Ebook Carotid artery stenting - Current practice and techniques: Part 2
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Ebook Carotid artery stenting - Current practice and techniques: Part 2
15CAROTID ARTERY STENTING WITH THE DISTAL OCCLUSION ANTI-EMBOLIZATION SYSTEMMICHEL HENRY ANTONIOS POLYDOROU ISABELLE HENRY MICHÈLE HUCELDespite meticu Ebook Carotid artery stenting - Current practice and techniques: Part 2ulous techniques and the advanced experience, embolic stroke represents a major drawback of the carotid stenting procedure (CAS). The majority of the neurological complications arc due to the intracerebral embolism of plaque fragments or thrombus during different procedural steps. Anti-Embolization Ebook Carotid artery stenting - Current practice and techniques: Part 2devices have been developed to reduce the incidence of embolic events during CAS (29-32). We have prospectively examined the outcome of CAS under cereEbook Carotid artery stenting - Current practice and techniques: Part 2
bral protection using rhe distal occlusion balloon protection (GuardWirc System, PcrcuSurgc-Mcdtronic, Minneapolis, MN) to assess whether this therapy15CAROTID ARTERY STENTING WITH THE DISTAL OCCLUSION ANTI-EMBOLIZATION SYSTEMMICHEL HENRY ANTONIOS POLYDOROU ISABELLE HENRY MICHÈLE HUCELDespite meticu Ebook Carotid artery stenting - Current practice and techniques: Part 2tients (264 carotid stenoses) met the inclusion criteria and underwent CAS under protection using the Guard Wire Anti-Embolization system. Patients were eligible for treatment if they had more than or equal to 70% diameter stenosis of the internal carotid artery (ICA) evaluated by angiography accord Ebook Carotid artery stenting - Current practice and techniques: Part 2ing to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria (2). We excluded the following patients from the treatment: multiEbook Carotid artery stenting - Current practice and techniques: Part 2
ple stenoses in the ICA, intracranial pathology, presence of angiographically visible thrombus, gastrointestinal bleeding in the last 6 months, and he15CAROTID ARTERY STENTING WITH THE DISTAL OCCLUSION ANTI-EMBOLIZATION SYSTEMMICHEL HENRY ANTONIOS POLYDOROU ISABELLE HENRY MICHÈLE HUCELDespite meticu Ebook Carotid artery stenting - Current practice and techniques: Part 2er day for at least 2 days and preferably 1 week before the procedure and for I month after it. Un fractionated heparin (5000 IU intravenously) and atropine (1 mg intravenously) arc routinely administered just after the introducer sheath is placed. Patients were usually discharged the day after the Ebook Carotid artery stenting - Current practice and techniques: Part 2procedure.All patients underwent neurological examination, a duplex scan, and a computed tomography (CT) scan the day after CAS, a neurological examinEbook Carotid artery stenting - Current practice and techniques: Part 2
ation and a duplex scan at 30 days and every 6 months thereafter, and an angiogram at 6 months. Any change in the neurological status after CAS requir15CAROTID ARTERY STENTING WITH THE DISTAL OCCLUSION ANTI-EMBOLIZATION SYSTEMMICHEL HENRY ANTONIOS POLYDOROU ISABELLE HENRY MICHÈLE HUCELDespite meticu Ebook Carotid artery stenting - Current practice and techniques: Part 2or/minor stroke, death, or myocardial infarction (MI) within the first 30 days postprocedure. The periprocedural complications were defined as any major/minor stroke, death, or MI occurring in the early 48 hours. The secondary clinical end points were the need of new intervention, angioplasty, or en Ebook Carotid artery stenting - Current practice and techniques: Part 2darterectomy at 6 months.https://khothuvien.cori!15. Carotid Artery Stenting with the Distal Occlusion Anti-Embolization System 171Angiographic endpoiEbook Carotid artery stenting - Current practice and techniques: Part 2
nts were: angiographic success rate, defined as achieving a less than or equal to 30% residual stenosis, and angiographic restenosis, defined as a red15CAROTID ARTERY STENTING WITH THE DISTAL OCCLUSION ANTI-EMBOLIZATION SYSTEMMICHEL HENRY ANTONIOS POLYDOROU ISABELLE HENRY MICHÈLE HUCELDespite meticu Ebook Carotid artery stenting - Current practice and techniques: Part 2equal to 30% and absence of any neurological complication, MI, or death.A total of 264 carotid angioplasties were attempted in 238 consecutive patients (190 males, 48 females, mean age 71.2 ± 9.4 years, range 40-91 years). Twenty-six patients had bilateral procedures. Ninety-five stenoses were asymp Ebook Carotid artery stenting - Current practice and techniques: Part 2tomatic (36%), and 169 were symptomatic (64%). A total of 224 lesions were atherosclerotic, 30 were restenoses (postsur-gical: 27. postangioplasty: 3)Ebook Carotid artery stenting - Current practice and techniques: Part 2
. and 8 were postradiation stenoses. One lesion was an inflammatory arteritis and another one a posttraumatic aneurysm. The mean percentage of stenosi15CAROTID ARTERY STENTING WITH THE DISTAL OCCLUSION ANTI-EMBOLIZATION SYSTEMMICHEL HENRY ANTONIOS POLYDOROU ISABELLE HENRY MICHÈLE HUCELDespite meticu Ebook Carotid artery stenting - Current practice and techniques: Part 2e calcified, and 188 were ulcerated (72%).DESCRIPTION OF THE GUARDWIRE SYSTEMThe device consists of three main components (sec Figs. 15-1-15-3):1The Guardwire temporary occlusion catheter: a 0.014-inch or 0.018-inch wire con-FIGURE 15-2. Export aspiration catheter mounted on a Guardwire temporary oc Ebook Carotid artery stenting - Current practice and techniques: Part 2clusion catheter.172 II. Carotid Artery Stenting TechniquesFIGURE 15-3. The PcrcuSurge GuardWirc.strucced of a hollow nitinol hypotubc incorporating iEbook Carotid artery stenting - Current practice and techniques: Part 2
