence of carotid canal have also been reported, which causes variations of the internal carotid artery. Attempt has been made in this study to give a detailed view of the ‘external opening of carotid canal’ (EOCC which is the gateway of the carotid canal at the skull base. This study shall be useful for Surgeons, Radiologists, Anatomists, Forensic Experts, Anthropologists, etc. Aim: This study aims at measuring the various dimensions of the external openings of the carotid canal pair present at the base of skull, and to observe the age changes, sexual dimorphism, and symmetry of the external opening of the carotid canal from the analysis of these measurements. Materials and methods: Total 235 dry skulls that included 181 adolescent to adult skulls of known age and sex (age ranging from 13 years up to old age skulls of 60 years or above and 54 foetal skulls were studied for this purpose. The longest & shortest diameter of each carotid canal, was measured using a screw adjusted compass and a Vernier Calliper. Their distance from pharyngeal tubercle and from the X axis and Y axis was measured. Observations and Results: In the present study, it was observed that external opening of each carotid canal was unique in its morphology and morphometry. The dimensions of external opening of carotid canal progressively increased from foetal age to 25 years of age, however after 25 years of age, it did not show any age change within same sex, but it showed age changes when adolescent female skulls of age less than 25 years

  6. Internal Carotid Artery Ectasia: The Value of Imaging Studies Prior to Biopsy of a Retropharyngeal Mass

    Directory of Open Access Journals (Sweden)

    Kenneth Chan

    2010-11-01

    Full Text Available The presence of retropharyngeal tissue mass often raises the suspicion of malignancy, especially in elderly patients. This prompts urgent biopsy to investigate tissue histology. We discuss a case where this is contraindicated as the retropharyngeal mass was illustrated by CT scanning and confirmed with MRI to be a tortuous coursing internal carotid artery. An awareness of this unusual anatomical variation and a careful interpretation of imaging studies both at the stage of differential diagnosis and pre-operative screening are essential to avoid damage to important structures, causing unnecessary complications.

  7. A comparison between NASCET and ECST methods in the study of carotids

    International Nuclear Information System (INIS)

    Purpose: NASCET and ECST systems to quantify carotid artery stenosis use percent diameter ratios from conventional angiography. With the use of Multi-Detector-Row CT scanners it is possible to easily measure plaque area and residual lumen in order to calculate carotid stenosis degree. Our purpose was to compare NASCET and ECST techniques in the measurement of carotid stenosis degree by using MDCTA. Methods and material: From February 2007 to October 2007, 83 non-consecutive patients (68 males; 15 females) were studied using Multi-Detector-Row CT. Each patient was assessed by two experienced radiologists for stenosis degree by using both NASCET and ECST methods. Statistic analysis was performed to determine the entity of correlation (method of Pearson) between NASCET and ECST. The Cohen kappa test and Bland-Altman analysis were applied to assess the level of inter- and intra-observer agreement. Results: The correlation Pearson coefficient between NASCET and ECST was 0.962 (p < 0.01). Intra-observer agreement in the NASCET evaluation, by using Cohen statistic was 0.844 and 0.825. Intra-observer agreement in the ECST evaluation was 0.871 and 0.836. Inter-observer agreement in the NASCET and ECTS were 0.822 and 0.834, respectively. Agreement analysis by using Bland-Altman plots showed a good intra-/inter-observer agreement for the NASCET and an optimal intra-/inter-observer agreement for the ECST. Conclusions: Results of our study suggest that NASCET and ECST methods show a strength correlation according to quadratic regression. Intra-observer agreement results high for both NASCET and ECST.

  8. Effects of candesartan cilexetil on carotid remodeling in hypertensive diabetic patients: the MITEC study

    Directory of Open Access Journals (Sweden)

    JP Baguet

    2009-01-01

    Full Text Available JP Baguet1, R Asmar2, P Valensi3, S Nisse-Durgeat4, JM Mallion11Clinique de Cardiologie, CHU de Grenoble, Grenoble, France; 2Institut CardioVasculaire, Paris, France; 3Service d’Endocrinologie-Diabétologie-Nutrition, CHU Jean Verdier, AP-HP, Bondy, France; 4Laboratoires Takeda, Puteaux, FranceAbstract: In hypertension and diabetes, early structural changes of the arterial wall precede or support atherosclerosis. There is evidence that some antihypertensive drugs exert an antiatherosclerotic effect. Over 36 months, we investigated the effect of candesartan cilexetil (CC on the common carotid intima-media thickness (IMT vs amlodipine besylate (AML in patients with type 2 diabetes and mild to moderate essential hypertension. After a 4-week wash-out period, 209 patients were randomized to either CC 8 mg or AML 5 mg once daily for a minimum of 1 month, after which, if BP was not normalized, the dosage was doubled, followed by the addition of hydrochlorothiazide 12.5 mg if necessary. No significant differences were observed between the two groups for change in IMT at M12 (−0.001 vs −0.027 mm/year for CC and AML respectively, p = 0.425, at M24 (−0.033 vs −0.019 mm per year respectively, p = 0.442, and at the last visit (−0.016 vs −0.039 mm per year respectively, p = 0.549. Within the group, comparisons did not show a significant difference in changes in IMT from baseline to the three visits. At the last visit, IMT regression was observed in 52.2% of patients receiving CC and in 51.3% of those receiving AML (p = 0.908. The augmentation in carotid lumen diameter from baseline was statistically greater in the AML group at the last visit (p = 0.034. BP variations during the study were similar in the two groups. The results of this study show that CC and AML treatments may alter identically the natural progression of carotid IMT in hypertensive type 2 diabetic patients.Keywords: hypertension, diabetes, carotid, intima-media thickness

  9. Early prediction of acute kidney injury biomarkers after endovascular stent graft repair of aortic aneurysm: a prospective observational study

    OpenAIRE

    Ueta, Kazuyoshi; Watanabe, Michiko; Iguchi, Naoya; Uchiyama, Akinori; Shirakawa, Yukitoshi; Kuratani, Toru; Sawa, Yoshiki; Fujino, Yuji

    2014-01-01

    Background Acute kidney injury (AKI) is a common and serious condition usually detected some time after onset by changes in serum creatinine (sCr). Although stent grafting to repair aortic aneurysms is associated with AKI caused by surgical procedures or the use of contrast agents, early biomarkers for AKI have not been adequately examined in stent graft recipients. We studied biomarkers including urinary neutrophil gelatinase-associated lipocalin (NGAL), blood NGAL, N-acetyl-β-d-glucosaminid...

  10. Transarterial endovascular treatment of traumatic direct carotid-caveronous fistulas: a report of 51 cases

    International Nuclear Information System (INIS)

    Objective: To present our single-center experience in treating traumatic direct carotid-cavernous fistulas (TDCCFs) by using detachable balloon, coil and Willis covered stent via arterial route. Methods: During the last five years, transarterial endovascular treatment by using detachable balloon, coil and Willis covered stent was performed in fifty-one consecutive patients of traumatic direct carotid-cavernous fistulas, with a total of 54 TDCCFs. The detachable balloon was the material of first choice, while Willis covered stents and coils were regarded as the back-up materials. A clinical and angiographic follow-up for 3 - 48 months (mean 20.8 months) was conducted to evaluate the arterial patency and the stability of embolization. The clinical data were retrospectively analyzed. Results: By using the detachable balloon alone via transarterial route, 85% TDCCFs were successfully treated with good preservation of ICA. A total of 98% TDCCFs in this study were successfully treated by using detachable balloon, coil and / or Willis covered stent, the fistulas became occluded, and ICAs were preserved except one patient. Forty TDCCFs were treated with detachable balloons alone, two TDCCFs with the Willis covered stent alone, and one DCCF with coils alone. Eight TDCCFs were treated with detachable balloons together with Willis covered stent. Of these eight TDCCFs, two were treated with a single session, three were treated with detachable balloons in combination with coils, and one had to receive Willis covered stent. Second and third times of endovascular treatment were needed in 12 TDCCFs. The TDCCF-related symptoms were gradually relived or improved within 1 day to 6 months after treatment, except for five patients who suffered from ipsilateral moderate visual loss or cranial nerve deficit. No perioperative complications, such as vessel rupture, distal embolization or new neurologic deficits, occurred. During the follow-up period lasting for six months, neither delayed

  11. Targeting In-Stent-Stenosis with RGD- and CXCL1-Coated Mini-Stents in Mice

    Science.gov (United States)

    Weinandy, Stefan; Schreiber, Fabian; Megens, Remco T. A.; Theelen, Wendy; Smeets, Ralf; Jockenhövel, Stefan; Gries, Thomas; Möller, Martin; Klee, Doris; Weber, Christian; Zernecke, Alma

    2016-01-01

    Atherosclerotic lesions that critically narrow the artery can necessitate an angioplasty and stent implantation. Long-term therapeutic effects, however, are limited by excessive arterial remodeling. We here employed a miniaturized nitinol-stent coated with star-shaped polyethylenglycole (star-PEG), and evaluated its bio-functionalization with RGD and CXCL1 for improving in-stent stenosis after implantation into carotid arteries of mice. Nitinol foils or stents (bare metal) were coated with star-PEG, and bio-functionalized with RGD, or RGD/CXCL1. Cell adhesion to star-PEG-coated nitinol foils was unaltered or reduced, whereas bio-functionalization with RGD but foremost RGD/CXCL1 increased adhesion of early angiogenic outgrowth cells (EOCs) and endothelial cells but not smooth muscle cells when compared with bare metal foils. Stimulation of cells with RGD/CXCL1 furthermore increased the proliferation of EOCs. In vivo, bio-functionalization with RGD/CXCL1 significantly reduced neointima formation and thrombus formation, and increased re-endothelialization in apoE-/- carotid arteries compared with bare-metal nitinol stents, star-PEG-coated stents, and stents bio-functionalized with RGD only. Bio-functionalization of star-PEG-coated nitinol-stents with RGD/CXCL1 reduced in-stent neointima formation. By supporting the adhesion and proliferation of endothelial progenitor cells, RGD/CXCL1 coating of stents may help to accelerate endothelial repair after stent implantation, and thus may harbor the potential to limit the complication of in-stent restenosis in clinical approaches. PMID:27192172

  12. Targeting In-Stent-Stenosis with RGD- and CXCL1-Coated Mini-Stents in Mice.

    Directory of Open Access Journals (Sweden)

    Sakine Simsekyilmaz

    Full Text Available Atherosclerotic lesions that critically narrow the artery can necessitate an angioplasty and stent implantation. Long-term therapeutic effects, however, are limited by excessive arterial remodeling. We here employed a miniaturized nitinol-stent coated with star-shaped polyethylenglycole (star-PEG, and evaluated its bio-functionalization with RGD and CXCL1 for improving in-stent stenosis after implantation into carotid arteries of mice. Nitinol foils or stents (bare metal were coated with star-PEG, and bio-functionalized with RGD, or RGD/CXCL1. Cell adhesion to star-PEG-coated nitinol foils was unaltered or reduced, whereas bio-functionalization with RGD but foremost RGD/CXCL1 increased adhesion of early angiogenic outgrowth cells (EOCs and endothelial cells but not smooth muscle cells when compared with bare metal foils. Stimulation of cells with RGD/CXCL1 furthermore increased the proliferation of EOCs. In vivo, bio-functionalization with RGD/CXCL1 significantly reduced neointima formation and thrombus formation, and increased re-endothelialization in apoE-/- carotid arteries compared with bare-metal nitinol stents, star-PEG-coated stents, and stents bio-functionalized with RGD only. Bio-functionalization of star-PEG-coated nitinol-stents with RGD/CXCL1 reduced in-stent neointima formation. By supporting the adhesion and proliferation of endothelial progenitor cells, RGD/CXCL1 coating of stents may help to accelerate endothelial repair after stent implantation, and thus may harbor the potential to limit the complication of in-stent restenosis in clinical approaches.

  13. Auxetic coronary stent endoprosthesis

    DEFF Research Database (Denmark)

    Amin, Faisal; Ali, Murtaza Najabat; Ansari, Umar;

    2014-01-01

    BACKGROUND: Cardiovascular heart disease is one of the leading health issues in the present era and requires considerable health care resources to prevent it. The present study was focused on the development of a new coronary stent based on novel auxetic geometry which enables the stent to exhibit...... favorable for mechanical adhesion of the commercially available coronary stents with the arterial wall. It is believed that an auxetic coronary stent with inherent anisotropic mechanical properties and negative Poisson's ratio will have good mechanical adhesion with the arterial wall. METHODS: The auxetic...... design was obtained via laser cutting, and surface treatment was performed with acid pickling and electropolishing, followedby an annealing process. In vitro mechanical analysis was performed to analyze the mechanical performance of the auxetic coronary stent. Scanning electronic microscopy (SEM) was...

  14. Concepts to optimize stent-grafting of abdominal aortic aneurysms based on results of experimental studies

    International Nuclear Information System (INIS)

    Purpose. In the endoluminal therapy of abdominal aortic aneurysms, a short proximal aneurysm neck, endoleaks and the large size and stiffness of the introducer systems are responsible for many of the complications and sub-optimal outcomes. The purpose of the present review article is to to suggest strategies to minimize these complications based on the results of experimental studies in animals. Material and methods. After implanting various types of stents across the renal artery origins, the functional and morphological changes in the kidneys and renal vessels were studied by various authors. In order to prevent progressive widening of the proximal aneurysmal neck and graft dislocation, Sonesson et al. performed a laparoscopic banding around the proximal neck in pigs. To study the effects of endoleaks, Marty, Schurink and Pitton carried out pressure measurements in experimental aneurysms with and without endoleaks. Sakaguchi and Pavcnik developed the 'Twin-tube endografts' (TTEG) and the 'Bifurcated drum occluder endografts' (BDOEG) and tested them in dogs. Results. Up to 3 months after suprarenal stent placement, Chavan et al. detected no significant fall in the mean inulin clearance in sheep (140±46 ml/min before, 137±58 ml/min after). Nasim et al. and Malina et al. reported similar observations with respect to renal function. Suprarenal fixation may result in isolated thrombotic occlusions of the renal arteries and microinfarcts in the kidneys. Mean aortic diameters at the level of banding were significantly smaller in the animals with aortic banding as opposed to those in the control group without banding (8 mm vs 11 mm, p=0.004). The banding caused a secure proximal fixation of the stent-graft. Persistent endoleaks resulted in significantly higher intraaneurysmal pressures. Although the TTEG and the BDOEG stent-grafts required smaller sheaths, occlusions were observed in 8% (TTEG) and 60% (BDOEG) of the graft limbs. (orig.)

  15. A comprehensive study of stent visualization enhancement in X-ray images by image processing means.

    Science.gov (United States)

    Bismuth, Vincent; Vaillant, Régis; Funck, François; Guillard, Niels; Najman, Laurent

    2011-08-01

    In this work we propose a comprehensive study of Digital Stent Enhancement (DSE), from the analysis of the requirements to the validation of the proposed solution. First, we derive the stent visualization requirements in the context of the clinical application and workflow. Then, we propose a DSE algorithm combining automatic detection, tracking, registration and contrast enhancement. The most original parts of our solution: landmark segmentation and non-linear image registration are detailed. Finally, we validate the algorithm on a large number of synthetic and clinical cases. Performance is characterized in terms of automation, image quality and execution time. This work is, to the best of our knowledge, the first comprehensive article on DSE, covering problem statement, proposed solution, and validation strategies. PMID:21530360

  16. Carotid chemoreceptor development in mice

    OpenAIRE

    Shirahata, Machiko; Kostuk, Eric W.; Pichard, Luis E

    2012-01-01

    Mice are the most suitable species for understanding genetic aspects of postnatal developments of the carotid body due to the availability of many inbred strains and knockout mice. Our study has shown that the carotid body grows differentially in different mouse strains, indicating the involvement of genes. However, the small size hampers investigating functional development of the carotid body. Hypoxic and/or hyperoxic ventilatory responses have been investigated in newborn mice, but these r...

  17. A study of impact of stent implantation in distal common bile duct on duodenal-biliary reflux

    International Nuclear Information System (INIS)

    Objective: This study aimed to investigate the incidence and the cause for duodenal- biliary reflux and reflux cholangitis after metallic stent placement in distal common bile duct. Methods: After percutaneous transhepatic bile duct puncture and biliary outside drainage was performed, 16 cases with malignant distal biliary stricture underwent metallic stent placement in distal common bile duct. Before stent placement, the routine laboratory studies including leukocyte, neutrophil percentage and the levels of total bilimbin and direct bilirubin in blood were performed for all patients. Two to five days [an average of (3.3±0.9) days] after stent implantation, the above indexes were tested again, and 1 ml of water containing 185 MBq of 99Tcm-DTPA was given orally before extubation, then 99Tcm radioactivity in the bile was detected 2 hours later. For the measurement data obtained from the experiment, t test or Wilcoxon signed rank test was adopted to compare them, and P9/L, and the median of neutrophil percentage was 0.74. Compared with those before stent implantation, the difference did not reach statistical significance (t=0.423, Z=1.036, P>0.05). After stent implantation, the median of total bilirubin and direct bilirubin were significantly lower, which were 92.2 and 74.3 μmol/L. Compared with those before stenting, the difference was statistically significant (Z=-3.170, -3.170, P<0.05). Conclusions: There is a high incidence of duodenal-biliary reflux after stent implantation in distal common bile duct in the early stage. However, there is no simultaneous cholangitis caused by duodenal-biliary reflux. (authors)

  18. Carotid Stump Syndrome: Case Report and Endovascular Treatment.

    Science.gov (United States)

    Dakhoul, Lara Toufic; Tawk, Rabih

    2014-01-01

    Objectives. To highlight the case of a patient with multiple transient ischemic attacks and visual disturbances diagnosed with carotid stump syndrome and managed with endovascular approach. Case Presentation. We present the case of a carotid stump syndrome in an elderly patient found to have moderate left internal carotid artery stenosis in response to an advertisement for carotid screening. After a medical therapeutic approach and a close follow-up, transient ischemic attacks recurred. Computed tomographic angiography showed an occlusion of the left internal carotid artery and the presence of moderate stenosis in the right internal carotid artery, which was treated by endovascular stenting and balloon insertion. One month later, the patient presented with visual disturbances due to the left carotid stump and severe stenosis of the left external carotid artery that was reapproached by endovascular stenting. Conclusion. Considerations should be given to the carotid stump syndrome as a source of emboli for ischemic strokes, and vascular assessment could be used to detect and treat this syndrome. PMID:26425620

  19. Bronchial stents

    Directory of Open Access Journals (Sweden)

    Ibrahim Emad

    2006-01-01

    Full Text Available Bronchial stents are mostly used as a Palliative relief of symptoms often caused by airway obstruction, It is also used for sealing of stump fistulas after pneumonectomy and dehiscence after bronchoplastic operations. Advances in airway prosthetics have provided a variety of silicone stents, expandable metal stents, and pneumatic dilators, enabling the correction of increasingly complex anatomical problems. Several series have been published describing the application and results of these techniques. This manuscript reviews the historical development of stents, types, indication, outcome, and complications. Alternative therapies for tracheobronchial stenting were also reviewed

  20. Experimental Study on Heterograft of Glomus Ccl ls of Carotid Body for Hemioarkinsonian Rats

    Institute of Scientific and Technical Information of China (English)

    曹学兵; 孙圣刚; 童萼塘

    2002-01-01

    Summary: To observe the effects of heterograft of glomus cells of carotid body on hemiparkinsonian rat models, rats with unilateral 6-hydroxydopamine (6-OHDA)-induced lesions of the right dopamin ergic neurons of substantia nigra received intrastriatal glomus cells heterograft. Apomorphine-induced rotation was monitored for 30 rmin at various time points after grafting. The striata were cut and ex-amined for dopamine content by HPLC and for immunohistochemical staining of tyrosine hydroxylase positive neurons (TH+ ) at the end of the experiments. The results showed that apomorphine-induced rotational behavior was significantly reduced for 12 weeks and the dopamine contents were signifi cantly elevated after grafting (P<0.01), and TH+ cells survived better. The present study demon strates that intrastriatal heterograft of glomus cells within carotid body in rats with 6-OHDA-elicited lesions could reduce apomorphine-induced rotational behavior and elevate the dopamine contents and numbers of TH+ cell surviving within striatum, and can serve as a new and effective alternative for Parkinson disease.

  1. Carotid Artery Screening

    Science.gov (United States)

    ... Resources Professions Site Index A-Z Carotid Artery Screening What is carotid artery screening? Who should consider ... about carotid artery screening? What is carotid artery screening? Screening examinations are tests performed to find disease ...

  2. Diagnostic workup in carotid stenosis - a neurologist's perspective

    International Nuclear Information System (INIS)

    Carotid artery stenosis is associated with the risk of stroke, myocardial infarction, and vascular death. In selected patients, revascularization of carotid narrowing by endarterectomy may reduce the risk of stroke distal to the stenosis. Carotid artery stenting has evolved as a potential alternative to endarterectomy. Four randomized clinical trials comparing safety and efficacy of endarterectomy versus stenting of symptomatic carotid stenosis have been published in recent years, but there remains some uncertainty about the implications of these trials for clinical routine. Both carotid stenting and endarterectomy are based on different treatment strategies which may result in different specific risk factors associated with each procedure. Hence, the procedural risk of either modality varies not only with the skills of the surgeon or the interventionalist but may depend on patient characteristics. It appears that the most important question is not whether one revascularization modality is superior but for which patient one modality is better than the other. A comprehensive diagnostic workup of patients with carotid stenosis based on a broad panel of covariates that affect the risk of vascular events may improve selection of patients for carotid revascularization and may help to decide for whom one revascularization modality is likely to be better than the other. (orig.)

