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Osipova OS, Bugurov SV, Gostev AA, Saaya SB, Cheban AV, Ignatenko PV, Karpenko AA. Impact of shaggy aorta on intraoperative cerebral embolism during carotid artery stenting. INT ANGIOL 2024; 43:298-305. [PMID: 38801345 DOI: 10.23736/s0392-9590.24.05150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND Careful selection of patients for carotid stenting is necessary. We suggest that patients with a shaggy aorta syndrome may be at higher risk for perioperative embolic complications. METHODS The study is a retrospective subanalysis of the SIBERIA Trial. We included 72 patients undergoing transfemoral carotid artery stenting. Patients were monitored during the procedures using multifrequency transcranial Doppler with embolus detection and differentiation. Pre- and postprocedural (2 and 30 days) cerebral diffusion-weighted cerebral MRIs were performed. RESULTS Forty-six patients had shaggy aorta syndrome. Intraoperative embolisms were recorded in 82.6% and 46.1% of patients with and without shaggy aorta syndrome, respectively (P=0.001). New asymptomatic ischemic brain lesions in the postoperative period occurred in 78.3% and in 26.9% of patients with and without shaggy aorta syndrome, respectively (P<0.001). There were no cases of stroke within 2 days in both groups. 3 (6.5%) cases of stroke within 30 days after the procedure were observed only in patients with shaggy aorta syndrome. There were no cases of contralateral stroke. Shaggy aorta syndrome (OR 5.54 [1.83:16.7], P=0.001) and aortic arch ulceration (OR 6.67 [1.19: 37.3], P=0.02) were independently associated with cerebral embolism. Shaggy aorta syndrome (OR 9.77 [3.14-30.37], P<0.001) and aortic arch ulceration (OR 12.9 [2.3: 72.8], P=0.003) were independently associated with ipsilateral new asymptomatic ischemic brain lesions. CONCLUSIONS Shaggy aorta syndrome and aortic arch ulceration significantly increase the odds of intraoperative embolism and new asymptomatic ischemic brain lesions. Carotid endarterectomy or transcervical carotid stent should be selected in patients with shaggy aorta syndrome.
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Affiliation(s)
- Olesia S Osipova
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia -
| | - Savr V Bugurov
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Alexander A Gostev
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Shoraan B Saaya
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Alexey V Cheban
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Pavel V Ignatenko
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Andrey A Karpenko
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
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Pérez-Sánchez S, Barragán Prieto A, Gamero García MÁ, Moniche F, Tomasello A, Delgado-Acosta F, González A, Montaner J. Predictive Factors for Stroke and TIA Following Carotid Artery Stenting. J Endovasc Ther 2023:15266028221144586. [PMID: 36609162 DOI: 10.1177/15266028221144586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Carotid artery stenting (CAS) is an effective and minimally invasive method for the treatment of extracranial carotid artery stenosis. The aim of the present study was to explore independent risk factors to predict cerebrovascular events following CAS to identify high-risk patients and improve the safety of CAS in this population. MATERIALS AND METHODS HISPANIAS is a national prospective multicenter study that included 14 hospitals that collected data from patients who underwent CAS. We analyzed morbidity and mortality within 30 days after CAS, looking for factors that might be associated with cerebrovascular events (stroke and transient ischemic attack [TIA]). RESULTS The HISPANIAS cohort included 757 patients: 80.32% were men, the mean age was 70.73 years, and 82.96% underwent symptomatic CAS. Cerebrovascular complications occurred in 42 patients (5.6%), including TIA in 24 patients (70.8% ipsilateral; mean 2.79 days after CAS) and stroke in 18 patients (72.2% ipsilateral; mean 6.72 days after CAS). The main independent clinical predictors of stroke/TIA identified by logistic regression were female sex (odds ratio [OR] 2.29, 95% CI 1.15-4.54) and diabetes (OR 3.29, 95% CI 1.71-6.40). Survival analysis showed that diabetic women, compared with the rest of the patients, had a higher number of events concentrated mainly in the first days after the intervention (p=0.003). CONCLUSION Cerebrovascular ischemic complications after CAS continue to be a challenge for the management of these patients. Although there are other factors, female sex and the presence of diabetes are emerging as strong risk factors for the development of complications after symptomatic CAS. CLINICAL IMPACT Carotid artery stenting (CAS) is an effective and minimally invasive method for the treatment of extracranial carotid artery stenosis. Although CAS has been regarded as a reliable and safety approach, some studies reported that CAS was associated with a higher risk of procedure-related stroke. Cerebrovascular complications after CAS continue to be a main problem and a challenge for the management of these patients. Therefore, it is essential to identify the factors involved in the development of these complications. Our study shows that the combination of female sex and diabetes is associated with a clearly worse outcome, with a greater number of events concentrated mainly in the first days. This is different from other studies that have explored each factor separately. It would be interesting to perform separate interventions for this group given the increased risk of complications.