nto its distal segment an inflatable compliant balloon that is capable of occluding the ICA outflow. The balloon diameter (3 to 6 mm) is chosen depend15CAROTID ARTERY STENTING WITH THE DISTAL OCCLUSION ANTI-EMBOLIZATION SYSTEMMICHEL HENRY ANTONIOS POLYDOROU ISABELLE HENRY MICHÈLE HUCELDespite meticu Ebook Carotid artery stenting - Current practice and techniques: Part 2y systems for dilatation and stenting. The terminal 3.5'Cm segment of the wire can be shaped as needed to facilitate lesion-crossing maneuvers, much like coronary wires.2A Microseal that is incorporated at the proximal end of the wire, allowing inflation and deflation of the distal protection balloo Ebook Carotid artery stenting - Current practice and techniques: Part 2n (PB), utilizing a Microseal adapter, rhe Microscal keeps the electrometric balloon inflated while allowing catheter exchange at the proximal end, siEbook Carotid artery stenting - Current practice and techniques: Part 2
milar to commonly used guide wires.3The aspiration catheter placed over the GuardWirc to aspirate generated debris. It may also be used to flush the I15CAROTID ARTERY STENTING WITH THE DISTAL OCCLUSION ANTI-EMBOLIZATION SYSTEMMICHEL HENRY ANTONIOS POLYDOROU ISABELLE HENRY MICHÈLE HUCELDespite meticu Ebook Carotid artery stenting - Current practice and techniques: Part 2 sheath (depending on the stent type) is initially placed into the common carotid artery (CCA) via the femoral approach. I he Guardwire is then gently advanced through the guide catheter, the lesion is crossed, and the marker ol the protection balloon placed 2 or 3 cm beyond it. I he Microseal adapt Ebook Carotid artery stenting - Current practice and techniques: Part 2er is then attached and the protection balloon slowly inflated with a fixed volume of dilute contrast, occluding the ICA and deriving vessel outflow tEbook Carotid artery stenting - Current practice and techniques: Part 2
owards the external carotid artery (EGA). It is important to verify by injection of contrast that the blood flow is totally interrupted in the ICA in 15CAROTID ARTERY STENTING WITH THE DISTAL OCCLUSION ANTI-EMBOLIZATION SYSTEMMICHEL HENRY ANTONIOS POLYDOROU ISABELLE HENRY MICHÈLE HUCELDespite meticu Ebook Carotid artery stenting - Current practice and techniques: Part 2h in the ICA at the base of the skull, where the ICA is smaller and the stability of the balloon is achieved. Upon detaching the Microseal adapter, the occlusion balloon remains inflated. Predilatation of the lesion or direct stenting arc then performed under protection. Any generated debris is remo Ebook Carotid artery stenting - Current practice and techniques: Part 2ved from the ICA using aspiration alone or aspiration and flushing techniques.Two protection techniques have been used:75. Carotid Artery Stenting witEbook Carotid artery stenting - Current practice and techniques: Part 2
h the Distal Occlusion Anti-Embolization System 173FIGURE 15-4. PercuSurge Guardwire system: procedure description. (A) The lesion is ơossed with Guar15CAROTID ARTERY STENTING WITH THE DISTAL OCCLUSION ANTI-EMBOLIZATION SYSTEMMICHEL HENRY ANTONIOS POLYDOROU ISABELLE HENRY MICHÈLE HUCELDespite meticu Ebook Carotid artery stenting - Current practice and techniques: Part 2ormed once after stent placement and postdilatation.Technique 2: The occlusion balloon is deflated between prcdilatation and stent placement to restore the cerebral flow. Aspiration is performed alter each of these two stages.The technique used depends on patient tolerance to the occlusion, the cere Ebook Carotid artery stenting - Current practice and techniques: Part 2bral collateral circulation, the status of the contralateral artery, the duration of the procedure, and the technical problems encountered. In both scEbook Carotid artery stenting - Current practice and techniques: Part 2
enarios, the aspiration catheter is advanced overFIGURE 15-5. PercuSurge Guardwire system, procedure description. (C) Intervention is performed under 15CAROTID ARTERY STENTING WITH THE DISTAL OCCLUSION ANTI-EMBOLIZATION SYSTEMMICHEL HENRY ANTONIOS POLYDOROU ISABELLE HENRY MICHÈLE HUCELDespite meticu Ebook Carotid artery stenting - Current practice and techniques: Part 2edure description. (D) Export catheter removes emboli and thrombus (right)the wire into the dilated area, with a 20-cc syringe connected to it to aspirate debris. A minimum of two aspirations are performed successively. Additionally, in our initial 40 cases, a flushing of the treated area was perfor Ebook Carotid artery stenting - Current practice and techniques: Part 2med using saline injections through the guide catheter to drive the particles towards the ECẠ. The injection was performed with an injection pump at aEbook Carotid artery stenting - Current practice and techniques: Part 2
rate of 2 mL per second for 10 seconds. Two flushes may be performed: the first with the guiding catheter positioned at the carotid bifurcation, and 15CAROTID ARTERY STENTING WITH THE DISTAL OCCLUSION ANTI-EMBOLIZATION SYSTEMMICHEL HENRY ANTONIOS POLYDOROU ISABELLE HENRY MICHÈLE HUCELDespite meticu Ebook Carotid artery stenting - Current practice and techniques: Part 2uarcM/ire balloon is deflated.Gọi ngay
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