  3. Prevalence and clinical characteristics of carotid atherosclerosis in newly diagnosed patients with ketosis-onset diabetes: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Li Lian-Xi

    2013-01-01

    Full Text Available Abstract Background The features of carotid atherosclerosis in ketosis-onset diabetes have not been investigated. Our aim was to evaluate the prevalence and clinical characteristics of carotid atherosclerosis in newly diagnosed Chinese diabetic patients with ketosis but without islet-associated autoantibodies. Methods In total, 423 newly diagnosed Chinese patients with diabetes including 208 ketosis-onset diabetics without islet-associated autoantibodies, 215 non-ketotic type 2 diabetics and 79 control subjects without diabetes were studied. Carotid atherosclerosis was defined as the presence of atherosclerotic plaques in any of the carotid vessel segments. Carotid intima-media thickness (CIMT, carotid atherosclerotic plaque formation and stenosis were assessed and compared among the three groups based on Doppler ultrasound examination. The clinical features of carotid atherosclerotic lesions were analysed, and the risk factors associated with carotid atherosclerosis were evaluated using binary logistic regression in patients with diabetes. Results The prevalence of carotid atherosclerosis was significantly higher in the ketosis-onset diabetic group (30.80% than in the control group (15.2%, p=0.020 after adjusting for age- and sex-related differences, but no significant difference was observed in comparison to the non-ketotic diabetic group (35.8%, p=0.487. The mean CIMT of the ketosis-onset diabetics (0.70±0.20 mm was markedly higher than that of the control subjects (0.57±0.08 mm, p Conclusions The prevalence and risk of carotid atherosclerosis were significantly higher in the ketosis-onset diabetics than in the control subjects but similar to that in the non-ketotic type 2 diabetics. The characteristics of carotid atherosclerotic lesions in the ketosis-onset diabetics resembled those in the non-ketotic type 2 diabetics. Our findings support the classification of ketosis-onset diabetes as a subtype of type 2 diabetes.

  4. Searching the perfect ultrasonic classification in assessing carotid artery stenosis: comparison and remarks upon the existing ultrasound criteria.

    Science.gov (United States)

    Mozzini, Chiara; Roscia, Giuseppe; Casadei, Alder; Cominacini, Luciano

    2016-01-01

    Doppler ultrasound scanning is the first line investigation for quantifying the internal carotid artery stenosis. Nevertheless, the lack of internationally accepted ultrasound criteria for describing the degree of stenosis has contributed to the different and confusing measurements ranges. The use of two different angiographic methods, the North American Symptomatic Carotid Endoarterectomy Study and the European Carotid Surgery Trial was probably the major initial source of confusion in deriving valid and reliable duplex ultrasound criteria worldwide. The consensus proposed in 2003 by the Society of Radiologists in Ultrasound has been a great attempt to create a conformity document, establishing grey scale and Doppler criteria in considering the different degrees of stenosis. According to this attempt, in 2010, the multi-parametric Deutsche Gesellschaft für Ultraschall in der Medizin ultrasound criteria have been proposed with a precise differentiation between main and additional criteria and depicted a different peak systolic velocity (PSV) threshold. In 2012, these criteria have been implemented, focusing on the multi-parametric approach, re-defining the PSV values and clearly introducing the concept of PSV average. Despite these attempts, a wide range of practice patterns still exists, with consistent disparities in patients' care. This paper collects these previous experiences and summarizes their strengths and weaknesses, to give a contribution in the carotid artery stenosis grading standardization using ultrasonic methods. Carotid ultrasound as the only diagnostic tool for the selection of patients for carotid surgery or stenting will be possible only with internationally accepted criteria. PMID:27298648

  5. COMPARATIVE STUDY OF EXTRACRANIAL CAROTID AND VERTEBRAL ARTERY DOPPLER WITH CONTRAST ENHANCED MR ANGIOGRAPHY IN PATIENTS WITH STROKE

    Directory of Open Access Journals (Sweden)

    Archana

    2016-01-01

    Full Text Available CONTEXT Cerebrovascular accident or stroke is one of the most common causes of death. Ultrasonography of the carotid arteries is an easily available, cost effective, non-invasive method of evaluation. Treatment of stroke depends on reaching the most accurate diagnosis. Accurate and prompt diagnosis is crucial because timely and appropriate therapy can significantly reduce the risk of stroke and long-term sequelae. Several modalities of investigation are available to determine carotid artery status. The value of safe, non-invasive screening test is therefore great. AIMS The purpose of this study is to compare the diagnostic value of extracranial carotid and vertebral artery Doppler and Magnetic Resonance Angiography for the diagnosis of carotid artery pathology in patients with stroke. SETTINGS AND DESIGN The principal appealing points in favour of sonography are patient comfort, accuracy and lack of risk. MR Angiography produces reproducible three dimensional image of carotid bifurcation with good sensitivity for high-grade stenosis. METHODS AND MATERIAL After taking consent, 50 patients presenting with focal neurological deficit underwent Colour Doppler and Gadolinium enhanced MRA examination of the carotid and vertebral arteries at KIMS Hospital, Bangalore, with the help of VOLUSON 730 [WIPRO GE ULTRASOUND MACHINE] and GE SIGNA HDXT 1.5 TESLA 16 CHANNEL MRI. RESULTS The highest incidence of stroke was found in the age group of 50-70 years with male population commonly affected. The various risk factors include family history of stroke, hypertension and diabetes mellitus. Total pathologies were most commonly found on the right side. Most common site for atheromatous plaque was carotid bifurcation. Grading of stenosis was done based on the NASCET criteria and the findings of Doppler and MRA were compared. MRA had a better role than Doppler for detecting 80-99% stenosis. CONCLUSIONS MRA has progressively gained clinical relevance in the

  6. Relationship between carotid intima-media thickness and coronary angiographic findings: a prospective study

    Directory of Open Access Journals (Sweden)

    Kilickesmez Kadriye O

    2009-12-01

    Full Text Available Abstract Background Since cardiovascular diseases are associated with high mortality and generally undiagnosed before the onset of clinical findings, there is a need for a reliable tool for early diagnosis. Carotid intima-media thickness (CIMT is a non-invasive marker of coronary artery disease (CAD and is widely used in practice as an inexpensive, reliable, and reproducible method. In the current study, we aimed to investigate prospectively the relationship of CIMT with the presence and extent of significant coronary artery narrowing in patients evaluated by coronary angiography for stable angina pectoris. Methods One hundred consecutive patients with stable angina pectoris and documented ischemia on a stress test were included in the study. The patients were divided into two groups according to the result of the coronary angiography: group 1 (39 patients without a noncritical coronary lesion, and group 2 (61 patients having at least one lesion more than 50% within the main branches of the coronary arteries. All of the patients underwent carotid Doppler ultrasound examination for measurement of the CIMT by a radiologist blinded to the angiographic data. Results The mean CIMT was 0.78 ± 0.21 mm in Group 1, while it was 1.48 ± 0.28 mm in Group 2 (p = 0.001. The mean CIMT in patients with single vessel disease, multi-vessel disease, and left main coronary artery disease were significantly higher compared to Group 1 (1.2 ± 0.34 mm, p = 0.02; 1.6 ± 0.32 mm, p = 0.001; and 1.8 ± 0.31 mm, p = 0.0001, respectively. Logistic regression analysis identified CIMT (OR 4.3, p Conclusions The findings of this study show that increase in CIMT is associated with the presence and extent of CAD. In conclusion, we demonstrated the usefulness of carotid intima-media thickness in predicting coronary artery disease but large-scale studies are required to define its role in clinical practice.

  7. Carotid artery calcification in ischemic stroke patients detected in standard dental panoramic radiographs - a preliminary study

    International Nuclear Information System (INIS)

    Purpose: Examine the prevalence of carotid artery calcifications in standard dental panoramic radiographs (OPT), their association to gender, medical history and oral status. Assess the predictive value of a dental OPT in early diagnosis of carotid artery calcifications. Material and Methods: Fourteen patients admitted to Geneva University Hospital for recent ischemic stroke and stenosis of the carotid artery confirmed by Duplex sonography. All OPTs were digitised and subsequently assessed independently by two operators. Results: From 21 carotid artery calcifications detected with Doppler sonography 15 were visible on the corresponding OPT, most of them on the right side (n=11). No correlation was found between the side of calcification and cerebral lesion. Hypertension and periodontal disease were the most prevalent cardiovascular risk factors. Conclusions: Dentists who either detect carotid artery calcifications in OPTs or see patients with severe periodontitis should consider a prophylactic specialist examination. (authors)

  8. Complications of intravenous DSA performed for carotid artery disease: a prospective study

    International Nuclear Information System (INIS)

    One hundred and two patients, who were being evaluated for carotid artery disease, were prospectively studied for complications occurring as a result of intravenous digital subtraction angiography (DSA). The authors recorded the type, number, and outcome of complications and reviewed the amount of contrast material used, along with the patient's age and medical history for possible correlation with increased complications. There were 55 total complications or side effects involving 37 patients. Central nervous system (CNS) complications included six major-transient and one major-permanent complication. Systemic complications included 20 major-transient and two major-permanent events. Complications in our series were significantly higher than previous DSA reports and published data on conventional angiography studies. Many of our patients were in a relatively high risk group

  9. A stent for co-delivering paclitaxel and nitric oxide from abluminal and luminal surfaces: Preparation, surface characterization, and in vitro drug release studies

    Energy Technology Data Exchange (ETDEWEB)

    Gallo, Annemarie; Mani, Gopinath, E-mail: Gopinath.Mani@usd.edu

    2013-08-15

    Most drug-eluting stents currently available are coated with anti-proliferative drugs on both abluminal (toward blood vessel wall) and luminal (toward lumen) surfaces to prevent neointimal hyperplasia. While the abluminal delivery of anti-proliferative drugs is useful for controlling neointimal hyperplasia, the luminal delivery of such drugs impairs or prevents endothelialization which causes late stent thrombosis. This research is focused on developing a bidirectional dual drug-eluting stent to co-deliver an anti-proliferative agent (paclitaxel – PAT) and an endothelial cell promoting agent (nitric oxide – NO) from abluminal and luminal surfaces of the stent, respectively. Phosphonoacetic acid, a polymer-free drug delivery platform, was initially coated on the stents. Then, the PAT and NO donor drugs were co-coated on the abluminal and luminal stent surfaces, respectively. The co-coating of drugs was collectively confirmed by the surface characterization techniques such as Fourier transform infrared spectroscopy, scanning electron microscopy (SEM), 3D optical surface profilometry, and contact angle goniometry. SEM showed that the integrity of the co-coating of drugs was maintained without delamination or cracks formation occurring during the stent expansion experiments. In vitro drug release studies showed that the PAT was released from the abluminal stent surfaces in a biphasic manner, which is an initial burst followed by a slow and sustained release. The NO was burst released from the luminal stent surfaces. Thus, this study demonstrated the co-delivery of PAT and NO from abluminal and luminal stent surfaces, respectively. The stent developed in this study has potential applications in inhibiting neointimal hyperplasia as well as encouraging luminal endothelialization to prevent late stent thrombosis.

  10. A stent for co-delivering paclitaxel and nitric oxide from abluminal and luminal surfaces: Preparation, surface characterization, and in vitro drug release studies

    International Nuclear Information System (INIS)

    Most drug-eluting stents currently available are coated with anti-proliferative drugs on both abluminal (toward blood vessel wall) and luminal (toward lumen) surfaces to prevent neointimal hyperplasia. While the abluminal delivery of anti-proliferative drugs is useful for controlling neointimal hyperplasia, the luminal delivery of such drugs impairs or prevents endothelialization which causes late stent thrombosis. This research is focused on developing a bidirectional dual drug-eluting stent to co-deliver an anti-proliferative agent (paclitaxel – PAT) and an endothelial cell promoting agent (nitric oxide – NO) from abluminal and luminal surfaces of the stent, respectively. Phosphonoacetic acid, a polymer-free drug delivery platform, was initially coated on the stents. Then, the PAT and NO donor drugs were co-coated on the abluminal and luminal stent surfaces, respectively. The co-coating of drugs was collectively confirmed by the surface characterization techniques such as Fourier transform infrared spectroscopy, scanning electron microscopy (SEM), 3D optical surface profilometry, and contact angle goniometry. SEM showed that the integrity of the co-coating of drugs was maintained without delamination or cracks formation occurring during the stent expansion experiments. In vitro drug release studies showed that the PAT was released from the abluminal stent surfaces in a biphasic manner, which is an initial burst followed by a slow and sustained release. The NO was burst released from the luminal stent surfaces. Thus, this study demonstrated the co-delivery of PAT and NO from abluminal and luminal stent surfaces, respectively. The stent developed in this study has potential applications in inhibiting neointimal hyperplasia as well as encouraging luminal endothelialization to prevent late stent thrombosis.

  11. A stent for co-delivering paclitaxel and nitric oxide from abluminal and luminal surfaces: Preparation, surface characterization, and in vitro drug release studies

    Science.gov (United States)

    Gallo, Annemarie; Mani, Gopinath

    2013-08-01

    Most drug-eluting stents currently available are coated with anti-proliferative drugs on both abluminal (toward blood vessel wall) and luminal (toward lumen) surfaces to prevent neointimal hyperplasia. While the abluminal delivery of anti-proliferative drugs is useful for controlling neointimal hyperplasia, the luminal delivery of such drugs impairs or prevents endothelialization which causes late stent thrombosis. This research is focused on developing a bidirectional dual drug-eluting stent to co-deliver an anti-proliferative agent (paclitaxel - PAT) and an endothelial cell promoting agent (nitric oxide - NO) from abluminal and luminal surfaces of the stent, respectively. Phosphonoacetic acid, a polymer-free drug delivery platform, was initially coated on the stents. Then, the PAT and NO donor drugs were co-coated on the abluminal and luminal stent surfaces, respectively. The co-coating of drugs was collectively confirmed by the surface characterization techniques such as Fourier transform infrared spectroscopy, scanning electron microscopy (SEM), 3D optical surface profilometry, and contact angle goniometry. SEM showed that the integrity of the co-coating of drugs was maintained without delamination or cracks formation occurring during the stent expansion experiments. In vitro drug release studies showed that the PAT was released from the abluminal stent surfaces in a biphasic manner, which is an initial burst followed by a slow and sustained release. The NO was burst released from the luminal stent surfaces. Thus, this study demonstrated the co-delivery of PAT and NO from abluminal and luminal stent surfaces, respectively. The stent developed in this study has potential applications in inhibiting neointimal hyperplasia as well as encouraging luminal endothelialization to prevent late stent thrombosis.

  12. The subpetrous carotid wall hematoma. A sign of spontaneous dissection of the internal carotid artery on non-enhanced computed tomography. A retrospective study

    Energy Technology Data Exchange (ETDEWEB)

    Jensen-Kondering, U. [Univ. Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Radiology and Neuroradiology; Univ. Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Neurology; Huhndorf, M.; Madjidyar, J.; Jansen, O. [Univ. Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Radiology and Neuroradiology

    2015-03-15

    Spontaneous dissection of the internal carotid artery (CAD) is an increasingly recognized cause for stroke especially in young and middle-aged patients. We hypothesized that non-enhanced cranial computed tomography (NECCT) can visualize the subpetrous carotid wall hematoma and thus enable identification of patients with CAD. We retrospectively reviewed patients with confirmed CAD (n=21) and a control group with ischemic symptoms but without CAD (n=42) who received NECCT at admission. Two independent neuroradiologists rated the presence and shape of SPH, density and diameter of the subpetrous internal carotid artery. Additionally, we correlated the shape of the subpetrous carotid wall hematoma with the grade of stenosis on subsequent angiographic imaging. The subpetrous carotid wall hematoma was present in 14 of 21 patients (Cohen's k = 0.67). Mean diameter was 6.95 ± 1.05 mm in dissected vessels and 5.71 ± 1.52 mm in the contralateral vessel (p<0.05). Mean difference in vessel density was 15.05 ± 8.01 HU (p<0.01). Median grade of stenosis was significantly higher in patients with a full moon- shaped (n=11) than crescent-shaped (n=3) subpetrous carotid wall hematoma (21% vs. 80%, p<0.05). Two-thirds of patients with CAD were correctly identified on NECCT. The extracranial carotid artery should be evaluated in patients with symptoms of cerebral ischemia.

  13. Immediate and six months clinical and angiographic results of intracoronary paclitaxel-coated stent implantation – the Meo:DrugStar-1 study

    Directory of Open Access Journals (Sweden)

    Cihangir Uyan

    2008-03-01

    Full Text Available Cihangir Uyan, Huseyin Arinc, Huseyin Gunduz, Ramazan AkdemirAbant Izzet Baysal University, Izzet Baysal Medical Faculty, Cardiology Department, Bolu, TurkeyAbstract: The study was conducted to evaluate the clinical and angiographic results of the implantation of the paclitaxel-eluting stent Meo:DrugStar ST in patients with symptomatic coronary artery disease. The Meo:DrugStar ST stent has a stainless steel stent platform with a homogenous non-biodegradable coating of paclitaxel mixed with a polyether-based biostable, monophase, and hemocompatible coating. Sixty patients with native coronary artery disease were included in the study. The Meo:DrugStar ST stents were implanted in 60 de novo lesions detected in these patients. Immediate and long-term clinical and angiographic follow-up results were evaluated. There was a high proportion of patients with hypertension (55% according to JNC-VII. Mean stenosis ratio was 78 ± 13 %, mean implanted stent diameter was 3.0 ± 0.4 mm and mean length was 22 ± 5 mm. Restenosis was detected in 4 (10% of those patients and 11 (27.5% of 40 patients had insignificant amount of restenosis.The results of this study indicate a potential benefit of the Meo:DrugStar ST stent for the prevention of stent thrombosis and restenosis in these relatively high-risk patients.Keywords: Meo:DrugStar ST stent, paclitaxel drug-eluting stent, coronary artery disease

  14. Comparison of endoscopic stenting for malignant biliaryobstruction: A single-center study

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    AIM: To evaluate the efficacy and safety of single-stependoscopic placement of self-expandable metallic stents(SEMS) for treatment of obstructive jaundice.METHODS: A retrospective study was performedamong 90 patients who underwent transpapillarybiliary metallic stent placement for malignant biliaryobstruction (MBO) between April 2005 and October2012. The diagnosis of primary disease and MBO wasbased on abdominal ultrasound, computed tomography,magnetic resonance imaging, endoscopic ultrasound,endoscopic retrograde cholangiopancreatography withbrush cytology, biopsy, and/or a combination of thesemodalities. The type of SEMS (covered or non-covered,8 mm or 10 mm in diameter) was determined by theendoscopist. Ninety patients were divided into twogroups: group 1 (49 patients) who underwent a singlestepSEMS placement and group 2 (41 patients) whounderwent a two-step SEMS placement. The technicalsuccess rate, complication rate, stent patency, andpatient survival rate were compared between thegroups. In addition, to identify the clinical prognosticfactors associated with patient survival, the followingvariables were evaluated in Cox-regression analysis:gender, age, etiology of MBO (pancreatic cancer or nonpancreaticcancer), clinical stage (Ⅳb; with distant metastases or Ⅳa 〉; without distant metastases),chemotherapy (with or without), patency of the stent,and the use of single-step or two-step SEMS.RESULTS: Immediate technical success was achievedin 93.9% (46/49) in group 1 and in 95.1% (39/41)in group 2, with no significant difference (P = 1.0).Similarly, there was no difference in the complicationrates between the groups (group 1, 4.1% and group 2,4.9%; P = 0.62). Stent failure was observed in 10 casesin group 1 (20.4%) and in 16 cases in group 2 (39.0%).The patency of stent and patient survival revealed nodifference between the two groups with Kaplan-Meieranalysis, with a mean patency of 111 ± 17

  15. Sympathoinhibition and hypotension in carotid sinus hypersensitivity

    Science.gov (United States)

    Smith, M. L.; Ellenbogen, K. A.; Eckberg, D. L.

    1992-01-01

    Carotid sinus reflex hypersensitivity is a known cause of syncope in humans. The condition is characterized by cardioinhibition and vasodepression, each to varying degrees. The extent and importance of sympathoinhibition has not been determined in patients with carotid sinus hypersensitivity. This study reports on the extent of sympathoinhibition measured directly directly during carotid massage with and without atrioventricular sequential pacing, in a patient with symptomatic carotid sinus reflex hypersensitivity. Carotid massage elicited asystole, hypotension and complete inhibition of muscle sympathetic nerve activity. Carotid massage during atrioventricular pacing produced similar sympathoinhibition, but with minimal hypotension. Therefore, sympathoinhibition did not contribute importantly to the hypotension during carotid massage in the supine position in this patient. Further investigations are required to elucidate the relation of sympathoinhibition to hypotension in patients with carotid sinus hypersensitivity in the upright position.

  16. In-vitro study on the accuracy of a simple-design CT-guided stent for dental implants

    International Nuclear Information System (INIS)

    An individual surgical stent fabricated from computed tomography (CT) data, called a CT-guided stent, would be useful for accurate installation of implants. The purpose of the present study was to introduce a newly developed CT-guided stent with a simple design and evaluate the accuracy of the stent placement. A resin template was fabricated from a hog mandible and a specially designed plastic plate, with 4 metal balls inserted in it for radiographic recognition, was attached to the occlusal surface of the template. With the surgical stent applied, CT images were taken, and virtual implants were placed using software. The spatial positions of the virtually positioned implants were acquired and implant guiding holes were drilled into the surgical stent using a specially designed 5-axis drilling machine. The surgical stent was placed on the mandible and CT images were taken again. The discrepancy between the central axis of the drilled holes on the second CT images and the virtually installed implants on the first CT images was evaluated. The deviation of the entry point and angulation of the central axis in the reference plane were 0.47±0.27 mm, 0.57±0.23 mm, and 0.64±0.16 degree, 0.57±0.15 degree, respectively. However, for the two different angulations in each group, the 20 degree angulation showed a greater error in the deviation of the entry point than did the 10 degree angulation. The CT-guided template proposed in this study was highly accurate. It could replace existing implant guide systems to reduce costs and effort.