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Affiliation(s)
- Soledad Pérez-Sánchez
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Group, Biomedicine Institute of Seville, IBiS/Hospital Virgen del Rocío/CSIC/University of Seville, Seville, Spain
| | - Ana Barragán Prieto
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Miguel Ángel Gamero García
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Francisco Moniche
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology, Department of Radiology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Fernando Delgado-Acosta
- Interventional Neuroradiology, Department of Radiology, Hospital Reina Sofía, Córdoba, Spain
| | - Alejandro González
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Interventional Neuroradiology, Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Joan Montaner
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
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Osipova OS, Bugurov SV, Saaya SB, Cheban AV, Gostev AA, Rabtsun AA, Ignatenko PV, Karpenko AA. Relationship of pharmacotherapy and the incidence of embolic complications of carotid reconstructive surgery. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To evaluate the relationship between lipid-lowering and antiplatelet therapy and the incidence of cerebral microembolism and related complications in open and endovascular revascularization of the carotid arteries (CA).Material and methods. This single-center study involved patients with internal CA stenosis. The patients were divided into 2 groups depending on the surgery type performed: carotid endarterectomy (CEA) — 163 patients; CA stenting (CAS) — 71 patients. All patients underwent intraoperative transcranial Doppler monitoring to register cerebral embolism during CAS and CE.Results. In CAS, microembolism episodes were observed in 66,2% vs 22,1% of patients in the CEA group (p=0,04), the largest number of which was recorded during catheterization of the internal CA and embolic filter installation (p=0,000). There were no significant differences between the groups in terms of the stroke incidence. In 8 patients in the CAS group and 1 patient in the CEA group, a transient ischemic attack was observed within 30 days after surgery (p=4x10-4 ). Intraoperative embolism was a predictor of a neurological event in the early postoperative period (odds ratio (OR), 33,08; 95% confidence interval (CI): 3,49-56,37 (p6 months before surgery reduces the likelihood of embolism by 4 times (OR 0,25; 95% CI: 0,11-0,58 (p=0,001), while lipid-lowering and antiplatelet therapy combination — by 12,5 times (OR, 0,08; 95% CI: 0,01-0,40 (p=0,001)).Conclusion. Preoperative antiplatelet and statin therapy reduces the likelihood of embolism during the CA revascularization procedure.