  17. In-vitro study on the accuracy of a simple-design CT-guided stent for dental implants

    Energy Technology Data Exchange (ETDEWEB)

    Huh, Young June; Choi, Bo Ram; Huh, Kyung Hoe; Yi, Won Jin; Heo, Min Suk; Lee, Sam Sun; Choi, Soon Chul [School of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    2012-09-15

    An individual surgical stent fabricated from computed tomography (CT) data, called a CT-guided stent, would be useful for accurate installation of implants. The purpose of the present study was to introduce a newly developed CT-guided stent with a simple design and evaluate the accuracy of the stent placement. A resin template was fabricated from a hog mandible and a specially designed plastic plate, with 4 metal balls inserted in it for radiographic recognition, was attached to the occlusal surface of the template. With the surgical stent applied, CT images were taken, and virtual implants were placed using software. The spatial positions of the virtually positioned implants were acquired and implant guiding holes were drilled into the surgical stent using a specially designed 5-axis drilling machine. The surgical stent was placed on the mandible and CT images were taken again. The discrepancy between the central axis of the drilled holes on the second CT images and the virtually installed implants on the first CT images was evaluated. The deviation of the entry point and angulation of the central axis in the reference plane were 0.47{+-}0.27 mm, 0.57{+-}0.23 mm, and 0.64{+-}0.16 degree, 0.57{+-}0.15 degree, respectively. However, for the two different angulations in each group, the 20 degree angulation showed a greater error in the deviation of the entry point than did the 10 degree angulation. The CT-guided template proposed in this study was highly accurate. It could replace existing implant guide systems to reduce costs and effort.

  18. Limitations of rat carotid balloon de-endothelialization model in arterial photodynamic therapy: a study using 5-aminolaevulinic acid

    Science.gov (United States)

    Nyamekye, Isaac; MacRobert, Alexander J.; Bishop, Christopher C. R.; Bown, Stephen G.

    1995-05-01

    Photodynamic therapy (PDT) effectively inhibits fibrocellular intimal hyperplasia (FCIH) two and four weeks after arterial traction balloon injury in rat carotid arteries. The aim of the present study was to assess the long term effects of PDT in this rat model of FCIH. 5- aminolaevulinic acid-induced protoporphyrin IX was used to sensitize rats for PDT after traction balloon arterial injury to the whole of the left common carotid artery. Rats were sacrificed at intervals of six to 26 weeks, and perfusion fixed and H and E stained sections were analyzed using computerized morphometry. PDT inhibition of FCIH was only partial at these late times. The amount of FCIH present increased with increasing time after injury. The late occurrence of FCIH appeared to be due to migration of FCIH from balloon injured areas outside the PDT treated field as a result of the traction injury being applied to the whole carotid. We recommend segmental balloon injury rather than the traction injury of the whole common carotid injury for future studies in this model.

  19. Impact of sirolimus-eluting stent fractures without early cardiac events on long-term clinical outcomes: A multislice computed tomography study

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Tsuyoshi [Toyohashi Heart Center, Oyama-cho, Toyohashi (Japan); Nagoya City University Graduate School of Medical Sciences, Department of Cardio-Renal Medicine and Hypertension, Nagoya (Japan); Kimura, Masashi; Ehara, Mariko; Terashima, Mitsuyasu; Nasu, Kenya; Kinoshita, Yoshihisa; Habara, Maoto; Tsuchikane, Etsuo; Suzuki, Takahiko [Toyohashi Heart Center, Oyama-cho, Toyohashi (Japan)

    2014-05-15

    This study sought to evaluate the impact of sirolimus-eluting stent (SES) fractures on long-term clinical outcomes using multislice computed tomography (MSCT). In this study, 528 patients undergoing 6- to 18-month follow-up 64-slice MSCT after SES implantation without early clinical events were followed clinically (the median follow-up interval was 4.6 years). A CT-detected stent fracture was defined as a complete gap with Hounsfield units (HU) <300 at the site of separation. The major adverse cardiac events (MACEs), including cardiac death, stent thrombosis, and target lesion revascularisation, were compared according to the presence of stent fracture. Stent fractures were observed in 39 patients (7.4 %). MACEs were more common in patients with CT-detected stent fractures than in those without (46 % vs. 7 %, p < 0.01). Univariate Cox regression analysis indicated a significant relationship between MACE and stent fracture [hazard ratio (HR) 7.65; p < 0.01], age (HR 1.03; p = 0.04), stent length (HR 1.03; p < 0.01), diabetes mellitus (HR 1.77; p = 0.04), and chronic total occlusion (HR 2.54; p = 0.01). In the multivariate model, stent fracture (HR 5.36; p < 0.01) and age (HR 1.03; p = 0.04) remained significant predictors of MACE. An SES fracture detected by MSCT without early clinical events was associated with long-term clinical adverse events. (orig.)

  20. SU-E-T-115: Dose Perturbation Study of Self-Expandable Metal and Polyester Esophageal Stents in Proton Therapy Beams

    International Nuclear Information System (INIS)

    Purpose: This work investigates dose perturbations due to Self-expandable metal and polyester esophageal stents undergoing proton radiotherapy for esophageal cancer. Methods: Five commercially available esophageal stents made of nitinol (Evolution, Wallflex and Ultraflex), stainless steel (Z-Stent) and polyester (Polyflex) were tested. Radiochromic film (GafChromic EBT3 film, Ashland, Covington, KY) wrapped around a stent and a 12cc syringe was irradiated with 2CGE (Cobalt Gray Equivalent) of proton beam in a custom fabricated acrylic phantom. An air-hollow syringe simulates the esophagus. Results: The Z-stent created the largest dose perturbations ranges from -14.5% to 6.1% due to the steel composition. The WallFlex, Evolution and Ultraflex stents produced the dose perturbation ranges of (−9.2%∼8.6%), (−6.8%∼5.7%) and (−6.2%∼6.2%), respectively. The PolyFlex stent contains the radiopaque tungsten markers located top, middle and bottom portions. When the focal cold spots induced by the markers were excluded in the analysis, the dose perturbation range was changed from (−11.6%∼6.4%) to (−0.6%∼5.0%). Conclusion: The magnitude of dose perturbation is related to material of a metallic stent. The non-metallic stent such as PolyFlex shows relatively lower dose perturbation than metallic stents except a radiopaque marker region. Overall Evolution and Ultraflex stent appear to be less dose perturbations. The largest dose perturbations (cold spots) were located at both edges of stents in distal area for the single proton beam irradiation study. The analysis of more than two proton beam which is more typical clinical beam arrangement would be necessary to minimize the doe perturbation effect in proton ratiotherapy

  1. Evaluation of the combined application of ultrasound imaging techniques for middle cerebral artery stent surveillance and follow-up study.

    Directory of Open Access Journals (Sweden)

    Yu Wang

    Full Text Available OBJECTIVE: In recent years, cerebral artery stenting has become an effective method for the treatment of cerebral artery stenosis. However, methods for assessing efficacy and techniques for follow-up imaging still need to be developed. This study was designed to evaluate the application of transcranial color-coded sonography (TCCS in assessing stenting of middle cerebral artery (MCA stenosis. And, two new imaging techniques (vascular enhancement technology (VET and 3-dimensional (3D imaging were tried out and evaluated. METHOD: We enrolled 43 patients with cerebral artery stenosis for vascular stent implantation. All patients were examined by ultrasonography and confirmed through digital subtraction angiography. The stenosis was imaged and blood flow parameters were analyzed before and after the procedure using TCCS. VET and 3D imaging model were used in part of the patients. Important postoperative hemodynamic changes were noted. RESULTS: 1 Adequate stent image was present in 41 out of 43 patients as detected by postoperative 2-dimensional imaging. Images lacking clarity were obtained in 2 patients. 2 The perioperative and postoperative (one week follow-up instantaneous blood flow velocity at the site of stenosis was significantly decreased (P0.05. 3 VET imaging visualizes the MCA lumen and stent morphology clearly. 3D ultrasound can be used for imaging of the stent shape as well as its inner surface. CONCLUSION: TCCD can be considered a quick and effective clinical detection method to evaluate the intracranial arterial hemodynamics changes before and after stenting treatment for MCA stenosis. New imaging technologies 3D and VET can achieve additional image information.

  2. Carotid-anterior cerebral artery anastomosis on MR angiography: a university hospital-based study

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, Akira; Saito, Naoko; Okada, Yoshitaka; Inoue, Kaiji [Saitama Medical University International Medical Center, Department of Diagnostic Radiology, Hidaka, Saitama (Japan)

    2012-01-15

    Rarely in the anterior circulation, an anastomosis of the carotid and anterior cerebral arteries occurs when an anomalous branch arises from the ophthalmic segment of the internal carotid artery and anastomoses with the A1-A2 junction of the anterior communicating artery. Right-side predominance is known. To our knowledge, the incidence of carotid-anterior cerebral artery anastomosis has not been reported, so we researched cases in our institution records to determine incidence and investigated characteristic features of the condition on magnetic resonance (MR) angiography. To isolate such cases, we retrospectively reviewed cranial MR angiographic images of 3,491 consecutive patients in our institution. We found three cases with carotid-anterior cerebral artery anastomosis (two men, one woman), representing an incidence of 0.086%. The anastomosis was on the right in all three cases. A normal A1 segment of the anterior cerebral artery (ACA) was present in two cases but could not be identified in the remaining case on MR angiographic images that included source images. Two of the three patients demonstrated associated arterial variations in their carotid systems. On MR angiography, we observed a 0.086% incidence of carotid-anterior cerebral artery anastomosis in our institution and reaffirmed the right-side predominance of this anomaly. We found a high frequency of other associated arterial variations in the carotid system. (orig.)

  3. Carotid thin fluttering bands: A new element of arterial wall remodelling? An ultrasound study.

    Science.gov (United States)

    Costanzo, Luca; Sole, Andrea; Tamburino, Corrado; Di Pino, Luigi

    2015-10-01

    Carotid artery ultrasound is a non-invasive and reproducible technique used for early atherosclerotic assessment. Intimal flap has been described in the presence of dissection or mobile plaque rupture, however presence of carotid thin fluttering bands (TFBs) have not been described yet. To investigate frequency, characteristics and impact of TFBs in carotid lumen of patients who underwent carotid ultrasound scan (CUS). 3341 patients were admitted from January 2009 to January 2014. Patients with history of cerebral ischemia (CI) were excluded. In the cases in which TFBs were observed, a 3-months clinical and CUS follow-up (FU) was performed. TFBs were found in 71 patients (2.1%). The mean age was 63.41 ± 11.20 years (range 42-89). All patients showed a mean increase in intima-media thickness. We identified two subgroups: in 22 patients the TFB was related to a carotid plaque while in 49 no carotid plaque was found. TFB mostly originated in the carotid bulb (88.7%) and was similarly located in carotid arteries (49.3% left-side and 50.7% right-side). CUS and clinical FU were available for all patients (mean duration 25.34 months, median 19). CI occurred in none of the patients. TFB disappeared in 13 patients (18.3%) with no sign or symptoms of CI. In 3 of 49 patients without carotid plaque (6.1%), progressive thickening beneath TFB was observed. TFB is a rare finding. Longer FU is needed to evaluate its prognosis. To date, the pathophysiology is unknown, however it could be related to vascular remodeling. PMID:26179862

  4. Ultrasonographic Carotid Changes in Patients with Hodgkin’s Disease after Radiotherapy: A Historical Cohort Study

    Directory of Open Access Journals (Sweden)

    R. Basiratnia

    2006-08-01

    Full Text Available Background/objective: Radiotherapy is the most effective treatment for Hodgkin’s disease in early stages. However, it can cause various side effects in radiated tissues, e.g., vascular structures. One of the effects of radiation on vessels is atherosclerosis. The primary objective of this study was to compare the atherosclerotic changes of carotid arteries, expressed as the mean intima-media thickness (IMT, in patients with Hodgkin’s disease after radiotherapy with a matched non-exposed group. We also tried to see whether there is a correlation between the time elapsed since the last radiotherapy session and the prevalence and severity of atherosclerosis. Moreover, we tested if radiation can augment the effect of age, as an in-dependent risk factor for atherosclerosis. Patients and Methods: In two groups of 50 patients, sonography of the common and internal carotid arteries in bifurcation of the artery was performed and the IMT was measured for both groups of patients exposed and unexposed to radiation. Results: The mean±SD IMT was significantly higher in exposed (0.67±0.22 mm than unex-posed (0.51±0.07 mm group. There were early atherosclerotic changes, diagnosed based on the vessel morphology, in 18% of exposed and none of the unexposed group. Correlation of IMT with age is stronger in the exposed than in the unexposed group. (r=0.61 in the exposed vs. 0.22 in the unexposed. Conclusion: Atherosclerotic changes are more prevalent in post-radiotherapy patients that may indicate the necessity of regular and careful follow-up of these patients for the early diagnosis of vascular pathologies and considering suitable screening and therapeutic interventions for prevention of cerebral complications. Ultrasound could be a suitable technique for screening and early detection of atherosclerosis considering it’s relatively low cost and non-invasiveness.

  5. Intracranial arteriovenous fistula caused by endovascular stent-grafting and dilatation

    Energy Technology Data Exchange (ETDEWEB)

    Moellers, M.O. [Department of Nuclear Medicine, Universitaetsklinik Saarland, 66421, Homburg (Germany); Reith, W. [Department of Neuroradiology, Saarland University, 66421, Homburg (Germany)

    2004-04-01

    A 58-year-old man developed a self-occluding arteriovenous fistula following stent-grafting of the right internal carotid artery (ICA). Due to prolonged ischaemic neurological deficits carotid angiography had been performed 3 weeks previously. It revealed marked atherosclerotic lesions predominantly narrowing the distal right carotid siphon. MRI confirmed ischaemic lesions and massive deficits of perfusion in the right ICA cerebral territory. Stent-grafting was performed successfully, but subsequent angiography revealed a new arteriovenous fistula adjacent to the stent, between the right carotid siphon and the cavernous sinus. On angiography 10 days later, the fistula no longer was present, and flow MRI were normal; the patient was by then asymptomatic. Arteriovenous fistula can thus complicate following endovascular stenting. (orig.)

  6. Intracranial arteriovenous fistula caused by endovascular stent-grafting and dilatation

    International Nuclear Information System (INIS)

    A 58-year-old man developed a self-occluding arteriovenous fistula following stent-grafting of the right internal carotid artery (ICA). Due to prolonged ischaemic neurological deficits carotid angiography had been performed 3 weeks previously. It revealed marked atherosclerotic lesions predominantly narrowing the distal right carotid siphon. MRI confirmed ischaemic lesions and massive deficits of perfusion in the right ICA cerebral territory. Stent-grafting was performed successfully, but subsequent angiography revealed a new arteriovenous fistula adjacent to the stent, between the right carotid siphon and the cavernous sinus. On angiography 10 days later, the fistula no longer was present, and flow MRI were normal; the patient was by then asymptomatic. Arteriovenous fistula can thus complicate following endovascular stenting. (orig.)

  7. RECENT TRENDS IN BIOMATERIALS USED FOR CARDIOVASCULAR STENTING

    Directory of Open Access Journals (Sweden)

    Sona Ann Sunny

    2013-06-01

    Full Text Available During the last decade, biodegradable metal stents have been established and examined as substitutes for the currently-used long-lasting cardiovascular stents. Degradable metallic substances could theoretically change corrosion-resistant metals presently used for stent application as it has been presented that the role of stenting is short-term and inadequate to duration of 6–12 months after joining during which arterial makeover and curing occur. Even though corrosion is usually measured as a failure in metallurgy, the corrodibility of guaranteed metals can be an advantage for their use as degradable implants. The applicant materials for such function should have automatic properties preferably close to those of 316L stainless steel. Non-toxicity of the metal itself and its ruin products is another condition as the stuff is immersed by blood and cells. Based on the mentioned necessities, iron-based and magnesium-based alloys have been the investigate candidate for biodegradable stents. Carotid angioplasty and stenting (CAS has become known as a useful substitute to carotid endarterectomy and Nitinol stents are normally helpful in CAS. This article reviews the recent developments in the design and assessment of metallic material for biodegradable stents. It also introduces the new metallurgical process which could be practical for the manufacture of metallic biodegradable stents and their consequence on the properties of the metals.

  8. Comparison between manual and automated analysis for the quantification of carotid wall by using sonography. A validation study with CT

    International Nuclear Information System (INIS)

    Purpose: The purpose of this paper was to compare manual and automated analysis for the quantification of carotid wall obtained with sonography by using the computed tomography as validation technique. Material and methods: 21 consecutive patients underwent MDCTA and ultrasound analysis of carotid arteries (mean age 68 years; age range 59–81 years). The intima–media-thickness (IMT) of the 42 carotids was measured with novel and dedicated automated software analysis (called AtheroEdge™, Biomedical Technologies, Denver, CO, USA) and by four observers that manually calculated the IMT. The carotid artery wall thickness (CAWT) was also quantified in the CT datasets. Bland–Altman statistics was employed to measure the agreement between methods. A Student's t-test was used to test the differences between the IMT values of AtheroEdge™. The study obtained the IRB approval. Results: The correlation between automated AtheroEdge™ measurements and those of the human experts were equal to 95.5%, 73.5%, 88.9%, and 81.7%. The IMT coefficient of variation of the human experts was equal to 11.9%. By using a Student's t-test, the differences between the IMT values of AtheroEdge™ and those of the human experts were not found statistically significant (p value = 0.02). On comparing AtheroEdge™ (using Ultrasound) with CAWT (using CT), the results suggested a very good concordance of 84.96%. Conclusions: Data of this preliminary study indicate that automated software AtheroEdge™ can analyze with precision the IMT of carotid arteries and that the concordance with CT is optimal.

  9. The infarction patterns and the compensatory effect of collateral circulation in patients with internal carotid artery occlusion: a correlative study

    International Nuclear Information System (INIS)

    Objective: To investigate the infarction patterns and the collateral circulation in patients with internal carotid artery occlusion with diffusion-weighted imaging and DSA, to analyze the mechanism of stroke caused by internal carotid artery occlusion and to discuss the correlation between the infarction patterns and the compensatory effect of collateral circulation. Methods: A total of 45 patients with acute cerebral infarction due to DSA-confirmed unilateral internal carotid artery occlusion, who were admitted to the hospital during the period from Jan. 2009 to Sep. 2010, were enrolled in this study. Diffusion-weighted imaging and DSA were performed in all patients. The infarction regions and the findings of PCoA/ACoA were recorded, and the ipsilateral infarction patterns were evaluated. The relationship between the infarction patterns and the compensatory effect of collateral circulation was statistically analyzed. Results: The ipsilateral infarction patterns caused by internal carotid artery occlusion were classified as small cortical infarcts (84.4%), internal watershed infarcts (48.9%), territory infarcts (46.7%), posterior watershed infarcts (22.2%), anterior watershed infarcts (13.3%), perforating artery infarcts (22.2%). Among them, 23 patients had small cortical infarcts together with cerebral watershed infarcts (60.5%). No territory infarcts were found in the patients with patent ACoA (0%, P=0.013), while 91.7% of the patients showing no patent PCoA and/or ACoA had territory infarcts (11/12, p=0.003). Conclusion: Both artery-to-artery embolism and hypoperfusion with impaired emboli clearance are involved in the mechanism of ipsilateral infarctions caused by internal carotid artery occlusion. Patent ACoA can reduce the incidence of territory infarcts, and it maybe protect patients from territory infarcts. (authors)

  10. A COMPARATIVE STUDY OF PERCUTANEOUS NEPHROSTOMY VERSUS DJ STENTING IN INFECTIVE HYDRONEPHROSIS IN CALCULOUS DISEASE

    Directory of Open Access Journals (Sweden)

    Rammohan

    2015-02-01

    Full Text Available AIMS AND OBJECTIVE: To compare the outcome of percutaneous nephrostomy versus double J ureteral stenting in the management infective hydronephrosis in calculous disease. MATERIALS AND METHODS: From October 2012 to January 2014,40 patients of age 25 - 65 years with obstructing ureteral or renal pelvic stones with clinical signs of infection were underwent decompression by double J stenting(20 patients or percutaneous nephrostomy (20 patients in this study. Patients with single calculus of size less than or equal to 15mm with fever and white blood count (WBC of 14000/ mm 3 or greater were included in this study. Calculus size greater than 15 mm, patients with bilateral or multiple calculi, pregnancy, ureteral or urethral stricture disease, uncorrected coagulopathy, Patients with solitary kidney were excluded from the study. Outcome parameters included time to achieve normal temperature and WBC of 11000 /mm 3 or less, and resolution of pyuria if present were analyzed in both group of patients. RESULTS: Majority of the patients were between 25 to 65 years of age with male to female ratio was2.12:2.87.The most common location of stone was at distal ureter in either group. There was no significant difference between pre procedural WBC count, maximum temperature and stone size in either group. Procedura land fluoroscopy times were significantly shorter for double j stenting (30.95±6.02 and5.3±3.2 compared with percutaneous nephrostomy (35.9± 5.4 and7.2± 4.2. During drainage the appearance of the urine was grossly purulent in 5 patients (12.5%, turbid in 19 (47.5% and clear in 16 (40%. Overall urine cultures and blood cultures were positive in 50 and 12.5% of patients, respectively. Urine cultures were positive in 60% of the percutaneous nephrostomy compared with 40% of the double j stenting group (p not significant. There was no significant difference in time to clinical improvement (T ime to normal WBC and temperature and time for purulent drain

  11. Acute Effects of Liver Vein Occlusion by Stent-Graft Placed in Transjugular Intrahepatic Portosystemic Shunt Channel: An Experimental Study

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the effects of hepatic vein occlusion by stent-graft used in transjugular intrahepatic portosystemic shunt (TIPS). The experiments were performed in six healthy pigs under general anesthesia. Following percutaneous transhepatic implantation of a port-a-cath in the right hepatic vein, TIPS was created with a stent-graft (Viatorr; W L Gore, Flagstaff, AZ, USA). The outflow from the hepatic vein, blocked by the stent-graft was documented by injection of contrast medium and repeated injections of 99Tcm-labeled human serum albumin through the port-a-cath. After 2 weeks, the outflow was re-evaluated, the pigs were sacrificed, and histopathologic examination of the liver was performed. Occlusion of the hepatic vein by a stent-graft had a short and temporary effect on the outflow. Histopathological examination from the affected liver segment showed no divergent pattern. Stent-grafts used in TIPS block the outflow from the liver vein, but do not have a prolonged circulatory effect and do not affect the liver parenchyma

  12. An preliminary clinical study of transbronchoscopic interventional treatment for severe emphysema with local made one-way valvular stents

    International Nuclear Information System (INIS)

    Objective: To evaluate the safety and efficiency of bronchoscopic interventional lung volume reduction with domestic-made stents. Methods: The target areas of 7 patients with severe emphysema for valvular stenting form May 2006 to Aug. 2007 were prospectively selected on the basis of CT scan. Under general anesthesia, one-way valvular stenting were carried out over a guidewire under flexible bronchoscopy and fluoroscopic control. The symptom, pulmonary function, blood gas analysis, B-ultrasonic wave, 6 minute walk distance and thoracic CT were undertaken. Results: 4-6 stents per patient took place in 136 ± 72.3 min to obstruct the upper-lobe segments unilaterally but without obvious atelectasis under imaging. The patients could walk 2 hours after the operation with relief of dyspnea. No major change in radiologic findings and lung function occurred in 2 weeks, only bronchi distal to the stents gathered together. 6-min walk distance, Borg dyspnea scale fell and the pulmonary arterial pressure showed significant (P<0.05)statistical discrepancy. No major life-threatening complications were noted in the 15-day study period and no conspicuous change in lung function, blood gas analysis and lung volume. Lower-lobe pneumonia of nontarget area developed in 1 patient and acute episode of COPD occurred in another. Conclusions: Bronchoscopic interventional lung volume reduction may improve dyspnea and quality of life, as a rather safety therapeutic measure. (authors)

  13. Biocompatibility and occlusive efficiency of self-made aortic half-cycle stent-graft:an experimental study in dogs

    International Nuclear Information System (INIS)

    Objective: To explore the biocompatibility of self-made half-cycle stent-graft and the efficiency of occluding unilateral renal artery while retaining other branches of abdominal aorta in experimental dogs. Methods: Fifteen dogs were used in this study. The self-made aortic half-cycle stent-graft was 16 mm x 60 mm in size and the length of vascular-graft was 4 cm. Left or right renal arteries were occluded at random. Then angiography and enhanced spiral CT scan of abdominal aorta were performed. At 1, 4, 8, 12 and 16 weeks after operation, angiography and enhanced spiral CT scan were repeated in all dogs. The animals were sacrificed and aortic specimens were collected for pathological examination. The abdominal aortic specimens of normal aorta,naked stent area and stent-graft area were examined with both microscope and electronic microscope. Results: The self-made aortic half-cycle stent-graft was successfully placed in all 15 dogs. The occlusion site included right renal artery (n=7) and left renal artery (n =8), while other branches of aorta were spared. No vascular rupture occurred during the procedure. Postoperative angiography and CT scan showed that no displacement of the stent occurred, no blood flow was found in the occluded renal artery and other branches of aorta showed normal blood flow. At 16 weeks after operation,the thickness of intima of the normal aorta, naked stenting aorta and stent-grafts area was 85.7 μm, 943.1 μm and 2481.2μm respectively, while the thickness of the adjacent media was 1401.5 μm, 615.1 μm and 593.6μm respectively. The occluded kidney became smaller in size. Conclusion: The self-made aortic half-cycle stent-graft carries excellent biocompatibility and occlusive effect in experimental dogs, which might be employed in clinical practice to treat aortic dissection. (authors)

  14. Angioplasty of symptomatic high-grade internal carotid artery stenosis with intraluminal thrombus: therapeutic approach

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, A.; Mayol, A. [Seccion de Neurorradiologia Intervencionista, Servicio de Radiologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Gil-Peralta, A.; Gonzalez-Marcos, J.R. [Servicio de Neurologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Boza, F. [Servicio de Neurofisiologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Ruano, J. [Unidad de Cuidados Intensivos, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain)

    2004-04-01

    Intraluminal thrombus in the internal carotid artery (ICA) is usually found in patients with severe atheromatous stenosis. Having reviewed 300 carotid angioplasties for symptomatic >70% ICA stenosis, we found three patients (1%) with intraluminal thrombus. Conservative treatment with anticoagulants and double antiplatelet coverage can result in lysis of the thrombus without severe risks. Percutaneous transluminal angioplasty and stenting, preferably with distal protection, can be an excellent alternative to carotid endarterectomy. (orig.)

  15. Prospective clinical study of endoscopic ultrasound-guided choledochoduodenostomy with direct metallic stent placement using a forward-viewing echoendoscope.

    Science.gov (United States)

    Hara, K; Yamao, K; Hijioka, S; Mizuno, N; Imaoka, H; Tajika, M; Kondo, S; Tanaka, T; Haba, S; Takeshi, O; Nagashio, Y; Obayashi, T; Shinagawa, A; Bhatia, V; Shimizu, Y; Goto, H; Niwa, Y

    2013-01-01

    A prospective clinical study was conducted to evaluate the safety, feasibility, and efficacy of endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) with direct metallic stent placement using a prototype forward-viewing echoendoscope. The indication for EUS - CDS in this study was lower biliary obstruction only, and not failed endoscopic biliary drainage, because the aim was to evaluate EUS - CDS for first-line biliary drainage therapy. The technical and functional success rates were 94 % (17 /18) and 94 % (16 /17), respectively. Early complications (focal peritonitis) were encountered in two patients (11 %). No patients developed late complications. EUS - CDS with direct metallic stent placement using a forward-viewing echoendoscope was generally feasible and effective for malignant distal biliary tract obstruction. The forward-viewing echoendoscope was useful, especially for deploying the metallic stent. PMID:23338620

  16. Angioplasty and stent placement - carotid artery - discharge

    Science.gov (United States)

    ... Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society ...

  17. Preliminary study on hemodynamics in human carotid bifurcation by computational fluid dynamics

    International Nuclear Information System (INIS)

    Objective: To investigate the visualization and quantitation of hemodynamic variables at carotid artery bifurcation in vivo by combining computational fluid dynamics (CFD) and vascular imaging. Methods: A healthy volunteer underwent CT angiography of left carotid artery by SIEMENS multi-slice CT. Parameters of hemodynamics at this carotid bifurcation were calculated and visualized by combining vascular imaging post-processing and CFD. Results: (1) The average range of flow velocity was 0.04-0.36 m/s. A region of high velocity was seen at medial wall of internal carotid artery (ICA) and medial wall of external carotid artery (ECA), respectively. The largest contiguous region of low velocity occurred at the carotid bulb. (2)The average range of absolute pressure, static pressure and dynamic pressure was 100 266.70-101 615.90 Pa, -1058.34-290.88 Pa, and 6.12-553.25 Pa, respectively. (3) The average range of wall shear stress (WSS) at the bifurcation was 0.59-5.35 Pa. There was a large region of low WSS at carotid bulb and posterior wall of ICA, with the lowest value of 0.25 Pa. Also there was a small region of low WSS at anterior and lateral wall of ECA. Conclusion: CFD combined with vascular imaging can calculate and visualize the parameters of hemodynamics at carotid bifurcation in vivo individually. It is an interdisciplinary science of computer, radiology and hemodynamics and provides a new method to investigate the relationship of vascular geometry and flow condition with atherosclerotic pathological changes. (authors)

  18. Unusual Intracranial Stent Navigation through the Circle of Willis in a Patient with Recurrent Basilar Tip Aneurysm during Stent-Assisted Coiling: A Case Report

    OpenAIRE

    Puri, A.S.; Erdem, E.

    2009-01-01

    We describe a case of unusual Enterprise stent navigation through the Circle of Willis in a patient with a basilar tip aneurysm, left internal carotid artery (ICA) occlusion and previous right ICA stenting. Basilar tip aneurysms are known for their therapeutic challenges, especially when the posterior cerebral arteries (PCAs) are incorporated in the aneurysm neck. This becomes more technically demanding if the vertebral artery does not offer a route for stent navigation.

  19. Stent intracoronario. Intracoronary stent.

    OpenAIRE

    Lorenzo D. Llerena Rojas; Luis Roberto Llerena Rojas

    2000-01-01

    Diez años después de introducida la angioplastia coronaria por vía transluminal percutánea (ACTP), fue implantada la primera prótesis metálica intracoronaria en el hombre con lo que se redujeron 2 de los inconvenientes de la ACTP: la oclusión súbita del vaso recién dilatado y la reestenosis que aparece en los 6 meses que siguen a una ACTP exitosa y que se presenta aproximadamente en el 30 % de los pacientes. El uso del stent se ha difundido rápidamente en el mundo incluyendo nuestro país dond...

  20. A comparative study of short- and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction.

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2013-04-01

    The use of self-expanding metal stents as a bridge to surgery in the setting of malignant colorectal obstruction has been advocated as an acceptable alternative to emergency surgery. However, concerns about the safety of stenting have been raised following recent randomized studies.

  1. Association of depression with common carotid artery intima media thickness and augmentation index in a large Urban South Indian population- The Chennai Urban Rural Epidemiology Study (CURES - 138)

    OpenAIRE

    Subramani Poongothai; Rajendra Pradeepa; Karunakaran Indulekha; Jayagopi Surendar; Viswanathan Mohan

    2015-01-01

    AIM: The aim of the study was to assess the relationship of depression with carotid intima media thickness and augmentation index in Asian Indians. Research Design and Methods : For this study, 1505 subjects were randomly selected from a population based study conducted in Chennai, South India. Right common carotid artery intima medial thickness [IMT] was determined using high-resolution B-mode ultrasonography. Augmentation index [AI] was measured using the Sphygmocor apparatus. Depressive sy...

  2. Serial and static brain radioangiogram in diagnosis of carotid disease: value, indication and limits by comparative study with EEG, Doppler study and cerebral arteriography

    International Nuclear Information System (INIS)

    Value, indication and limits of serial and static brain radioangiogram in carotid disease are studied comparatively with EEG, Doppler study and cerebral arteriograhy. The isotopic study shows the occlusion and its consequences on middle cerebral artery and cerebral hemisphere. The 'Hot-Nose' sign is rarely seen, but then with large focal abnormalities. In 20% of studied cases, isotopic study provides information about the efficiency of suppleance circulation or the existence of a blood derivation. The value of serial and static scintigraphy deserves it a better place among the non invasive diagnosis method of carotid disease

  3. M-Guard Stent in Stemi Patients with High Thrombus Burden Lesions: A Prospective, Single Arm Study

    Directory of Open Access Journals (Sweden)

    Mohammad Zade Shabestari M

    2014-04-01

    Full Text Available Introduction: Primary PCI is the preferred modality to restore blood perfusion in STEMI patients, but myocardial reperfusion is sometimes lower than optimal. Distal embolization seems to play the leading role. There is rare evidence suggestive of M-Guard stents; a recent innovation which protects against distal embolization may be beneficial in this circumstance. Materials and Methods:This was a prospective single arm study. Patients with acute STEMI admitted at the Cardiac Emergency Unit of Imam Reza Hospital from July 2011 to November  2012 who had a large bulk of thrombus in their angiogram, underwent M-Guard stenting and were followed up for six months for chest pain and secondary revascularization. Results: The 23 patients, aged between 34 and 84; 65.2%, were male and had undergone primary PCI, mechanical thrombus aspiration, and M-Guard stenting. Left Anterior Descending (LAD (63.9% and Right Coronary Artery (RCA (39.1% were most commonly involved. 78.2%, 13.1%, and 8.9% of patients had primary Thrombolysis in Myocardial Infarction (TIMI Thrombus grade five, four, and three. Among them, 86.9% achieved TIMI Flow grade three and 13.04% TIMI Flow grade two. The rate of transient "no-reflow" phenomenon was 21%. One patient died after stenting in the setting of cardiogenic shock. There was one case of in-stent restenosis five months after the procedure. Of the other 15 accessible patients, after six months, none experienced a second angioplasty or any ischemic symptoms. Conclusion: Using M-Guard stents in acute STEMI patients having undergone primary PCI with high thrombus burden is probably associated with lower rates of the "no-reflow" phenomenon and improved vessel reperfusion.  

  4. Effect of antithrombotic agents on the patency of PTFE-Covered stents in the inferior vena cava: An experimental study

    International Nuclear Information System (INIS)

    Purpose: To evaluate the efficacy of antithrombotic agents in the prevention of stenosis of polytetrafluororethylene (PTFE)-covered stents in the venous system.Methods: Spiral Z stents covered with PTFE (PTFE-covered stents) were placed in the inferior vena cava (IVC) of 34 dogs. Nineteen dogs, used as a control group, were sacrificed at 2, 4, and 12 weeks. Fifteen dogs, previously given antithrombotic agents [cilostazol (n=5), warfarin potassium (n=5), cilostazol plus warfarin potassium (n=5)] were sacrificed at 4 weeks, and then examined angiographically and histopathologically. The effect of the antithrombotic agents was compared between groups.Results: The patency rate of the antithrombotic agent group was 93% (14/15), which was higher than the control group rate of 63% (12/19). The mean stenosis rate of the patent stent at both ends and at the midportion was lower at 4 weeks in the antithrombotic agent group than in the control group. In particular, the mean stenosis rate in the cilostazol plus warfarin potassium group was significantly lower than the control group (Tukey's test, p < 0.05). The mean neointimal thickness of the patent stent at both ends and at the midportion was thinner at 4 weeks in the antithrombotic agent group than in the control group. In particular, the thickness of the neointima in the cilostazol plus warfarin potassium group was significantly decreased when compared with the control group (Tukey's test p < 0.05). At 4 weeks, endothelialization in the antithrombotic agent group tended to be almost identical to that in the control group.Conclusion: The present study suggests that administration of an antithrombotic agent is an effective way of preventing the stenosis induced by a neointimal thickening of PTFE-covered stents in the venous system.

  5. Effect of Antithrombotic Agents on the Patency of PTFE-Covered Stents in the Inferior Vena Cava: An Experimental Study

    International Nuclear Information System (INIS)

    Purpose: To evaluate the efficacy of antithrombotic agents in the prevention of stenosis of polytetrafluoroethylene (PTFE)-covered stents in the venous system. Methods: Spiral Z stents covered with PTFE (PTFE-covered stents) were placed in the inferior vena cava (IVC) of 34 dogs. Nineteen dogs, used as a control group, were sacrificed at 2, 4, and 12 weeks. Fifteen dogs, previously given antithrombotic agents [cilostazol (n= 5), warfarin potassium (n= 5), cilostazol plus warfarin potassium (n= 5)] were sacrificed at 4 weeks, and then examined angiographically and histopathologically. The effect of the antithrombotic agents was compared between groups. Results: The patency rate of the antithrombotic agent group was 93% (14/15), which was higher than the control group rate of 63% (12/19). The mean stenosis rate of the patent stent at both ends and at the midportion was lower at 4 weeks in the antithrombotic agent group than in the control group. In particular, the mean stenosis rate in the cilostazol plus warfarin potassium group was significantly lower than the control group (Tukey's test, p < 0.05). The mean neointimal thickness of the patent stent at both ends and at the midportion was thinner at 4 weeks in the antithrombotic agent group than in the control group. In particular, the thickness of the neointima in the cilostazol plus warfarin potassium group was significantly decreased when compared with the control group (Tukey's test p < 0.05). At 4 weeks, endothelialization in the antithrombotic agent group tended to be almost identical to that in the control group. Conclusion: The present study suggests that administration of an antithrombotic agent is an effective way of preventing the stenosis induced by a neointimal thickening of PTFE-covered stents in the venous system

  6. Carotid intima-media thickness and apolipoproteins in patients of ischemic stroke in a rural hospital setting in central India: A cross-sectional study

    OpenAIRE

    Jyoti Jain; Tejal Lathia; Om Prakash Gupta; Vishakha Jain

    2012-01-01

    Context: Carotid intima-media thickness (CIMT) and apolipoproteins have been found as a risk factor for ischemic stroke . Objective: The objective was to study the carotid intima-media thickness, apolipoproteins, and their relation in patients of ischemic stroke in central rural India. Settings and Design: A cross-sectional study was performed in a rural hospital in central India. Materials and Methods: In all patients of ischemic stroke proven by computerized tomography (CT), CIMT, apolipopr...

  7. A Multicenter, Prospective Study of a New Fully Covered Expandable Metal Biliary Stent for the Palliative Treatment of Malignant Bile Duct Obstruction

    Directory of Open Access Journals (Sweden)

    Bret T. Petersen

    2013-01-01

    Full Text Available Background and Study Aims. Endoscopic placement of self-expanding metal stents (SEMSs is indicated for palliation of inoperable malignant biliary obstruction. A fully covered biliary SEMS (WallFlex Biliary RX Boston Scientific, Natick, USA was assessed for palliation of extrahepatic malignant biliary obstruction. Patients and Methods. 58 patients were included in this prospective, multicenter series conducted under an FDA-approved IDE. Main outcome measurements included (1 absence of stent occlusion within six months or until death, whichever occurred first and (2 technical success, need for reintervention, bilirubin levels, stent patency, time to stent occlusion, and adverse events. Results. Technical success was achieved in 98% (57/58, with demonstrated acute removability in two patients. Adequate clinical palliation until completion of followup was achievedin 98% (54/55 of evaluable patients, with 1 reintervention due to stent obstruction after 142 days. Mean total bilirubin decreased from 8.9 mg/dL to 1.2 mg/dL at 1 month. Device-related adverse events were limited and included 2 cases of cholecystitis. One stent migrated following radiation therapy. Conclusions. The WallFlex Biliary fully covered stent yielded technically successful placement with uncomplicated acute removal where required, appropriate reduction in bilirubin levels, and low rates of stent migration and occlusion. This SEMS allows successful palliation of malignant extrahepatic biliary obstruction.

  8. The placement of Y-shaped titanium-nickel memory alloy stent in the carina: a fundamental study in experimental canines

    International Nuclear Information System (INIS)

    Objective: To investigate the pathological changes of local airway tissue after inserting Yshaped titanium-nickel memory alloy stent in carina, and to evaluate CT three-dimensional reconstruction technique in postoperative and follow-up observation. Methods: Twelve healthy adult canines were enrolled in this study. Based on the information of the carina obtained from CT three-dimensional reconstruction images, the preparation of Y-shape netlike stent was made by knitting method with single Ni-Ti memory alloy wire. The stent was then inserted in canine's carina with the help of a releasing system. After the operation fiberbronchoscopy and CT three-dimensional reconstruction were performed. The animals were sacrificed 12 weeks after the procedure and the bronchus of the stenting segment was removed and sent for histopathologic examination. Results: Technical success was achieved in all canines with the stent right in the carina. The airway remained unobstructed 12 weeks after the procedure. Histopathologic examination revealed that the stent became partial epithelialization. Conclusion: The Y-shaped titanium-nickel memory alloy stent has good histocompatibility and physicochemical stability and no re-stenosis of the airway develops in the follow-up period of three months. The stent-releasing technique is easy and simple. As a non-invasive and convenient exam, CT three-dimensional reconstruction technique is of great value in postoperative follow-up observation. (authors)

  9. Long-term follow-up study of dilation with temporary cardia stent in different diameters for achalasia

    International Nuclear Information System (INIS)

    Objective: To determine the curative effect of dilation for achalasia with temporary cardia stent in different diameters based on a long-term follow-up. Methods: Th study cohort was comprised of 135 patients of achalasia. Among them differentiated by stent diameters as followings: 30 patients were treated under fluoroscopy with dilation of temporary cardia stent in 20 mm diameter (group A), 30 patients with dilation of temporary cardia stent in 25 mm diameter (group B), and 75 patients with dilation of temporary cardia stent in 30 mm diameter (group C). 135 cardia stents were temporarily placed in the 135 patients and withdrawn after 3-5 days via gastroscopy. All the stents were inserted and withdrawn successfully. the follow-up in all groups lasted 6-128 months. Results: Six (20.0%) out of 30 patients, 6(20.0%) out of 30 patients, 5(22.7%) out of 22 patients, 6 (37.5%) out of 16 patients, 5 out of 9 patients, 3 out of 3 patients in group A exhibited dysphagia relapse during 6 months, 1 year, 3 years, 5 years, 8 years, and 10 years follow-up, respectively. Four (13.3%) out of 30 patients, 4(13.3%) out of 30 patients, 3(13.0%) out of 23 patients, 4(22.2%) out of 18 patients, 5(45.4%) out of 11 patients, and 3 out of 4 patients in group B exhibited dysphagia relapse during 6 months, 1 year, 3 years, 5 years, 8 years, and 10 years follow-up, respectively. No (0.0%) out of 75 patients, 1(1.5%) out of 66 patients, 4(8.3%) out of 48 patients, 6(18.2%) out of 33 patients, 6(33.3%) out of 18 patients, 2 out of 5 patients in group C exhibited dysphagia relapse during 6 months, 1 year, 3 years, 5 years, 8 years, and 10 years follow-up, respectively. Conclusion: Dilation with temporary cardia metal stent in 30 mm diameter is the best dilation for achalasia in long-term follow-up. (authors)

  10. High-Definition Computed Tomography for Coronary Artery Stent Imaging: a Phantom Study

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Wen Jie; Chen, Ke Min; Pang, Li Fang; Zhang, Huang; Pan, Zi Lai [Rui Jin Hospital, Medical School, Shanghai Jiao Tong University, Shangha (China); Guo, Ying; Li, Jian Ying [Beijing Economic and Technology Development Area, Beijing (China)

    2012-01-15

    To assess the performance of a high-definition CT (HDCT) for imaging small caliber coronary stents ({<=} 3 mm) by comparing different scan modes of a conventional 64-row standard-definition CT (SDCT). A cardiac phantom with twelve stents (2.5 mm and 3.0 mm in diameter) was scanned by HDCT and SDCT. The scan modes were retrospective electrocardiography (ECG)-gated helical and prospective ECG-triggered axial with tube voltages of 120 kVp and 100 kVp, respectively. The inner stent diameters (ISD) and the in-stent attenuation value (AVin-stent) and the in-vessel extra-stent attenuation value (AVin-vessel) were measured by two observers. The artificial lumen narrowing (ALN = [ISD - ISDmeasured]/ISD) and artificial attenuation increase between in-stent and in-vessel (AAI = AVin-stent - AVin-vessel) were calculated. All data was analyzed by intraclass correlation and ANOVA-test. The correlation coefficient of ISD, AVin-vessel and AVin-stent between the two observers was good. The ALNs of HDCT were statistically lower than that of SDCT (30 {+-} 5.7% versus 35 {+-} 5.4%, p < 0.05). HDCT had statistically lower AAI values than SDCT (15.7 {+-} 81.4 HU versus 71.4 {+-} 90.5 HU, p < 0.05). The prospective axial dataset demonstrated smaller ALN than the retrospective helical dataset on both HDCT and SDCT (p < 0.05). Additionally, there were no differences in ALN between the 120 kVp and 100 kVp tube voltages on HDCT (p = 0.05). High-definition CT helps improve measurement accuracy for imaging coronary stents compared to SDCT. HDCT with 100 kVp and the prospective ECG-triggered axial technique, with a lower radiation dose than 120 kVp application, may be advantageous in evaluating coronary stents with smaller calibers ({<=} 3 mm).