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Sirignano P, Stabile E, Mansour W, Capoccia L, Faccenna F, Intrieri F, Ferri M, Saccà S, Sponza M, Mortola P, Ronchey S, Praquin B, Grillo P, Chiappa R, Losa S, Setacci F, Pirrelli S, Taurino M, Ruffino MA, Udini M, Palombo D, Ippoliti A, Montelione N, Setacci C, de Donato G, Ruggeri M, Speziale F. 1-Year Results From a Prospective Experience on CAS Using the CGuard Stent System: The IRONGUARD 2 Study. JACC Cardiovasc Interv 2021; 14:1917-1923. [PMID: 34391704 DOI: 10.1016/j.jcin.2021.05.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the 1-year safety and efficacy of a dual-layered stent (DLS) for carotid artery stenting (CAS) in a multicenter registry. BACKGROUND DLS have been proved to be safe and efficient during short-term follow-up. Recent data have raised the concern that the benefit of CAS performed with using a DLS may be hampered by a higher restenosis rate at 1 year. METHODS From January 2017 to June 2019, a physician-initiated, prospective, multispecialty registry enrolled 733 consecutive patients undergoing CAS using the CGuard embolic prevention system at 20 centers. The primary endpoint was the occurrence of death and stroke at 1 year. Secondary endpoints were 1-year rates of transient ischemic attack, acute myocardial infarction, internal carotid artery (ICA) restenosis, in-stent thrombosis, and external carotid artery occlusion. RESULTS At 1 year, follow-up was available in 726 patients (99.04%). Beyond 30 days postprocedure, 1 minor stroke (0.13%), four transient ischemic attacks (0.55%), 2 fatal acute myocardial infarctions (0.27%), and 6 noncardiac deaths (1.10%) occurred. On duplex ultrasound examination, ICA restenosis was found in 6 patients (0.82%): 2 total occlusions and 4 in-stent restenoses. No predictors of target ICA restenosis and/or occlusion could be detected, and dual-antiplatelet therapy duration (90 days vs 30 days) was not found to be related to major adverse cardiovascular event or restenosis occurrence. CONCLUSIONS This real-world registry suggests that DLS use in clinical practice is safe and associated with minimal occurrence of adverse neurologic events up to 12-month follow-up.
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Affiliation(s)
- Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy.
| | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Federico Faccenna
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Intrieri
- Unit of Vascular and Endovascular Surgery, Annunziata Hospital, Cosenza, Italy
| | - Michelangelo Ferri
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Salvatore Saccà
- Division of Cardiology, Mirano Public Hospital, Mirano, Italy
| | - Massimo Sponza
- Division of Vascular and Interventional Radiology, Udine University Hospital, Udine, Italy
| | - Paolo Mortola
- Department of Vascular and Endovascular Surgery, Galliera Hospital, Genoa, Italy
| | - Sonia Ronchey
- Unit of Vascular Surgery, Surgical Specialty Department, S. Filippo Neri Hospital, Rome, Italy
| | - Barbara Praquin
- Unit of Vascular Surgery, Surgical Specialty Department, S. Filippo Neri Hospital, Rome, Italy
| | - Placido Grillo
- Division of Cardiology, Sant. Anna Hospital, Catanzaro, Italy
| | - Roberto Chiappa
- Department of Vascular and Endovascular Surgery, Sandro Pertini Hospital, Rome, Italy
| | - Sergio Losa
- Cardiovascular Department, MultiMedica IRCCS Scientific Institute, Milan, Italy
| | - Francesco Setacci
- Cardiovascular Department, MultiMedica IRCCS Scientific Institute, Milan, Italy
| | - Stefano Pirrelli
- Division of Vascular Surgery, Carlo Poma Hospital, Mantova, Italy
| | - Maurizio Taurino
- Unit of Vascular Surgery, Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Maria Antonella Ruffino
- Department of Diagnostic Imaging and Radiotherapy - Vascular Radiology, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Udini
- Vascular Surgery, Moriggia Pelascini Hospital, Gravedona, Como, Italy
| | - Domenico Palombo
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Arnaldo Ippoliti
- Vascular Surgery Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Nunzio Montelione
- Vascular Surgery, University of Campus Biomedico of Rome, Rome, Italy
| | - Carlo Setacci
- Department of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery, University of Siena, Siena, Italy
| | - Gianmarco de Donato
- Department of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery, University of Siena, Siena, Italy
| | - Massimo Ruggeri
- Vascular Surgery, San Camillo de Lellis Hopital, Rieti, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
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Sirignano P, Stabile E, Mansour W, Capoccia L, Faccenna F, Intrieri F, Ferri M, Saccà S, Sponza M, Mortola P, Ronchey S, Grillo P, Chiappa R, Losa S, Setacci F, Pirrelli S, Taurino M, Ruffino MA, Udini M, Palombo D, Ippoliti A, Montelione N, Setacci C, de Donato G, Ruggeri M, Speziale F. 1-Month Results From a Prospective Experience on CAS Using CGuard Stent System. JACC Cardiovasc Interv 2020; 13:2170-2177. [DOI: 10.1016/j.jcin.2020.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/26/2022]
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