  11. Drug-eluting or bare-metal stents for large coronary vessel stenting? The BASKET-PROVE (PROspective Validation Examination) trial: Study protocol and design

    DEFF Research Database (Denmark)

    Pfisterer, M.; Bertel, O.; Bonetti, P.O.;

    2008-01-01

    refute this hypothesis, we set up an 11-center 4-country prospective trial of 2260 consecutive patients treated with >= 3.0-mm stents only, randomized to receive Cypher (Johnson & Johnson, Miami Lakes, FL), Vision (Abbott Vascular, Abbott Laboratories, IL), or Xience stents (Abbott Vascular). Only...

  12. The elusive link between high sensitivity C-reactive protein and carotid subclinical atherosclerosis in coronary artery bypass grafting candidates: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Nezami Nariman

    2008-05-01

    Full Text Available Abstract Background Previous studies demonstrated a modest association between C-Reactive Protein (CRP, stenosis of carotid artery, and carotid Intima-Media Thickness (IMT in general population. During present study, we aimed to evaluate the relationship between High Sensitivity C-Reactive Protein (hsCRP and Common Carotid Intima-Media Thickness (CCIMT in patients who candidate for Coronary Artery Bypass Grafting (CABG. Methods The study subjects were enrolled from patients with coronary arteries disease referred from Shahid Madani Hospital (Tabriz, Iran, who have been candidate for elective CABG from January 2005 to August 2007. The common carotid arteries were evaluated with high-resolution B-mode ultrasonography using a 7.5- MHz linear-array transducer to determine the IMT and grade of stenosis. Serum hsCRP level was measured using commercially available enzyme linked immunosorbent assay kit. Results Finally, information of 176 CABG candidates was analysed. The mean age of participants was 62.71 ± 9.45 years with 1.63 male to female ratio. The mean of CCIMT was 0.69 ± 0.54 mm. Although there was no significant correlation between serum hsCRP level and CCIMT in patients without carotid stenosis (p=0.113, r=0.186, participants with common carotid artery stenosis had higher levels of serum hsCRP than participants without stenosis (2.42+/-1.30 vs. 1.20+/-0.97 mg/dl; p=0.009. Conclusion Study results showed that there was no correlation between serum hsCRP level and CCIMT in patients without carotid stenosis, but patients with common carotid artery stenosis had higher levels of serum hsCRP than patients without stenosis.

  13. Evaluation of the Anti-migration Effect of Barbed Prostatic Stents: In Vitro Study in Urethra-mimicking Bovine Pericardium Phantoms

    International Nuclear Information System (INIS)

    This study was designed to compare the migration rates of covered stents with eight, four, and zero barbs in urethra-mimicking bovine pericardium models. Three types of polytetrafluoroethylene-covered retrievable self-expandable prostatic stents, with eight, four, and zero barbs, were tested in bovine pericardium models, consisting of normal saline-filled acrylic containers with tubes at both ends and a replica of the human urethra. The barbs were 2 mm in length and projected 60° toward the urinary bladder. The anti-migration force (AMF) and resistance force against stent removal (RFSR) were measured by an automatic push–pull gauge system at a fixed rate (2 mm/s). Significant differences in AMF among the three stent types were detected (P < 0.001). Median AMF was far greater for eight-barbed than for four-barbed stents (11.96 vs. 7.55 N, P = 0.003). For stent removal, the difference between 4- and 8-barbed stents were not significant in median static (5.54 vs. 6.08 N, P = 0.15) or sliding (prostatic urethra, 5.32 vs. 5.59 N, P = 0.65; membranous urethra, 7.78 vs. 8.57 N, P = 0.364) RFSR. No perforations or scratched traces were observed during removal of these stents. The inclusion of eight barbs projecting 60° toward the urinary bladder were not only effective against stent migration in this model but suggests that these stents may be suitable for the treatment of prostatic urethral strictures without severely irritating the tissue. However, whether these results translate into living urethral tissue is unclear, necessitating further studies.

  14. Wall shear stress as a stimulus for carotid atherosclerotic plaque progression: An MRI-based CFD pilot study

    Science.gov (United States)

    Canton, Gador; Chiu, Bernard; Hatsukami, Tom; Kerwin, William; Yuan, Chun

    2010-11-01

    The aim of this study was to explore the hypothesis that intra-plaque hemorrhage, a feature associated with adverse outcomes and atherosclerotic plaque progression and destabilization, is more likely to occur in plaques with elevated levels of wall shear stress (WSS). We used multi-sequence in-vivo magnetic resonance imaging (MRI) to characterize ten human carotid atherosclerotic plaques and an MRI-based computational fluid dynamics (CFD) model to solve the equations governing the blood flow. Hemorrhage was detected within the necrotic core (intra-plaque hemorrhage) in five of these ten cases. WSS data were extracted from the results of the CFD simulations to compare patterns between the cases with and without hemorrhage. We computed the mean value of the WSS (for each time point of the cardiac cycle) at the region where a necrotic core was detected. The results from this pilot study indicate a possible link between the presence of hemorrhage within a lipid-rich necrotic core in human carotid atherosclerotic plaques and elevated levels of shear stress force acting on the luminal surface. Thus, elevated wall shear stress may be used as a high risk feature in advanced carotid atherosclerotic plaques.

  15. Clinical study on external carotid artery infusion (trans-femoral) treatment of recurrent nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Objective: To evaluate the effect and safety of external carotid artery infusion treatment of recurrent nasopharyngeal carcinoma (NPC). Methods: 20 cases of recurrent NPC (13 male and 7 female, age 36-65 years, mean 50 years) diagnosed by clinical examination (including nasopharyngoscope), serology (VCA-IgA) and imaging (CT, MR) and treated by external carotid artery infusion (trans-femoral) with adriamycin (or epi-adriamycin), cisplatin (or carboplatin), Pingyangmycin and 5-Fluorouracil. Results: Of all the patients, 8 cases (40%) had a complete response (CR), 7 cases (35%) had a partial response (PR). The overall response rate (CR + PR) was 75%. Cumulative survival rates at 1, 3 years were 90% (18/20), 50%(10/20) respectively. No severe side-effects and complications found. Conclusion: External carotid artery infusion (trans-femoral) should be effective and safe in the treatment of recurrent NPC

  16. Relation of glycated hemoglobin with carotid atherosclerosis in ischemic stroke patients: An observational study in Indian population

    Directory of Open Access Journals (Sweden)

    Amit Shankar Singh

    2013-01-01

    Full Text Available Context: Glycated hemoglobin A 1 c (HbA 1 c indicates long-term uncontrolled hyperglycemia in the body, which in diabetic patients leads to various vascular complications as a part of generalized atherosclerosis culminating ultimately into ischemic stroke. Aims: Study aims to show the association between marker of uncontrolled long-term hyperglycemia HbA 1 c and marker of atherosclerosis (Carotid intima media thickness [CIMT] and carotid plaque in ischemic stroke patients. Subjects and Methods: Carotid sonography using high resolution 7.5 MHz sonography technique was done in each patient to find the occurrence of increased CIMT and presence of plaque according to Mannheim CIMT Consensus (2004-2006. Levels of HbA 1 c measured in blood in both diabetic and non-diabetic patients and a comparison made between them. Finally an association sought between HbA 1 c levels with CIMT and plaque. Results: The average value of HbA 1 c of this cohort was 7.51 ± 1.75% with higher values in diabetic patients (9.29 ± 1.73%. The patients with high CIMT (>0.8 mm had higher values of HbA 1 c then that of normal CIMT patients and this was nearly significantly (P = 0.06. However, HbA 1 c levels of blood were significantly associated with stroke patients with presence of carotid arteries plaque (P = 0.008. Conclusions: Prediction of future risk and prevention strategies for ischemic stroke could be formulated by utilizing HbA 1 c levels in both diabetic and non-diabetic population.

  17. Quantitative studies of the vasculature of the carotid body in the chronically hypoxic rat

    OpenAIRE

    Clarke, J.A.; Daly, M. B.; Marshall, J. M.; Ead, H. W.; Hennessy, E M

    2000-01-01

    The carotid bodies of rats made chronically hypoxic by breathing 12% O2 in a normobaric chamber (inspired PO2 91 mmHg) were compared with those of controls. Serial 5-µm sections of the organs were examined using an interactive image analysis system. The total volume of the carotid bodies was increased by 64%. The total vascular volume rose by 103% and was likely due to an increase in size of the large vessels (>12 µm lumen diameter) because the small vessel (5-12 µm lumen diameter) volume ...

  18. Performing Permanent Distal Middle Cerebral with Common Carotid Artery Occlusion in Aged Rats to Study Cortical Ischemia with Sustained Disability.

    Science.gov (United States)

    Wayman, Christina; Duricki, Denise A; Roy, Lisa A; Haenzi, Barbara; Tsai, Shi-Yen; Kartje, Gwendolyn; Beech, John S; Cash, Diana; Moon, Lawrence

    2016-01-01

    Stroke typically occurs in elderly people with a range of comorbidities including carotid (or other arterial) atherosclerosis, high blood pressure, obesity and diabetes. Accordingly, when evaluating therapies for stroke in animals, it is important to select a model with excellent face validity. Ischemic stroke accounts for 80% of all strokes, and the majority of these occur in the territory of the middle cerebral artery (MCA), often inducing infarcts that affect the sensorimotor cortex, causing persistent plegia or paresis on the contralateral side of the body. We demonstrate in this video a method for producing ischemic stroke in elderly rats, which causes sustained sensorimotor disability and substantial cortical infarcts. Specifically, we induce permanent distal middle cerebral artery occlusion (MCAO) in elderly female rats by using diathermy forceps to occlude a short segment of this artery. The carotid artery on the ipsilateral side to the lesion was then permanently occluded and the contralateral carotid artery was transiently occluded for 60 min. We measure the infarct size using structural T2-weighted magnetic resonance imaging (MRI) at 24 hr and 8 weeks after stroke. In this study, the mean infarct volume was 4.5% ± 2.0% (standard deviation) of the ipsilateral hemisphere at 24 hr (corrected for brain swelling using Gerriet's equation, n = 5). This model is feasible and clinically relevant as it permits the induction of sustained sensorimotor deficits, which is important for the elucidation of pathophysiological mechanisms and novel treatments. PMID:26967269

  19. Combined-stent covered technique and single covered stent technique for transjugular intrahepatic porto-systemic shunt: a prospective randomized controlled study

    International Nuclear Information System (INIS)

    Objective: To compare the technique of combined stents with that of single stent-graft for the construction of transjugular intrahepatic porto-systemic shunt (TIPS) and to discuss their clinical outcomes. Methods: During the period from April 2011 to Dec. 2012, a total of 30 patients with upper gastrointestinal bleeding due to portal hypertension were admitted to the hospital. TIPS procedure was carried out in all the 30 patients. The patients were randomly allocated into either combined-stent group (n=17) or stent-graft group (control group, n=13) on the basis of a computer-generated randomization sequence. The PSC quality control, the patency rate of portal vein branches and the shunts, the incidence of encephalopathy and the survival rate of the two groups were documented and analyzed. Results: Technical success rate was 100%. After the treatment, in both groups the PSG became significantly lower than the PSG determined before the treatment (P<0.000). According to quality control chart, the of combined stents was superior to stent-graft technique in effectively controlling PSG. Five days after TIPS, the ammonia level in the combined- stent group was significantly decreased (P=0.029), while in the control group the ammonia level showed no significant changes (P=0.065). One patient died shortly after TIPS. The median follow- up time was 181 days. During the follow-up period death occurred in 3 cases in each group. The difference in the survival rate between the two groups was no significant (P=0.906). Of the three patients who developed encephalopathy, two were in the combined-stent group and one was in the control group. After medication the symptoms of encephalopathy were relieved. The patency rate of the shunts was 100% and the re-bleeding rate was 0% for both groups. The patency rate of portal vein branches was significantly higher in the combined-stent group than that in the control group (P=0.039). Conclusion: For the construction of TIPS, the technique of

  20. Direct coronary stenting in reducing radiation and radiocontrast consumption

    International Nuclear Information System (INIS)

    Coronary stenting is the primary means of coronary revascularization. There are two basic techniques of stent implantation: stenting with balloon predilatation of stenosis and stenting without predilatation (direct stenting). Limiting the time that a fluoroscope is activated and by appropriately managing the intensity of the applied radiation, the operator limits radiation in the environment, and this saves the exposure to the patient and all personnel in the room. Nephrotoxicity is one of the most important properties of radiocontrast. The smaller amount of radiocontrast used also provides multiple positive effects, primarily regarding the periprocedural risk for the patients with the reduced renal function. The goal of the study was to compare fluoroscopy time, the amount of radiocontrast, and expenses of material used in direct stenting and in stenting with predilatation. In a prospective study, 70 patients with coronary disease were randomized to direct stenting, or stenting with predilatation. Fluoroscopy time and radiocontrast use were significantly reduced in the directly stented patients in comparison to the patients stented with balloon-predilatation. The study showed a significant reduction of expenses when using a direct stenting method in comparison to stenting with predilatation. If the operator predicts that the procedure can be performed using direct stenting, he is encouraged to do so. Direct stenting is recommended for all percutaneous coronary interventions when appropriate conditions have been met. If direct stenting has been unsuccessful, the procedure can be converted to predilatation

  1. Efficacy and safety of fully covered self-expandable metallic stents in biliary complications after liver transplantation: a preliminary study.

    Science.gov (United States)

    Traina, Mario; Tarantino, Ilaria; Barresi, Luca; Volpes, Riccardo; Gruttadauria, Salvatore; Petridis, Ioannis; Gridelli, Bruno

    2009-11-01

    After liver transplantation, the most common biliary complication is the anastomotic stricture, which is followed by biliary leakage. Studies have focused on the endoscopic treatment of biliary complications in transplanted patients with duct-to-duct reconstruction, showing a success rate of 70% to 80% after orthotopic liver transplantation and of 60% after living-related liver transplantation. Once the endoscopic approach fails, surgical treatment with a Roux-en-Y choledochojejunostomy is the sole alternative treatment. The aim of this prospective observational study was to analyze the efficacy and safety of fully covered self-expandable metallic stents for the treatment of posttransplant biliary stenosis and leaks in patients in whom conventional endoscopic retrograde cholangiopancreatography (ERCP) failed. From January 2008 to January 2009, 16 patients met the criteria of endoscopic treatment failure, and instead of surgery, a fully covered stent was placed. All patients had at least 6 months of follow-up (mean follow-up of 10 months). After removal, 14 patients showed immediate resolution of both the biliary stenosis and leak. After a mean of 10 months of follow-up, only 1 patient showed biliary stenosis recurrence. No major complications occurred in any of the patients, except for stent migration in 6 patients, although these presented with no clinical consequences. In conclusion, in patients not responding to standard endoscopic treatment, the placement of fully covered metal stents is a valid alternative to surgery. A cost analysis should be performed in order to evaluate whether to treat transplanted patients suffering from biliary complications with covered self-expandable metallic stent placement as first-line therapy. PMID:19877248

  2. Peri-stent contrast staining, major evaginations and severe malapposition after biolimus-eluting stent implantation

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Thayssen, Per; Jensen, Lisette Okkels

    2014-01-01

    Peri-stent contrast staining and late acquired malapposition represent pathological vessel wall healing patterns following percutaneous coronary intervention with stent implantation. Earlier studies have described these abnormal vessel wall responses commonly present after implantation of first...

  3. 64-slice Computed Tomography Assessment of Coronary Artery Stents: a Phantom Study

    Energy Technology Data Exchange (ETDEWEB)

    Mahnken, A.H.; Muehlenbruch, G.; Seyfarth, T.; Flohr, T.; Stanzel, S.; Wildberger, J.E.; Guenther, R.W.; Kuettner, A. [Aachen Univ. of Technology (Germany). Dept. of Diagnostic Radiology

    2006-02-15

    Purpose: To compare the use of a new 64-slice computed tomography (CT) scanner with 16-slice CT in the visualization of coronary artery stent lumen. Material and Methods: Eight different coronary artery stents, each with a diameter of 3 mm, were placed in a static chest phantom. The phantom was positioned in the CT gantry at an angle of 0 deg and 45 deg towards the z-axis and examined with both a 64-slice and a 16-slice CT scanner. Effective slice thickness was 0.6 mm with 64-slice CT and 1 mm with 16-slice CT. A reconstruction increment of 0.3 mm was applied in both scanners. Image quality was assessed visually using a 5-point grading scale. Stent diameters were measured and compared using paired Wilcoxon tests. Results: Artificial lumen reduction was significantly less with 64-slice than with 16-slice CT. Average visible stent lumen was 53.4% using 64-slice CT and 47.5% with 16-slice MSCT. Most severe artifacts were seen in stents with radiopaque markers. Using 64-slice CT, image noise increased by approximately 30% due to thinner slice thickness. Conclusion: Improved spatial resolution of 64-slice CT resulted in superior assessment of coronary artery stent lumen compared to 16-slice CT. However, a relevant part of the stent lumen is still not assessable with multi-slice CT.

  4. Prospective study of screening for blunt intracranial carotid arterial injuries following basilar skull fractures

    International Nuclear Information System (INIS)

    Blunt intracranial carotid arterial injuries (BCIs) are considered rare, but have the potential for a devastating outcome. Early diagnosis of intracranial vascular injuries is extremely difficult, owing to the preferential use of computed tomographic (CT) scanning on its own as a method for the evaluation of head trauma cases. Patients are commonly referred for angiographies only when their clinical conditions become obvious. To diagnose BCIs at an early stage, we performed cerebral angiographies aggressively when initial head CT scanning revealed basilar skull fractures in the proximity to the carotid artery. From November 2000 to September 2002, 202 patients with blunt head trauma were admitted to the Nakakawachi Medical Center of Acute Medicine, a certified Level I trauma center. We investigated a total of 16 blunt head trauma patients with basilar skull fractures to determine the existence of BCIs. A total of 16 patients were angiographically examined, with 7 patients (44%) being identified as having BCIs. Five patients had unilateral BCIs, while 2 patients were found to have bilateral BCIs. We observed various types of BCIs, including 3 stenotic lesions of stenosis due to dissection, 3 cases of carotid-cavernous fistulas, 3 aneurysmal dilatation lesions and one case of occlusion, which were found at initial angiography. Two patients underwent endovascular surgery. One patient underwent craniotomy (wrapping). Both endovascular surgery and craniotomy (trapping with anastomosis) were performed on one patient. The other 3 patients managed conservatively. After the performance of initial angiographies, neurologically deteriorated patients were not observed. BCI is rare, but lethal, particularly when the diagnosis is delayed, thus aggressive screening is necessary to prevent deterioration. Basilar skull fractures near the carotid artery are the most important risk factor for BCI. When initial head CT scanning reveals basilar skull fracture near the carotid artery in

  5. Feasibility study for the investigation of Nitinol self-expanding stents by neutron techniques

    Energy Technology Data Exchange (ETDEWEB)

    Rogante, M., E-mail: main@roganteengineering.i [Rogante Engineering Office, Contrada San Michele n. 61, 62012 Civitanova Marche (Italy); Pasquini, U. [Image and Neuroradiology Deptms, Azienda USL, Emilia-Romagna Region Health Service, 47023 Cesena (Italy); Rosta, L. [Research Institute for Solid State Physics and Optics, P.O. Box 49, H-1525 Budapest (Hungary); Lebedev, V. [Petersburg Nuclear Physics Institute, Gatchina, St. Petersburg (Russian Federation)

    2011-02-01

    In this paper, neutron techniques - in particular, small angle neutron scattering (SANS) and neutron diffraction (ND) - are considered for the non-destructive characterization of Nitinol artery stents. This roughly equiatomic (50Ni-50Ti at%) shape memory alloy (SMA) exhibits significant properties of superelasticity and biocompatibility that make it suitable to be typically used as smart material for medical implants and devices. Nitinol self-expanding artery stents, as permanent vascular support structures, supply an ideal option to bypass surgery, but they are submitted for the whole of patient's life to the dynamical stress of the artery pulsation and the aggression from the biological environment. These stents, consequently, can suffer from wear and fracture occurrence likely due to a variety of cyclic fatigue, overload conditions and residual stresses. Neutrons have recently become a progressively more important probe for various materials and components and they allow achieving information complementary to those obtained from the traditional microstructural analyses. The outputs from the preliminary works already carried out in this field consent to consider neutron techniques capable to contribute to the development of these crucial medical implants. The achievable results can yield trends adoptable in monitoring of the stent features. -- Research Highlights: {yields} Neutron techniques can contribute to develop Nitinol self-expanding artery stents. {yields} Neutrons investigations can help avoiding wear and fracture events in Nitinol stents. {yields} Neutron techniques can yield trends adoptable in monitoring of Nitinol stent features. {yields} SANS is able to perform a micro- and nano-scale characterization of Nitinol stents. {yields} Neutron Diffraction helps assessing stresses due to the exercise in Nitinol stents.

  6. Multi-link Vision and MiniVision stent registry in Asian patients with coronary artery disease: a prospective, multi-center study

    Institute of Scientific and Technical Information of China (English)

    XU Ya-wei; HOU Yu-qing; Ashok Jain; Parvez Grant; Gudapati Ramesh; Basavappa Ramesh; Chumpol Piamsomboon; Srun Kuanprasert; Hyeon-Cheol Gwon; Yoon Haeng Cho; Haizal Haroon Kamar; WEI Yi-dong; HUANG Cong-xin; TANG Kai; CHEN Yan-qing; LI Wei-ming; YU Xue-jing; QIN Yong-wen; QI Guo-xian; QU Peng

    2007-01-01

    Background Recent studies have showed that the fine mesh stents are associated with a significant reduction in both clinical and angiographic re-stenosis of the coronary arteries. To maintain a very satisfactory radio-opacity using the stents, Guidant of the USA has designed a new type of bare metal stents (BMS)-Multi-link (ML) Vision / ML MiniVision stents. The clinical outcomes of Asian patients with coronary artery disease (CAD) after implanting the Multi-link Vision or MiniVision stent were investigated in this study.Methods An observational, prospective, multi-center, non-randomized post marketing registry was conducted to demonstrate the efficacy of the BMS- ML Vision / ML MiniVision stents. The primary end point of the registry was clinical target lesion revascularization (TLR) at a 6-month follow-up. The major secondary end points included the rate of major adverse cardiac events (MACE) and serious adverse events (SAE) in hospital and at 6 months; and the rate of clinical TLR as a function of the type of angina. A total of 429 Asian people with 449 lesions from 14 centers were selected for this study. The average reference diameter of the lesions was (3.0±0.5) mm, and the mean length was (15.7±5.0) mm.Results The successful rate of the procedure was 99.3%. Twenty-five percent of the lesions were treated by direct stenting without pre-dilation. Eighty-six percent of the lesions were implanted with ML Vision stent. After the 6-month follow-up, the rate of clinical TLR was 1.4%. The MACE, SAE and target vessel revascularization (TVR) were 6.8%, 3.5%and 1.4% respectively.Conclusion The current registry showed the excellent 6-month clinical outcomes of ML Vision/ML MiniVision stents in Asian patients with CAD.

  7. Reperfusion hemorrhage following superior mesenteric artery stenting.

    LENUS (Irish Health Repository)

    Moore, Michael

    2012-02-03

    Percutaneous transluminal angioplasty and stent placement is now an established treatment option for chronic mesenteric ischemia and is associated with low mortality and morbidity rates. We present a case of reperfusion hemorrhage complicating endovascular repair of superior mesenteric artery stenosis. Although a recognized complication following repair of carotid stenosis, hemorrhage has not previously been reported following mesenteric endovascular reperfusion. We describe both spontaneous cessation of bleeding and treatment with coil embolization.

  8. Unilateral and bilateral internal carotid artery stenosis or occlusion: a study of the secondary collateral circulation

    International Nuclear Information System (INIS)

    Objective: It's a study of the collateral circulation secondary to unilateral and bilateral internal carotid artery (ICA) severe stenosis or occlusion using digital subtract angiography (DSA) and magnetic resonance angiography (MRA). Methods: Ninty-five patients with ICA stenosis or occlusion were diagnosed by DSA or MRA. Forty-four patients were assessed by DSA, and fifty-one patients were evaluated by MRA, who were divided into two groups of the unilateral and bilateral involvement. DSA, MRA findings were analyzed, by which the patterns of the collateral circulation were comparatively studied. Results: The presence rate of anterior communicating artery (AcoA) in the unilateral group on DSA and MRA was significantly higher than that in the bilateral group (P0.05). On DSA, the presence rate of ophthalmic artery (OphA) in the unilateral and bilateral groups had no significant difference between the two groups. The augmentation rate of the OphA in the bilateral group was significantly higher than that in the unilateral group (P<0.05). The presence rate of leptomeningeal anastomosis in the bilateral group was significantly higher than that in the unilateral group on DSA and MRA (P<0.01). Conclusion: In patients with the unilateral and bilateral ICA stenosis or occlusion, the collateral circulation formats in different patterns. The major collateral pathways secondary to the unilateral ICA stenosis or occlusion are AcoA and ispilateral PCoA, while to the bilateral ICA stenosis or' occlusion are PCoA, OPhA, and leptomeningeal anastomosis. (authors)

  9. A randomized multicenter comparison of hybrid sirolimus-eluting stents with bioresorbable polymer versus everolimus-eluting stents with durable polymer in total coronary occlusion: rationale and design of the Primary Stenting of Occluded Native Coronary Arteries IV study

    Directory of Open Access Journals (Sweden)

    Teeuwen Koen

    2012-12-01

    Full Text Available Abstract Background Percutaneous recanalization of total coronary occlusion (TCO was historically hampered by high rates of restenosis and reocclusions. The PRISON II trial demonstrated a significant restenosis reduction in patients treated with sirolimus-eluting stents compared with bare metal stents for TCO. Similar reductions in restenosis were observed with the second-generation zotarolimus-eluting stent and everolimus-eluting stent. Despite favorable anti-restenotic efficacy, safety concerns evolved after identifying an increased rate of very late stent thrombosis (VLST with drug-eluting stents (DES for the treatment of TCO. Late malapposition caused by hypersensitivity reactions and chronic inflammation was suggested as a probable cause of these VLST. New DES with bioresorbable polymer coatings were developed to address these safety concerns. No randomized trials have evaluated the efficacy and safety of the new-generation DES with bioresorbable polymers in patients treated for TCO. Methods/Design The prospective, randomized, single-blinded, multicenter, non-inferiority PRISON IV trial was designed to evaluate the safety, efficacy, and angiographic outcome of hybrid sirolimus-eluting stents with bioresorbable polymers (Orsiro; Biotronik, Berlin, Germany compared with everolimus-eluting stents with durable polymers (Xience Prime/Xpedition; Abbott Vascular, Santa Clara, CA, USA in patients with successfully recanalized TCOs. In total, 330 patients have been randomly allocated to each treatment arm. Patients are eligible with estimated duration of TCO ≥4 weeks with evidence of ischemia in the supply area of the TCO. The primary endpoint is in-segment late luminal loss at 9-month follow-up angiography. Secondary angiographic endpoints include in-stent late luminal loss, minimal luminal diameter, percentage of diameter stenosis, in-stent and in-segment binary restenosis and reocclusions at 9-month follow-up. Additionally, optical coherence

  10. Traumatic carotid-rosenthal fistula treated with Jostent Graftmaster

    Institute of Scientific and Technical Information of China (English)

    Hesham; Allam; R; Charles; Callison; Daniel; Scodary; Aws; Alawi; Daniel; W; Hogan; Amer; Alshekhlee

    2014-01-01

    Traumatic injuries of the carotid artery may result in severe morbidity and mortality. The most common location of carotid artery injury is the cavernous segment, which may result in fistulous connection to the cavernous sinus and ophthalmic veins, which in turn lead to pressure symptoms in the ipsilateral orbit. Unlike the commonly reported direct traumatic carotid-cavernous fistula, we describe an unusual case of a 38-year-old man presented with a traumatic brain injury led to a fistula connection between the cavernous carotid artery and the ipsilateral basal vein of Rosenthal, with eventual drainage to the straight and transverse sinuses. The basal vein of Rosenthal is usually formed from confluence of anterior and middle cerebral veins deep in the Sylvian fissure and drain the insular cortex and the cerebral peduncles to the vein of Galen. Immediate endovascular deployment of a covered stent in the cavernous carotid artery allowed sealing the laceration site. Three months follow up showed a non-focal neurological examination and healed carotid laceration over the covered stent.

  11. Population-based study of ABCD2 score, carotid stenosis, and atrial fibrillation for early stroke prediction after transient ischemic attack: the North Dublin TIA study.

    LENUS (Irish Health Repository)

    Sheehan, Orla C

    2010-05-01

    Transient ischemic attack (TIA) etiologic data and the ABCD(2) score may improve early stroke risk prediction, but studies are required in population-based cohorts. We investigated the external validity of the ABCD(2) score, carotid stenosis, and atrial fibrillation for prediction of early recurrent stroke after TIA.

  12. Novel J stents reduce the risk of embolic stroke in vitro

    Energy Technology Data Exchange (ETDEWEB)

    Bartoli, Carlo R. [University of Louisville, M.D./Ph.D. Program, Louisville, KY (United States); Spence, Paul A. [SCR Inc., Louisville, KY (United States); Giridharan, Guruprasad A. [Cardiovascular Innovation Institute, University of Louisville, Department of Bioengineering, Louisville, KY (United States)

    2010-05-15

    Two and a half million Americans with atrial fibrillation are at an elevated risk for embolic stroke. Warfarin therapy is standard treatment for high-risk patients, yet 40-65% of elderly patients do not receive anticoagulation therapy due to bleeding complications. To address this clinical need, we are evaluating a minimally invasive stent-based stroke prevention device to divert emboli from entering the arterial supply of the brain. The feasibility of a J-shaped stroke prevention device was tested in a mock circulatory loop. Sixteen sets of 100 simulated emboli (1-5 mm{sup 3}) were injected into the left atrium with and without J stents protecting the aortic arch vessels. To determine efficacy, emboli were trapped in filters in the aortic arch vessels and distal aorta for manual counting. J stents decreased the number of emboli that entered the brachiocephalic trunk by 93.7% (p<0.0001), left common carotid artery by 79.8% (p<0.0001), and left subclavian artery by 89.7% (p<0.0001). In a mock circulation, J stents positioned in the aortic arch vessels and oriented downstream of aortic flow significantly decreased the number of emboli that entered the aortic arch vessels. These results warrant further investigation to determine the safety and efficacy of this prophylactic intervention to reduce embolic events, and chronic large animal studies are underway. (orig.)

  13. Novel J stents reduce the risk of embolic stroke in vitro

    International Nuclear Information System (INIS)

    Two and a half million Americans with atrial fibrillation are at an elevated risk for embolic stroke. Warfarin therapy is standard treatment for high-risk patients, yet 40-65% of elderly patients do not receive anticoagulation therapy due to bleeding complications. To address this clinical need, we are evaluating a minimally invasive stent-based stroke prevention device to divert emboli from entering the arterial supply of the brain. The feasibility of a J-shaped stroke prevention device was tested in a mock circulatory loop. Sixteen sets of 100 simulated emboli (1-5 mm3) were injected into the left atrium with and without J stents protecting the aortic arch vessels. To determine efficacy, emboli were trapped in filters in the aortic arch vessels and distal aorta for manual counting. J stents decreased the number of emboli that entered the brachiocephalic trunk by 93.7% (p<0.0001), left common carotid artery by 79.8% (p<0.0001), and left subclavian artery by 89.7% (p<0.0001). In a mock circulation, J stents positioned in the aortic arch vessels and oriented downstream of aortic flow significantly decreased the number of emboli that entered the aortic arch vessels. These results warrant further investigation to determine the safety and efficacy of this prophylactic intervention to reduce embolic events, and chronic large animal studies are underway. (orig.)

  14. High-Definition Computed Tomography for Coronary Artery Stent Imaging: a Phantom Study

    International Nuclear Information System (INIS)

    To assess the performance of a high-definition CT (HDCT) for imaging small caliber coronary stents (≤ 3 mm) by comparing different scan modes of a conventional 64-row standard-definition CT (SDCT). A cardiac phantom with twelve stents (2.5 mm and 3.0 mm in diameter) was scanned by HDCT and SDCT. The scan modes were retrospective electrocardiography (ECG)-gated helical and prospective ECG-triggered axial with tube voltages of 120 kVp and 100 kVp, respectively. The inner stent diameters (ISD) and the in-stent attenuation value (AVin-stent) and the in-vessel extra-stent attenuation value (AVin-vessel) were measured by two observers. The artificial lumen narrowing (ALN = [ISD - ISDmeasured]/ISD) and artificial attenuation increase between in-stent and in-vessel (AAI = AVin-stent - AVin-vessel) were calculated. All data was analyzed by intraclass correlation and ANOVA-test. The correlation coefficient of ISD, AVin-vessel and AVin-stent between the two observers was good. The ALNs of HDCT were statistically lower than that of SDCT (30 ± 5.7% versus 35 ± 5.4%, p < 0.05). HDCT had statistically lower AAI values than SDCT (15.7 ± 81.4 HU versus 71.4 ± 90.5 HU, p < 0.05). The prospective axial dataset demonstrated smaller ALN than the retrospective helical dataset on both HDCT and SDCT (p < 0.05). Additionally, there were no differences in ALN between the 120 kVp and 100 kVp tube voltages on HDCT (p = 0.05). High-definition CT helps improve measurement accuracy for imaging coronary stents compared to SDCT. HDCT with 100 kVp and the prospective ECG-triggered axial technique, with a lower radiation dose than 120 kVp application, may be advantageous in evaluating coronary stents with smaller calibers (≤ 3 mm).

  15. Detailing radio frequency heating induced by coronary stents: a 7.0 tesla magnetic resonance study

    OpenAIRE

    Santoro, D; Winter, L. de; Mueller, A; Vogt, J; Renz, W.; Ozerdem, C; Graessl, A; Tkachenko, V.; Schulz-Menger, J.; Niendorf, T

    2012-01-01

    The sensitivity gain of ultrahigh field Magnetic Resonance (UHF-MR) holds the promise to enhance spatial and temporal resolution. Such improvements could be beneficial for cardiovascular MR. However, intracoronary stents used for treatment of coronary artery disease are currently considered to be contra-indications for UHF-MR. The antenna effect induced by a stent together with RF wavelength shortening could increase local radiofrequency (RF) power deposition at 7.0 T and bears the potential ...

  16. Placement of an implantable port catheter in the biliary stent: an experimental study in dogs

    International Nuclear Information System (INIS)

    To investigate the feasibility of port catheter placement following a biliary stent placement. We employed 14 mongrel dogs as test subject and after the puncture of their gaIl bladders using sonographic guidance, a 10-mm in diameter metallic stent was placed at the common duct. In 12 dogs, a 6.3 F port catheter was placed into the duodenum through the common duct and a port was secured at the subcutaneous space following stent placement. As a control group, an 8.5 F drain tube was placed into the gallbladder without port catheter placement in the remaining two dogs. Irrigation of the bile duct was performed every week by injection of saline into the port, and the port catheter was replaced three weeks later in two dogs. Information relating to the success of the procedure, complications and the five-week follow-up cholangiographic findings were obtained. Placement of a biliary stent and a port catheter was technically successful in 13 (93%) dogs, while stent migration (n=3), gallbladder rupture (n=1) and death (n=5) due to subcutaneous abscess and peritonitis also occurred. The follow-up was achieved in eight dogs (seven dogs with a port catheter placement and one dog with a drain tube placement). Irrigation of the bile duct and port catheter replacement were successfully achieved without any complications. Cholangiograms obtained five weeks after stent placement showed diffuse biliary dilation with granulation tissue formation. However, focal biliary stricture was seen in one dog with stent placement alone. Placement of a port catheter following biliary stent placement seems to be feasible. However, further investigation is necessary to reduce the current complications

  17. Detailing Radio Frequency Heating Induced by Coronary Stents: A 7.0 Tesla Magnetic Resonance Study

    OpenAIRE

    Davide Santoro; Lukas Winter; Alexander Müller; Julia Vogt; Wolfgang Renz; Celal Ozerdem; Andreas Grässl; Valeriy Tkachenko; Jeanette Schulz-Menger; Thoralf Niendorf

    2012-01-01

    The sensitivity gain of ultrahigh field Magnetic Resonance (UHF-MR) holds the promise to enhance spatial and temporal resolution. Such improvements could be beneficial for cardiovascular MR. However, intracoronary stents used for treatment of coronary artery disease are currently considered to be contra-indications for UHF-MR. The antenna effect induced by a stent together with RF wavelength shortening could increase local radiofrequency (RF) power deposition at 7.0 T and bears the potential ...

  18. Percutaneous biliary drainage and stenting

    International Nuclear Information System (INIS)

    Full text: Percutaneous transhepatic cholangiography (PTC) is an X-ray or US guided procedure that involves the injection of a contrast material directly into the bile ducts inside the liver to produce pictures of them. If a blockage or narrowing is found, additional procedures may be performed: 1. insertion of a catheter to drain excess bile out of the body or both - internal and external; 2. plastic endoprothesis placement; 3. self-expandable metal stents placement to help open bile ducts or to bypass an obstruction and allow fluids to drain. Current percutaneous biliary interventions include percutaneous transhepatic cholangiography (PTC) and biliary drainage to manage benign and malignant obstructions. Internal biliary stents are either plastic or metallic, and various types of each kind are available. Internal biliary stents have several advantages. An external tube can be uncomfortable and have a psychological disadvantage. An internal stent prevents the problems related to external catheters, for example, pericatheter leakage of bile and the need for daily flushing. The disadvantages include having to perform endoscopic retrograde cholangiopancreatography (ERCP) or new PTC procedures to obtain access in case of stent obstruction. Better patency rates are reported with metallic than with plastic stents in cases of malignant obstruction, though no effect on survival is noted. Plastic internal stents are the cheapest but reportedly prone to migration. Metallic stents are generally not used in the treatment of benign disease because studies have shown poor long-term patency rates. Limited applications may include the treatment of patients who are poor surgical candidates or of those in whom surgical treatment fails. Most postoperative strictures are treated surgically, though endoscopic and (less commonly) percutaneous placement of nonmetallic stents has increasingly been used in the past few years. Now there are some reports about use of biodegradable biliary

  19. Influence of a family history of type 2 diabetes, demographic and clinical data on carotid intima-media thickness in patients with type 1 diabetes: a cross-sectional study

    OpenAIRE

    de Andrade, Carlos Roberto Moraes; Silva, Eliete Leão Clemente; da Matta, Maria de Fátima Bevilaqua; Castier, Marcia Bueno; Rosa, Maria Luiza Garcia; Gomes, Marília Brito

    2014-01-01

    Background Intima-media thickness (IMT) of the common carotid artery is a surrogate end point of cardiovascular disease (CVD). Identifying the factors associated with a higher IMT may contribute to the identification of subjects with higher CVD risk. Our objective was to compare the common carotid IMT of type 1 diabetes patients to healthy control subjects. The secondary objective was to determine factors associated with a higher carotid IMT. Methods We conducted a cross-sectional study betwe...

  20. Quest for the Vulnerable Atheroma: Carotid Stenosis and Diametric Strain--A Feasibility Study.

    Science.gov (United States)

    Xu, Canxing; Yuan, Chun; Stutzman, Edward; Canton, Gador; Comess, Keith A; Beach, Kirk W

    2016-03-01

    The Bernoulli effect may result in eruption of a vulnerable carotid atheroma, causing a stroke. We measured electrocardiography (ECG)-registered QRS intra-stenotic blood velocity and atheroma strain dynamics in carotid artery walls using ultrasonic tissue Doppler methods, providing displacement and time resolutions of 0.1 μm and 3.7 ms. Of 22 arteries, 1 had a peak systolic velocity (PSV) >280 cm/s, 4 had PSVs between 165 and 280 cm/s and 17 had PSVs -0.05 mm), 2 with extreme wall expansion (>0.1 mm), 2 with extreme wall thinning (>-0.1 mm) and 4 with combinations. Decreases in systolic diameter and/or extreme systolic arterial wall thickening may indicate imminent atheroma rupture. PMID:26705891

  1. Influence of strut cross-section of stents on local hemodynamics in stented arteries

    Science.gov (United States)

    Jiang, Yongfei; Zhang, Jun; Zhao, Wanhua

    2016-04-01

    Stenting is a very effective treatment for stenotic vascular diseases, but vascular geometries altered by stent implantation may lead to flow disturbances which play an important role in the initiation and progression of restenosis, especially in the near wall in stented arterial regions. So stent designs have become one of the indispensable factors needed to be considered for reducing the flow disturbances. In this paper, the structural designs of strut cross-section are considered as an aspect of stent designs to be studied in details. Six virtual stents with different strut cross-section are designed for deployments in the same ideal arterial model. Computational fluid dynamics (CFD) methods are performed to study how the shape and the aspect ratio (AR) of strut cross-section modified the local hemodynamics in the stented segments. The results indicate that stents with different strut cross-sections have different influence on the hemodynamics. Stents with streamlined cross-sectional struts for circular arc or elliptical arc can significantly enhance wall shear stress (WSS) in the stented segments, and reduce the flow disturbances around stent struts. The performances of stents with streamlined cross-sectional struts are better than that of stents with non-streamlined cross-sectional struts for rectangle. The results also show that stents with a larger AR cross-section are more conductive to improve the blood flow. The present study provides an understanding of the flow physics in the vicinity of stent struts and indicates that the shape and AR of strut cross-section ought to be considered as important factors to minimize flow disturbance in stent designs.

  2. The Erasme Study: A Multicenter Study on the Safety and Technical Results of the Palmaz Stent Used for the Treatment of Atherosclerotic Ostial Renal Artery Stenosis

    International Nuclear Information System (INIS)

    Purpose: To assess, in a multicenter setting, safety, technical results, and restenosis rate of the Palmaz stent for treatment of atherosclerotic ostial renal artery stenosis. Methods: Ten centers enrolled 106 patients (120 treated renal artery stenoses) in the study. Patient selection was based on unsuccessful percutaneous transluminal renal angioplasty (residual stenosis ≥ 20%) performed for treatment of ostial stenosis ≥ 50%, in patients with hypertension and/or impaired renal function. Safety was assessed by means of the complication rate, and technical results by the number of successful stent placements and occurrence of restenosis (>50%) at intraarterial angiographic follow-up. Results: Stent placement was successful (n = 112) or partially successful (n = 5) in 117 (98%) arteries. Complications occurred in 19 procedures; seven were of serious clinical significance. Angiographic follow-up was performed in 89 of 117 (76%) cases, at a mean of 8 months (range 2.5-18 months). Fifteen stents (16.9%) showed restenosis (at a mean of 8.5 months), of which 10 were successfully redilated. Conclusion: Renal artery stenting has a high technical success rate, a complication rate comparable to percutaneous transluminal renal angioplasty, and a low rate of restenosis at 8 months angiographic follow-up

  3. Differential Associations of Weight Dynamics With Coronary Artery Calcium Versus Common Carotid Artery Intima-Media Thickness: The CARDIA Study

    OpenAIRE

    Lee, Duk-Hee; Steffes, Michael W.; Gross, Myron; Park, Kyong; Holvoet, Paul; Kiefe, Catarina I.; Lewis, Cora E.; Jacobs, David R.

    2010-01-01

    Change and fluctuation in body mass index (BMI; weight (kg)/height (m)2) may be associated differently with coronary artery calcification (CAC) than with carotid artery intima-media thickness (IMT). The authors analyzed data on 2,243 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, initially aged 18–30 years, who were examined every 2–5 years over a 20-year period (1985–2006). BMI at year 0 was associated positively and linearly with CAC at year 20; however...

  4. Comparison of Angiographic Outcomes of Side Branch Ostium at Bifurcation Coronary Lesion between Two-stent and One-stent Techniques

    OpenAIRE

    Seo, Jae-Bin; Park, Kyung Woo; Lee, Hae-Young; Kang, Hyun-Jae; Koo, Bon-Kwon; Kim, Sang-Hyun; Kim, Hyo-Soo

    2015-01-01

    Although the favored strategy for coronary bifurcation intervention is stenting main vessel with provisional side branch (SB) stenting, we occasionally use two-stent strategy. The objective of this study was to investigate the angiographic outcome of SB ostium in two-stent group, compared with one-stent group. We analyzed 199 patients with bifurcation lesion who underwent percutaneous coronary intervention (PCI) with drug-eluting stent and follow up angiography. The patients were divided into...

  5. An assessment of the vulnerability of carotid plaques: a comparative study between intraplaque neovascularization and plaque echogenicity

    International Nuclear Information System (INIS)

    Carotid plaque echolucency as detected by Color Doppler ultrasonography (CDUS) has been used as a potential marker of plaque vulnerability. However, contrast-enhanced ultrasound (CEUS) has recently been shown to be a valuable method to evaluate the vulnerability and neovascularization within carotid atherosclerotic plaques. The aim of this study was to compare CEUS and CDUS in the assessment of plaque vulnerability using transcranial color Doppler (TCD) monitoring of microembolic signals (MES) as a reference technique. A total of 46 subjects with arterial stenosis (≥ 50%) underwent a carotid duplex ultrasound, TCD monitoring of MES and CEUS (SonoVue doses of 2.0 mL) within a span of 3 days. The agreement between the CEUS, CDUS, and MES findings was assessed with a chi-square test. A p-value less than 0.05 was considered statistically significant. Neovascularization was observed in 30 lesions (44.4%). The vascular risk factors for stroke were similar and there were no age or gender differences between the 2 groups. Using CEUS, MES were identified in 2 patients (12.5%) within class 1 (non-neovascularization) as opposed to 15 patients (50.0%) within class 2 (neovascularization) (p = 0.023). CDUS revealed no significant differences in the appearance of the MES between the 2 groups (hyperechoic and hypoechoic) (p = 0.237). This study provides preliminary evidence to suggest that intraplaque neovascularization detected by CEUS is associated with the presence of MESs, where as plaque echogenicity on traditional CDUS does not. These findings argue that CEUS may better identify high-risk plaques

  6. Stenosis Asymmetry Index (SAI) between symptomatic and asymptomatic patients in the analysis of carotid arteries. A study using CT angiography

    International Nuclear Information System (INIS)

    Purpose: Extracranial carotid artery stenosis is accepted as a significant risk factor for cerebrovascular events. The purpose of this paper was to evaluate whether the Stenosis Asymmetry Index (SAI) between carotid arteries (in symptomatic and asymptomatic patients) can be considered a further parameter in the stroke risk stratification. Materials and methods: 60 consecutive symptomatic (males 36; median age 64) patients and 60 non symptomatic patients matched for gender and age, were analyzed using a 40-detector-row CT angiography. Each patient was analyzed by injecting 80 mL of contrast material at a 5 mL/s flow rate. Stenosis degree of 240 carotids was calculated according to NASCET method. For each patient, the ratio between the most severe stenosis and the contralateral was calculated to obtain the SAI. Multiple logistic regression analysis was performed and ROC curve was also calculated. Results: Results of our study indicate a mean SAI of 1.48 (±0.35 SD) in the asymptomatic group and a mean SAI of 1.69 (±0.53 SD) in the symptomatic group with a statistically significant difference (p value = 0.0204). The multiple logistic regression analysis did not find statistically significant association between SAI and symptoms. The ROC curve analysis indicated that an SAI value of 1.8 has a specificity of 84.31% presence of cerebral symptoms whereas using a 1.2 SAI we obtained a sensitivity of 88.24%. Conclusion: Results of our study suggest that a SAI > 1.8 has a good sensitivity in identifying the association with cerebrovascular events.

  7. Diagnostic workup in carotid stenosis - a neurologist's perspective

    Energy Technology Data Exchange (ETDEWEB)

    Rosenkranz, Michael; Gerloff, Christian [University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg (Germany)

    2010-07-15

    Carotid artery stenosis is associated with the risk of stroke, myocardial infarction, and vascular death. In selected patients, revascularization of carotid narrowing by endarterectomy may reduce the risk of stroke distal to the stenosis. Carotid artery stenting has evolved as a potential alternative to endarterectomy. Four randomized clinical trials comparing safety and efficacy of endarterectomy versus stenting of symptomatic carotid stenosis have been published in recent years, but there remains some uncertainty about the implications of these trials for clinical routine. Both carotid stenting and endarterectomy are based on different treatment strategies which may result in different specific risk factors associated with each procedure. Hence, the procedural risk of either modality varies not only with the skills of the surgeon or the interventionalist but may depend on patient characteristics. It appears that the most important question is not whether one revascularization modality is superior but for which patient one modality is better than the other. A comprehensive diagnostic workup of patients with carotid stenosis based on a broad panel of covariates that affect the risk of vascular events may improve selection of patients for carotid revascularization and may help to decide for whom one revascularization modality is likely to be better than the other. (orig.)

  8. [Absorbable coronary stents. New promising technology].

    Science.gov (United States)

    Erbel, Raimund; Böse, Dirk; Haude, Michael; Kordish, Igor; Churzidze, Sofia; Malyar, Nasser; Konorza, Thomas; Sack, Stefan

    2007-06-01

    Coronary stent implantation started in Germany 20 years ago. In the beginning, the progress was very slow and accelerated 10 years later. Meanwhile, coronary stent implantation is a standard procedure in interventional cardiology. From the beginning of permanent stent implantation, research started to provide temporary stenting of coronary arteries, first with catheter-based systems, later with stent-alone technology. Stents were produced from polymers or metal. The first polymer stent implantation failed except the Igaki-Tamai stent in Japan. Newly developed absorbable polymer stents seem to be very promising, as intravascular ultrasound (IVUS) and optical coherence tomography have demonstrated. Temporary metal stents were developed based on iron and magnesium. Currently, the iron stent is tested in peripheral arteries. The absorbable magnesium stent (Biotronik, Berlin, Germany) was tested in peripheral arteries below the knee and meanwhile in the multicenter international PROGRESS-AMS (Clinical Performance and Angiographic Results of Coronary Stenting with Absorbable Metal Stents) study. The first magnesium stent implantation was performed on July 30, 2004 after extended experimental testing in Essen. The magnesium stent behaved like a bare-metal stent with low recoil of 5-7%. The stent struts were absorbed when tested with IVUS. Stent struts were not visible by fluoroscopy or computed tomography (CT) as well as magnetic resonance imaging (MRI). That means, that the magnesium stent is invisible and therefore CT and MRI can be used for imaging of interventions. Only using micro-CT the stent struts were visible. The absorption process could be demonstrated in a patient 18 days after implantation due to suspected acute coronary syndrome, which was excluded. IVUS showed a nice open lumen. Stent struts were no longer visible, but replaced by tissue indicating the previous stent location. Coronary angiography after 4 months showed an ischemia-driven target lesion

  9. Histological Changes in the Bile Duct after Long-Term Placement of a Fully Covered Self-Expandable Metal Stent within a Common Bile Duct: A Canine Study

    OpenAIRE

    Lee, Sang Soo; Song, Tae Jun; Joo, Mee; Park, Do Hyun; Seo, Dong Wan; Lee, Sung Koo; Kim, Myung-Hwan

    2014-01-01

    Background/Aims To date, it has been difficult to determine the optimal stenting duration of a fully covered self-expandable metal stent (FCSEMS) in a benign biliary stricture. The purpose of this study was to identify the histopathological changes in a bile duct resulting from long-term placement of a FCSEMS. Methods An FCSEMS was inserted into the common bile duct of 12 canines, and the animals were divided into four groups. Posteuthanasia, necropsy was performed to examine the histopatholo...

  10. A Multicenter, Prospective Study of a New Fully Covered Expandable Metal Biliary Stent for the Palliative Treatment of Malignant Bile Duct Obstruction

    OpenAIRE

    Petersen, Bret T.; Michel Kahaleh; Kozarek, Richard A; David Loren; Kapil Gupta; Thomas Kowalski; Martin Freeman; Chen, Yang K.; Branch, Malcolm S; Steven Edmundowicz; Michael Gluck; Kenneth Binmoeller; Baron, Todd H; Raj J. Shah; Timothy Kinney

    2013-01-01

    Background and Study Aims. Endoscopic placement of self-expanding metal stents (SEMSs) is indicated for palliation of inoperable malignant biliary obstruction. A fully covered biliary SEMS (WallFlex Biliary RX Boston Scientific, Natick, USA) was assessed for palliation of extrahepatic malignant biliary obstruction. Patients and Methods. 58 patients were included in this prospective, multicenter series conducted under an FDA-approved IDE. Main outcome measurements included (1) absence of stent...

  11. [Study on the release of copper ion and corrosion for intrauterine contraceptive device with two kinds of Cu-containing stent].

    Science.gov (United States)

    Zou, Fengping; Huang, Shuze; Ji, Rong; Ding, Biao; Yao, Tianping

    2014-05-01

    Two kinds of Cu-containing intrauterine contraceptive device (Cu-IUD) has been evaluated through the study on the release of copper ion and corrosion of copper surface in artificially formulated fluid. The result showed that the copper ions were released profusely from the stainless steel stents Cu-IUD in the first week of soak (25-12 microg/d), and then it became slowly and steady. The release of the copper ions from the titanium nickel shape memory alloy stents Cu-IUD were always slowly and steady in two months (0.5-5 microg/d). It obviously shows that the corrosion on copper surface of stainless steel stents Cu-IUD were more serious than titanium nickel shape memory alloy stents Cu-IUD by using 200 times microscope testing before and after soaking in formulated fluid. PMID:25241523

  12. Accounting for the mortality benefit of drug-eluting stents in percutaneous coronary intervention: a comparison of methods in a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    McCulloch Charles E

    2011-06-01

    Full Text Available Abstract Background Drug-eluting stents (DES reduce rates of restenosis compared with bare metal stents (BMS. A number of observational studies have also found lower rates of mortality and non-fatal myocardial infarction with DES compared with BMS, findings not observed in randomized clinical trials. In order to explore reasons for this discrepancy, we compared outcomes after percutaneous coronary intervention (PCI with DES or BMS by multiple statistical methods. Methods We compared short-term rates of all-cause mortality and myocardial infarction for patients undergoing PCI with DES or BMS using propensity-score adjustment, propensity-score matching, and a stent-era comparison in a large, integrated health system between 1998 and 2007. For the propensity-score adjustment and stent era comparisons, we used multivariable logistic regression to assess the association of stent type with outcomes. We used McNemar's Chi-square test to compare outcomes for propensity-score matching. Results Between 1998 and 2007, 35,438 PCIs with stenting were performed among health plan members (53.9% DES and 46.1% BMS. After propensity-score adjustment, DES was associated with significantly lower rates of death at 30 days (OR 0.49, 95% CI 0.39 - 0.63, P P P Conclusions Although propensity-score methods suggested a mortality benefit with DES, consistent with prior observational studies, a stent era comparison failed to support this conclusion. Unobserved factors influencing stent selection in observational studies likely account for the observed mortality benefit of DES not seen in randomized clinical trials.

  13. Carotid artery stenosis. Current state of therapy; Karotisstenose. Aktueller Stand der Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, K.I.; Papanagiotou, P.; Zimmer, A.; Reith, W. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany); Schaefers, H.J. [Universitaetsklinikum des Saarlandes, Klinik fuer Thorax- und Herz-Gefaess-Chirurgie, Homburg/Saar (Germany)

    2010-07-15

    Ipsilateral occlusive or embolizing carotid artery stenoses are found in 20-30% of all cases of ischemic stroke. Several randomized studies revealed endarterectomy to be the gold standard in the therapy of severe symptomatic (NASCET, ESCT) and to some extent of asymptomatic carotid stenoses (ACAS, ACST). Stent angioplasty has been established as an alternative therapeutic option although non-inferiority of this procedure has not yet been proven. We provide an overview of both procedures as well of the state of current trials. (orig.) [German] Okkludierende oder embolisierende Stenosen der A. carotis interna sind in 20-30% der Faelle fuer einen ipsilateralen ischaemischen Schlaganfall verantwortlich. Nach Abschluss mehrerer randomisierter Studien erscheint die Karotisendarteriektomie als Therapie der Wahl bei hochgradigen symptomatischen (NASCET, ESCT) und z. T. auch asymptomatischen Stenosen (ACAS, ACST). Seit einigen Jahren hat sich die (Stent-)Angioplastie zunehmend als Therapiealternative etabliert, auch wenn die bislang veroeffentlichten Studien die Gleichwertigkeit beider Verfahren noch nicht zeigen konnten. Wir geben einen Ueberblick ueber beide Verfahren sowie ueber die derzeitige Studienlage. (orig.)

  14. A clinical study on perforator stroke resulting from Wingspan stent angioplasty for symptomatic intracranial artery stenosis

    International Nuclear Information System (INIS)

    Objective: To evaluate the incidence, potential hazards and effective countermeasure for perforator stroke (PS) resulting from stent angioplasty of symptomatic intracranial artery stenosis. Methods: Peri-operation PS complications of 258 patients receiving Gateway balloon-Wingspan stenting for severe symptomatic intracranial stenosis were analyzed. The incidence, clinical course, and prognosis of PS resulting from stenting were recorded. Special attention was given to the anatomical features, clinical manifestation and video materials of patients with PS. χ2 test was used for statistics. Results: Two hundred and fifty-five patients received stent angioplasty successfully and 7 patients had PS (incidence rate 2.7%). The patients with basilar artery stenosis had a higher incidence of PS resulting from intracranial stenting (6.1%, 4/66) than patients with middle cerebral artery stenosis (2.5%, 3/118) (χ2=2.320, P= 0.025). The potential hazards for PS included preoperative perforator stroke adjacent to the stenotic segment and prominent dissection during operation. Six patients presented symptoms after awake from general anaesthesia and one had symptoms 3 hours after stenting. One deteriorated gradually and the others reached the maximum deficit almost at once. At the follow-up of 3 months, 3 patients were disabled and scored one, two, two by mRS respectively. Conclusion: The incidence of PS resulting from intracranial stenting was low and the prognosis was not disastrous. Stenosis at basilar artery and preoperative perforator stroke adjacent to the stenotic segment were potential risk factors for PS complication. Proper maneuver of angioplasty may decrease the incidence of PS and improve the prognosis. (authors)

  15. Twin Valve Caval Stent for Functional Replacement of Incompetent Tricuspid Valve: A Feasibility Animal Study

    International Nuclear Information System (INIS)

    Objective: To evaluate feasibility of a twin valve caval stent (TVCS) for functional replacement of an incompetent tricuspid valve (TV) in an acute animal study. Methods: One swine and three sheep were used in the study. TVCS placement was tested in a swine with a normal TV. TVCS function was tested in three sheep with TV regurgitation created by papillary muscle avulsion. Cardiac angiograms and pressure measurements were used to evaluate TVCS function. Two sheep were studied after fluid overload. Results: TVCS was percutaneously placed properly at the central portions of the superior vena cava (SVC) and inferior vena cava (IVC) in the swine. Papillary muscle avulsion in three sheep caused significant tricuspid regurgitation with massive reflux into the right atrium (RA) and partial reflux into the SVC and IVC. TVCS placement eliminated reflux into the SVC and IVC. After fluid overload, there was enlargement of the right ventricle and RA and significant increase in right ventricle, RA, SVC, and IVC pressures, but no reflux into the IVC and SVC. Conclusion: The results of this feasibility study justify detailed evaluation of TVCS insertion for functional chronic replacement of incompetent TV.

  16. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... of the bare metal stent versus the drug-coated stents is an ongoing debate. And I think ... that with putting in a bunch of drug-coated stents, and it looks very pretty when we’ ...

  17. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... paves the path so we can pass the metal stent. And then we take a stent and ... open up that balloon, and it expands that metal stent, which is generally stainless steel in compound, ...

  18. A comparison of the temporary placement of 3 different self-expanding stents for the treatment of refractory benign esophageal strictures: a prospective multicentre study

    Directory of Open Access Journals (Sweden)

    Canena Jorge Manuel

    2012-06-01

    Full Text Available Abstract Background Refractory benign esophageal strictures (RBESs have been treated with the temporary placement of different self-expanding stents with conflicting results. We compared the clinical effectiveness of 3 types of stents: self-expanding plastic stents (SEPSs, biodegradable stents, and fully covered self-expanding metal stents (FCSEMSs, for the treatment of RBES. Methods This study prospectively evaluated 3 groups of 30 consecutive patients with RBESs who underwent temporary placement of either SEPSs (12 weeks, n = 10, biodegradable stents (n = 10 or FCSEMSs (12 weeks, n = 10. Data were collected to analyze the technical success and clinical outcome of the stents as evaluated by recurrent dysphagia, complications and reinterventions. Results Stent implantation was technically successful in all patients. Migration occurred in 11 patients: 6 (60% in the SEPS group, 2 (20% in the biodegradable group and 3 (30% in the FCSEMS group (P = 0.16. A total of 8/30 patients (26.6% were dysphagia-free after the end of follow-up: 1 (10% in the SEPS group, 3 (30% in the biodegradable group and 4 (40% in the FCSEMS group (P = 0.27. More reinterventions were required in the SEPS group (n = 24 than in the biodegradable group (n = 13 or the FCSEMS group (n = 13 (P = 0.24. Multivariate analysis showed that stricture length was significantly associated with higher recurrence rates after temporary stent placement (HR = 1.37; 95% CI = 1.08-1.75; P = 0.011. Conclusions Temporary placement of a biodegradable stent or of a FCSEMS in patients with RBES may lead to long-term relief of dysphagia in 30 and 40% of patients, respectively. The use of SEPSs seems least preferable, as they are associated with frequent stent migration, more reinterventions and few cases of long-term improvement. Additionally, longer strictures were associated with a higher risk of recurrence.

  19. Minimonoka Stent for Canalicular Reconstruction

    Directory of Open Access Journals (Sweden)

    Sunil G Biradar,

    2015-04-01

    Full Text Available Objective: Canalicular injuries are relatively common and accounts for 16-26% of all lid tears. There are different techniques for reconstructing traumatic canalicular lacerations. The most favorable intervention would be one that is simple, less invasive with reduced postoperative complications/recovery time. The aim of this study is to report the surgical outcome with the Mini-Monoka monocanalicular stent. Material and Methods: Patients with traumatic canalicular lacerations who underwent surgical reconstruction using the Mini-Monoka monocanalicular stent were included. The surgical outcome was based on subjective (epiphora and objective (tear meniscus level, and lacrimal irrigation findings after stent removal. Result: Ten patients (mean age: 9.7 years of lower canaliculus injury were included. Successful stenting was accomplished in all cases. Postoperative eyelid position was satisfactory in most patients. The mean postoperative follow-up period was 6 months. There were no cases of premature stent extrusion. Functional drainage after stent removal was normal in all of patients. Syringing showed full patency. Conclusion:The MiniMonoka monocanalicular stent is an effective tool in reconstructing traumatic canalicular lacerations. Easy to use, carries a minimal risk of infection and injury to the non-lacerated canaliculus, and results in high anatomical and functional success rates.

  20. Common carotid artery intima-media thickness, carotid plaques, and walking speed.

    OpenAIRE

    Elbaz, Alexis; Ripert, Mahaut; Tavernier, Béatrice; Février, Benoît; Zureik, Mahmoud; Gariépy, Jérôme; Alpérovitch, Annick; Tzourio, Christophe

    2005-01-01

    BACKGROUND AND PURPOSE: Gait dysfunction is an important cause of disability among the elderly and may be, in part, of vascular origin. We studied the association between carotid ultrasound parameters and measures of gait and balance in subjects 65 to 85 years of age who participated in the baseline phase of the Three-City Study in the Dijon center. METHODS: The study population comprised 2572 noninstitutionalized individuals. Carotid plaques and common carotid artery intima-media thickness (...

  1. Longitudinal stent deformation during coronary bifurcation stenting.

    Science.gov (United States)

    Vijayvergiya, Rajesh; Sharma, Prafull; Gupta, Ankush; Goyal, Praveg; Panda, Prashant

    2016-03-01

    A distortion of implanted coronary stent along its longitudinal axis during coronary intervention is known as longitudinal stent deformation (LSD). LSD is frequently seen with newer drug eluting stents (DES), specifically with PROMUS Element stent. It is usually caused by impact of guide catheter tip, or following passage of catheters like balloon catheter, IVUS catheter, guideliner, etc. We hereby report a case of LSD during coronary bifurcation lesion intervention, using two-stents technique. Patient had acute stent thrombosis as a complication of LSD, which was successfully managed. PMID:26811144

  2. Nitinol stent implantation for femoropopliteal disease in patients on hemodialysis: results of the 3-year retrospective multicenter APOLLON study.

    Science.gov (United States)

    Fujihara, Masahiko; Higashimori, Akihiro; Kato, Yoshihiro; Taniguchi, Hiromasa; Iwasaki, Yusuke; Amano, Tomonori; Sumiyoshi, Akinori; Nishiya, Daisuke; Yokoi, Yoshiaki

    2016-09-01

    The clinical outcomes of nitinol stents for femoropopliteal arterial (FP) disease in patients on hemodialysis were assessed. Endovascular therapy (EVT) is accepted for symptomatic FP disease. However, the clinical outcomes of patients on dialysis are not well known. A multicenter retrospective study was conducted with data between November 2010 and August 2013. A total of 484 consecutive patients who successfully underwent EVT for FP disease with nitinol stents were recruited and analyzed. Patients were categorized into the hemodialysis group (N = 161) and non-hemodialysis group (N = 323). The primary measure was primary patency verified by duplex ultrasound at a rest peak systolic velocity (PSVR) of >2.5, and secondary measures were freedom from target lesion revascularization (TLR) and major amputation-free survival (AFS). Average follow-up duration was 19.5 ± 13.5 months. The primary patency rate at 3 years was significantly lower in the hemodialysis group than the non-hemodialysis group (33.8 vs. 43.7 %; p = 0.036). Freedom from TLR at 3 years was 55.0 % in the hemodialysis group and 66.1 % in the non-hemodialysis group (p = 0.032). The hemodialysis group showed a significantly lower AFS rate at 3 years than the non-hemodialysis group (86.4 vs. 58.2 %; p < 0.001). In hemodialysis patients, nitinol stent use resulted in a lower patency rate, higher TLR rate, and lower AFS rate compared to non-hemodialysis patients. These data suggest that nitinol stent implantation for FP arteries in hemodialysis patient needs to be reconsidered. PMID:26337619

  3. Malignant Ureteral Obstruction: Functional Duration of Metallic versus Polymeric Ureteral Stents

    Science.gov (United States)

    Chow, Po-Ming; Chiang, I-Ni; Chen, Chia-Yen; Huang, Kuo-How; Hsu, Jui-Shan; Wang, Shuo-Meng; Lee, Yuan-Ju; Yu, Hong-Jeng; Pu, Yeong-Shiau; Huang, Chao-Yuan

    2015-01-01

    Background Ureteral obstruction caused by extrinsic compression is often associated with intra-abdominal cancers. Internal drainage with ureteral stents is typically the first-line therapy to relieve such obstructions. Novel designs of ureteral stents made of different materials have been invented to achieve better drainage. In this study, we described the functional outcomes of a Resonance metallic ureteral stent (Cook Medical, Bloomington, Indiana, USA) in patients with malignant ureteral obstruction and compare the functional duration of Resonance stents with regular polymeric stents in the same cohort. Methods Cancer patients who received polymeric stents and subsequent Resonance stents for ureteral obstruction between July 2009 and November 2012 were included in a chart review. Stent failure was detected by clinical symptoms, imaging studies, and renal function tests. The functional durations of each stent were calculated, and possible factors affecting stent patency were investigated. Results A total of 50 stents were successfully inserted into 50 ureteral units in 42 patients with malignant ureteral obstruction. There were 7 antegrade stents and 43 retrograde stents. There were no major complications. Stent-related symptoms were similar in both kinds of stents. After polymeric stents were replaced with Resonance metallic stents, hydronephrosis subsided or remained stable in 90% (45/50) of the ureteral units. Serum creatinine decreased or remained stable in 90% (38/42) of these patients. The Resonance stent exhibited a mean increase in functional duration of 4 months compared with the polymeric stents (p<0.0001), and 50% (25/50) of the Resonance stents exhibited a significant increase in functional duration (more than 3 months). Pre-operative serum creatinine < 2 was associated with a substantial increase in stent duration. Conclusions Resonance stents are effective and safe in relieving malignant ureteral obstructions after polymeric stents failure

  4. Treatment of Intra- and Extracranial Arterial Dissections Using Stents and Embolization

    International Nuclear Information System (INIS)

    Purpose. To evaluate the safety and efficacy of stent placement for extracranial and intracranial arterial dissections. Methods. Eighteen patients underwent endovascular treatment of carotid and vertebral dissections using intraluminal stent placement. Five patients with arterial dissection were treated, 2 using one insertion of a single stent and 3 using placement of two stents. Patients with a dissecting aneurysm were treated as follows: 7 patients with insertion of one stent, 4 with placement of two stents, and 2 by stent-assisted Guglielmi detachable coil embolization. In the 18 patients in whom stenting was attempted, the overall success in reaching the target lesion was 94.4%. Of the 17 patients treated with stents, stent release and positioning were considered optimal in 16 (94%) and suboptimal in one (6%). In patients who underwent a successful procedure, all parent arteries were preserved. There were no instances of postprocedural ischemic attacks, new neurologic deficits, or new minor or major strokes prior to patient discharge. In follow up, all patients were assessed, using the modified Rankin scale, as functionally improved or of stable clinical status. The reduction in dissection-induced stenosis or pseudoaneurysm, the patency rate obtained at follow-up, and the lack of strokes (ischemic or hemorrhagic) suggest that stent placement offers a viable alternative to complex surgical bypass or reconstructive procedures. The long-term efficacy and durability of stent placement for arterial dissection remain to be determined in a larger series

  5. Computed tomographic virtual intraarterial endoscopy after intravscular stent implantation: Phantom study and clinical assessment; CT-gestuetzte virtuelle intaarterielle Endoskopie nach Stentimplantation: Phantomstudien und erste klinische Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Rodenwaldt, J. [Abt. Roentgendiagnostik 1, Klinikum der Univ. Goettingen (Germany); Kopka, L. [Abt. Roentgendiagnostik 1, Klinikum der Univ. Goettingen (Germany); Lotfi, S. [Abt. Thorax-, Herz- und Gefaesschirurgie, Klinikum der Univ. Goettingen (Germany); Grabbe, E. [Abt. Roentgendiagnostik 1, Klinikum der Univ. Goettingen (Germany)

    1997-03-01

    Purpose: To evaluate the facilities of computed tomographic virtual intraarterial endoscopy (VIE). Imaging of an intravascular stent in a phantom study and clinical assessment in 10 patients. Methods: The optimal scan parameters for different 3 D reconstructions (MIP, SSD, VIE) were determined in a vessel phantom with intravascular stent. Furthermore, in vitro stenoses were analysed and initial in vivo investigations were performed. Results: The quality of CT-angiography (CTA) depended on the scanning parameters. VIE allowed the reconstruction of the intravascular surface of a stent. Conclusion: VIE is a new kind of post-processing CTA reconstruction. It permits the visualisation of the intravascular structure of a stent. In vitro relevant stenoses were correctly detected. First clinical investigations support these results. (orig.) [Deutsch] Ziel: Anhand von Phantomstudien und von klinischen Untersuchungen soll die Wertigkeit der virtuellen intraarteriellen Endoskopie (VIE) fuer die Bildgebung von Stentimplantaten geprueft werden. Methoden: An einem Gefaessphantom mit implantiertem Stent wurden die optimalen Untersuchungsparameter fuer diverse dreidimensionale Rekonstruktionen (MIP, SSD, VIE) bestimmt. Zusaetzlich wurden verschiedene Experimentelle Stenosegrade dargestellt und erste Patientenuntersuchungen im Rahmen der Nachsorge nach Stenteinlage durchgefuehrt. Ergebnisse: Die Qualitaet der CT-Angiographie (CTA) war entscheidend von der Wahl der Scanparameter abhaengig. Die VIE war in der Lage, die endoluminaeren Oberflaechen einer Stentstrecke darzustellen, die das Metallgitter der Stents ueberziehen. Schlussfolgerung: Die VIE stellt ein neues Nachverarbeitungsverfahren der CTA dar, welches erstmalig eine direkte Beurteilung des Gefaesslumens nach Stentimplantation zulaesst. Therapierelevante Stenosen konnten in vitro sicher nachgewiesen werden. Erste klinische Untersuchungen stuetzen diese Ergebnisse. (orig.)

  6. A pooled gender based analysis comparing the XIENCE V® everolimus-eluting stent and the TAXUS paclitaxel-eluting stent in male and female patients with coronary artery disease, results of the SPIRIT II and SPIRIT III studies: Two-year analysis

    NARCIS (Netherlands)

    A. Seth (Ashok); P.W.J.C. Serruys (Patrick); A.J. Lansky (Alexandra); J.B. Hermiller (James); Y. Onuma (Yosinobu); K. Miquel-Hébert (Karine); S. Yu (Shui); S. Veldhof (Susan); P. Sood (Poornima); K. Sudhir (Krishnankutty); G.W. Stone (Gregg)

    2010-01-01

    textabstractAims: To assess the safety and efficacy of the XIENCE V everolimus-eluting stent (EES) compared to the TAXUS paclitaxel-eluting stent (PES) in women at two years. Methods and results: In this pooled analysis, a cohort of 395 women and 906 men was studied by using patient level and lesion

  7. Two-year follow-up of the Genous™ endothelial progenitor cell capturing stent versus the Taxus Liberté stent in patients with de novo coronary artery lesions with a high-risk of restenosis: a randomized, single-center, pilot study

    NARCIS (Netherlands)

    M.A.M. Beijk; M. Klomp; N. van Geloven; K.T. Koch; J.P.S. Henriques; J. Baan; M.M. Vis; J.G.P. Tijssen; J.J. Piek; R.J. de Winter

    2011-01-01

    In the prospective randomized TRIAS pilot study, the bio-engineered Genous™ endothelial progenitor cell capturing stent was compared with the Taxus Liberté™ SR paclitaxel-eluting stent. At 1 yr, a statistically nonsignificant difference in the rates of target vessel failure (cardiac death, myocardia

  8. Carotid Artery Disease

    Science.gov (United States)

    ... brain with blood. If you have carotid artery disease, the arteries become narrow, usually because of atherosclerosis. ... one of the causes of stroke. Carotid artery disease often does not cause symptoms, but there are ...

  9. Carotid artery disease

    Science.gov (United States)

    ... you have had a stroke or TIA, a nervous system (neurological) exam will show other problems. You may also have the following tests: Blood cholesterol and triglycerides test Blood sugar (glucose) test Ultrasound of the carotid arteries ( carotid ...

  10. Covered Self-Expanding Transhepatic Biliary Stents:Clinical Pilot Study

    International Nuclear Information System (INIS)

    Purpose: We report our preliminary results with a new type of self-expanding covered stent for treatment of malignant biliary obstruction. Methods: Wallstents, fully covered with high elasticity polyurethane, with an unconstrained diameter of 10 mm and a total length of 69 mm, were placed transhepatically under fluoroscopic guidance in five patients. The length of the biliary obstruction varied between 30-50 mm. At 1 and 3 months (82-98 days) clinical assessment, serum bilirubin measurement, and ultrasound examination of the biliary tree were performed. Results: Initial uncomplicated deployment of the stents and internal drainage was possible in all patients. Distal stent migration resulted in early biliary reobstruction in one patient. At 3-month follow-up, partial reobstruction, most probably due to sludge formation, was found in another patient. Conclusion: Our initial results indicate that the covered, self-expanding Wallstent endoprosthesis can be reliably and safely deployed transhepatically for malignant biliary obstruction

  11. Antireflux metal stent with an antimigration system for distal malignant biliary obstruction: a feasibility pilot study.

    Science.gov (United States)

    Hamada, Tsuyoshi; Isayama, Hiroyuki; Nakai, Yousuke; Togawa, Osamu; Kogure, Hirofumi; Takahara, Naminatsu; Mohri, Dai; Sasaki, Takashi; Matsubara, Saburo; Yamamoto, Natsuyo; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

    2015-06-01

    An antireflux metal stent (ARMS) for distal malignant biliary obstruction has been reported to be useful, but the effectiveness of a flared-end structure to prevent migration on ARMS remains unclear. To evaluate the feasibility of a newly designed ARMS with both ends flared, 8 patients with covered metal stent occlusion due to sludge or food impaction were enrolled. ARMS were placed successfully after endoscopic removal of the occluded stents in all patients, and no procedure-related complication was observed. The median time to recurrent biliary obstruction was 71 days. ARMS occlusion occurred in 3 (38%) patients (sludge in 2 patients and hemobilia in 1). ARMS migration occurred in 1 (13%) patient. As a late complication, cholecystitis occurred in 1 (13%) patient. In conclusion, our newly designed ARMS with an antimigration system was technically feasible and safe, and a further investigation is warranted to evaluate the effectiveness of the current antimigration system. PMID:25856131

  12. Experiences with carotid endarterectomy at Sree Chitra Tirunal Institute

    Directory of Open Access Journals (Sweden)

    Unnikrishnan Madathipat

    2008-01-01

    Full Text Available Background: Atherosclerotic carotid artery disease poses a grave threat to cerebral circulation, leading to a stroke with its devastating sequelae, if left untreated. Carotid endarterectomy has a proven track record with compelling evidence in stroke prevention. Objectives: aTo confirm that carotid endarterectomy (CEA is safe and effective in preventing stroke at both short and long term. b to demonstrate long term patency of internal carotid artery when arteriotomy repair is performed using autologous saphenous vein patch. Materials and Methods: During ten years, from September 1997 to February 2008, thirty nine patients who underwent consecutive carotid endarterectomy at our institute, form the basis of this report. Their age ranged from thirty to seventy eight years, with a mean age of 56. There were four women in this cohort. Thirty seven patients were symptomatic with> 70% stenosis and two were asymptomatic with> 80% stenosis, incidentally detected. Imaging included Duplex scan and MRA for carotid territory and brain, and non-invasive cardiac assessment. Co-morbidities included smoking, hypertension, diabetes, and coronary artery disease. Carotid Endarterectomy was performed under general anaesthesia, using carotid shunt and vein patch arteriotomy repair. Results: All the patients made satisfactory recovery, without major adverse cerebral events in this series. Morbidities included Transient Ischemic Attack (TIA in two, needing only medications in one, and carotid stenting in the other. Minor morbidities included neck hematoma in two and transient hypoglossal paresis in three patients. Yearly follow-up included duplex scan assessment for all the patients. Two patients died of contralateral stroke, two of myocardial events and two were lost to follow up. Thirty three patients are well and free of the disease during the follow up of three to 120 months. Conclusion: Carotid endarterectomy provided near total freedom from adverse cerebral

  13. Emergency revascularization of acute internal carotid artery occlusion: Follow the spike, it guides you.

    Science.gov (United States)

    Cohen, José E; Gomori, John M; Leker, Ronen R; Eichel, Roni; Itshayek, Eyal

    2016-07-01

    The present study sought to examine the incidence of the angiographic "spike sign" and to assess its predictive significance for achieving carotid revascularization in 54 patients with acute internal carotid artery (ICA) occlusions that required urgent endovascular revascularization. Clinical and imaging files of consecutive patients with ICA occlusion who were treated in a tertiary care academic medical center from 2011-2015 were retrospectively examined under Institutional Review Board approval with a waiver of the requirement for informed consent. All proximal ICA occlusions were treated by stent-assisted carotid angioplasty, and all distal embolic occlusions were managed with stent-assisted mechanical thrombectomy. The study included 24 patients with acute ICA occlusion (group 1) and 30 patients with tandem ICA-intracranial occlusions (group 2). The spike sign was seen in 16/24 patients in group 1 (67%), and successful ICA revascularization was achieved in 14/16 (88%). The sign was seen in 26/30 patients in group 2 (87%), and ICA revascularization was successful in all 26 (100%). The remaining 12 patients had no spike sign, and ICA revascularization was successful in only 7/12 (58%). The spike sign is a transient finding that represents the proximal patent remnant of the stenotic corridor in fresh clot. Acute ICA occlusion frequently leaves the spike sign as a marker of the recent thrombotic event. The spike vertex points to the "path of least resistance" for the guidewire to cross the occlusion and engage the true arterial lumen, a critical step during ICA endovascular revascularization. PMID:26935747

  14. Development and assessment of 316LVM cardiovascular stents

    Energy Technology Data Exchange (ETDEWEB)

    Raval, Ankur [Research and Development Division, Sahajanand Medical Technologies, Surat 395003 (India)]. E-mail: ankur.med@sahmed.com; Choubey, Animesh [Research and Development Division, Sahajanand Medical Technologies, Surat 395003 (India); Engineer, Chhaya [Research and Development Division, Sahajanand Medical Technologies, Surat 395003 (India); Kothwala, Devesh [Research and Development Division, Sahajanand Medical Technologies, Surat 395003 (India)

    2004-11-25

    One of the most common causes for heart failure is vasoconstriction. The medical procedure for alleviating vasoconstriction, angioplasty, calls for intracoronary stents. And the manufacture of intracoronary stents demands absolutely unmatched precision. Current study investigates CNC controlled pulsed Nd:YAG (neodymium:yttrium aluminium garnet) laser for cutting complex geometry of a stent on 316LVM tubings. It has been shown that surface quality of cardiovascular stents has a significant influence on biocompatibility. Therefore, optimal method and parameters for acid pickling of these slotted tube laser cut stents were explored, as a pretreatment for electropolishing. Pickling was necessary prior to electropolishing for removing the oxide films covering the stent surface. An optimal condition for electrochemical polishing could also be established and it caused a smooth stent surface. Passivation of these electropolished stents was done. Furthermore, materials characterization of stents was performed by means of composition and microstructural analysis.

  15. Comparative Study of Ureteral Stents Following Endoureterotomy in the Porcine Model: 3 vs 6 Weeks and 7F vs 14F

    International Nuclear Information System (INIS)

    The aim of the study was to determine the optimal stent size and stenting duration following retrograde endoureterotomy of experimental ureteral strictures. Twenty healthy Large White female pigs were randomly divided into four groups, depending on stent size (7F vs 14F) and stenting duration (3 weeks vs 6 weeks). Three additional pigs were used as the control group. The internal ureteral diameter was measured 2 cm below the lower pole of the right kidney. Histopathological changes of the urinary tract, ultrasonographic and fluoroscopic studies, urine culture, and serum urea and creatine levels were analyzed during the different phases of the study. The study was divided into three phases. Phase I included premodel documentation of the normal urinary tract and laparoscopic ureteral stricture creation. During the second phase 1 month later, the diagnosis and endourologic treatment of strictures were performed. Phase III began 4 weeks after stent removal; follow-up imaging studies and postmortem evaluation of all animals were performed. Ureteral strictures developed in all animals 4 weeks after model creation. Results from ureteral diameter measurements and pathological studies revealed no statistically significant intergroup differences. However, prevalence of urinary infection proved to be directly related to stent size (14F) and permanence (6 weeks). The chi square results suggest a statistically significant relationship between the urinary tract infection and recurrent strictures (α = 0.046). We recommend the use of 7F stents for a period of 3 weeks or less, as these are more easily positioned and result in the reduction of secondary side effects (lower infection rate, less intramural ureteral lesions). A significant relationship between urinary tract infection and stricture recurrence was found in this experimental study

  16. Predictive Factors of In-Stent Restenosis in Renal Artery Stenting: A Retrospective Analysis

    International Nuclear Information System (INIS)

    Purpose. To retrospectively evaluate the role of clinical and procedural factors in predicting in-stent restenosis in patients with renovascular disease treated by renal artery stenting. Methods. From 1995 to 2002, 147 patients underwent renal artery stenting for the treatment of significant ostial atherosclerotic stenosis. Patients underwent strict clinical and color-coded duplex ultrasound follow-up. Ninety-nine patients (111 stents), with over 6 months of continuous follow-up (mean 22±12 months, range 6-60 months), were selected and classified according to the presence (group A, 30 patients, 32 lesions) or absence (group B, 69 patients, 79 lesions) of significant in-stent restenosis. A statistical analysis was performed to identify possible preprocedural and procedural predictors of restenosis considering the following data: sex, age, smoking habit, diabetes mellitus, hypertension, serum creatinine, cholesterol and triglyceride levels, renal artery stenosis grade, and stent type, length and diameter. Results. Comparing group A and B patients (χ2 test), a statistically significant relation was demonstrated between stent diameter and length and restenosis: the risk of in-stent restenosis decreased when the stent was ≥6 mm in diameter and between 15 and 20 mm in length. This finding was confirmed by multiple logistic regression analysis. Stent diameter and length were proved to be significantly related to in-stent restenosis also when evaluating only patients treated by Palmaz stent (71 stents). Conclusion. Although it is based on a retrospective analysis, the present study confirms the importance of correct stent selection in increasing long-term patency, using stents of at least 6 mm in diameter and with a length of approximately 15-20 mm

  17. Study on intraluminal embolization with microcoils treating traumatic pseudoaneurysms in common carotid artery in rabbits

    Institute of Scientific and Technical Information of China (English)

    刘云松; 马廉亭; 吴佐泉

    2004-01-01

    Objective: To evaluate the long-term effect of endovascular occlusion with microcoils on traumatic pseudoaneurysms (TPAs) in the common carotid artery in rabbits.Methods: TPAs in the right common carotid artery were surgically made in 16 rabbits. At 3-4 weeks after operation, the survived 12 models were randomly divided into a control group (n = 3 ) with no treatment and an experimental group (n = 9), in which TPAs were intraluminally embolized with microcoils and corresponding therapy was given. Three months after embolization, the TPAs were examined with digital subtraction angiography and pathology.Results: The 3 rabbits in the control group all died of rupture of TPA. Among the 9 TPAs occluded with microcoils, 4 were completely occluded, 4 were partially occluded, and 1 was excluded due to the microcoils migrating into the parent artery. Three months after embolization, the 4 TPAs which were completely occluded remained obliterated as determined by digital subtraction angiographic findings. The parent artery remained unobstructed and the structure of the TPAs were replaced by a mass of scar tissues. The 4 TPAs which were partially occluded remained unruptured and the microcoils were compressed.Conclusions: The lumen in TPA can be completely occluded by microcoils and the parent artery is unblocked.Partial occlusion of the lumen can al