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Carotid Angioplasty Procedures News
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All Recent Carotid Angioplasty Procedures News |
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Complications of Angioplasty and Stenting of Cervicocerebral Arteries in Iran [ORIGINAL ARTICLE]
Angioplasty and stenting of the cervicocerebral arteries is a novel treatment for atherosclerotic stenosis, which has periprocedural complications. Data were collected prospectively from 2007 to 2009 in a multicenter cohort of patients undergoing interventions for cervicocerebral stenosis. Retrospective assessment of the 2003–2006 archives of the same interventionists and a review of their published work is the second part of this national survey. In 592 extracranial internal carotid artery angioplasty and stenting procedures in 581 patients (73% male; mean age, 63.4 ± 7 years), transient ischemic attack, stroke, intracerebral hemorrhage, and death occurred in 1.7%, 1.7%, 0.34%, and 1.52%, respectively. In 114 extracranial vertebral artery angioplasty and stenting procedures i......
POSTED 02/02/2010 at 03:27 AM --
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Systematic Preoperative Coronary Angiography and Stenting Improves Postoperative Results of Carotid Endarterectomy in Patients with Asymptomatic Coronary Artery Disease: A Randomised Controlled Trial
Objective: To evaluate the usefulness of systematic coronary angiography followed, if needed, by coronary artery angioplasty (percutaneous coronary intervention (PCI)) on the incidence of cardiac ischaemic events after carotid endarterectomy (CEA) in patients without evidence of coronary artery disease (CAD). (Source: Journal of Vascular Surgery)...
POSTED 01/31/2010 at 06:00 PM --
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Despite Higher Utilization of Carotid Angioplasty and Stenting (CAS) in 2006, Postprocedure Stroke, Mortality Rates, Hospital Charges, and Discharges to Nursing Skilled Facilities Remain Higher for CAS than for Carotid Endarterectomy Compared with 2005
This study compared, at the national level, trends in utilization, mortality, and stroke of carotid angioplasty and stenting (CAS) and carotid endarterectomy (CEA) during 2005-2006. (Source: Journal of Vascular Surgery)...
POSTED 01/31/2010 at 06:00 PM --
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Indications and Applications for Extracranial Carotid Artery Stent Placement
Abstract Treatment of high-grade symptomatic carotid stenosis via carotid endarterectomy has been shown to be superior to medical management
alone in several studies. Carotid angioplasty and stenting (CAS) has emerged as an alternative approach to endarterectomy
to reduce the associated perioperative risks. Several anatomic and physiologic factors that increase the risk of stroke and/or
death associated with endarterectomy have been identified. The alternative approach of CAS has been found to be noninferior
to endarterectomy for high surgical risk patients with severe symptomatic carotid stenosis and the use of this procedure is
supported by the current widely accepted guidelines. In patients with standard surgical risk, the differential benefit of
CAS compared with endar......
POSTED 01/25/2010 at 11:02 AM --
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Protein Kinase-C Delta Mediates Arterial Injury Responses through Regulation of Vascular Smooth Muscle Cell Apoptosis
Introduction: Endovascular intervention has been proven to be a cost-effective approach in revascularization of peripheral arterial disease. However, the long-term efficacy of endovascular procedures is often limited by restenosis, which is primarily caused by excessive intimal hyperplasia after vascular injury. Intimal hyperplasia is a complex process involving vascular smooth muscle cell (VSMC) proliferation, migration, apoptosis and extracellular matrix deposition. Apoptosis of VSMC has been shown to influence intimal hyperplasia, presumably through reduction of the lesion cell numbers. However, how apoptosis is regulated after vascular injury is not fully understood. We have previously demonstrated Protein Kinase-C delta (PKCδ) is an integral mediator of VSMC apoptosis in vitro. Here,......
POSTED 01/25/2010 at 10:41 AM --
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The Role of Doxycycline as an Inhibitor of Intimal Hyperplasia after Balloon Angioplasty Arterial Injury
Objective: Intimal hyperplasia (IH) is the most common indicator for secondary intervention in peripheral vascular disease. The major cellular processes contributing to IH development are extracellular matrix (ECM) degradation and vascular smooth muscle cell (VSMC) migration and proliferation. Matrix metalloproteinases (MMPs) are implicated in vascular remodeling due to their ability to selectively degrade components of the ECM. Members of the tetracycline family of antibiotics are potent MMP inhibitors, doxycycline being one of the more potent inhibitors with better absorption and a longer half-life than the parent compound. We have previously shown doxycycline inhibits MMP activity and VSMC migration in vitro. Moreover, doxycycline has been found to inhibit cell proliferation in other ce......
POSTED 01/25/2010 at 10:41 AM --
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Nitric Oxide-Dependent Bone Marrow Progenitor Mobilization by Carbon Monoxide Enhances Endothelial Repair After Vascular Injury.
Conclusions-Collectively, the present data demonstrate that CO accelerates EC proliferation and vessel repair in a manner dependent on NO generation and enhanced recruitment of bone marrow-derived endothelial progenitor cells.
PMID: 20083679 [PubMed - as supplied by publisher] (Source: Circulation)...
POSTED 01/17/2010 at 06:00 PM --
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Indications and Applications of Arterial Stents for Stroke Prevention in Atherosclerotic Intracranial Stenosis
Abstract Intracranial stenosis accounts for 8–10% of all ischemic strokes in North America, a frequency slightly less than that of
extracranial carotid stenosis. Among patients presenting with transient ischemic attack or stroke due to intracranial stenosis,
the risk of recurrent stroke in the first year after initial symptoms is about 14%. Those with high-risk features (recent
stroke and severe stenosis) have up to a 23% rate of recurrent stroke in the year after their initial event. Angioplasty with
stenting has emerged as a potential treatment strategy, particularly in high-risk patients, although evidence is currently
limited to uncontrolled prospective trials and retrospective case series. In this article, we critically review the clinical
results supporting the use......
POSTED 01/11/2010 at 12:25 PM --
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Design of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST)
The objective is to compare the efficacy of CAS versus CEA in patients with symptomatic ([ge]50%) or asymptomatic ([ge]60%) extracranial carotid stenosis. The Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) is a prospective, randomized, parallel, two-arm, multi-center trial with blinded endpoint adjudication. Primary endpoints are analyzed using standard time-to-event statistical modeling with adjustment for major baseline covariates. Primary analysis is on an intent-to-treat basis. The primary outcome is the occurrence of any stroke, myocardial infarction, or death during a 30-day peri-procedural period, and ipsilateral stroke during follow-up of up to four years. Secondary outcomes include restenosis and health-related quality of life. (Source: International Journal o......
POSTED 01/06/2010 at 06:00 PM --
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Protein kinase C delta mediates arterial injury responses through regulation of vascular smooth muscle cell apoptosis
Conclusion
The expression of PKC is upregulated in the arterial wall in response to injury. This induction appears to be a mechanism of arterial response that negatively influences the degree of intimal hyperplasia by stimulating VSMC apoptosis. (Source: Cardiovascular Research)...
POSTED 01/05/2010 at 10:18 AM --
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A Reference Standard-Based Quality Assurance Program for Radiology
The authors have developed a comprehensive radiology quality assurance (QA) program that evaluates radiology interpretations and procedures by comparing them with reference standards. Performance metrics are calculated and then compared with benchmarks or goals on the basis of published multicenter data and meta-analyses. Additional workload for physicians is kept to a minimum by having trained allied health staff members perform the comparisons of radiology reports with the reference standards. The performance metrics tracked by the QA program include the accuracy of CT colonography for detecting polyps, the false-negative rate for mammographic detection of breast cancer, the accuracy of CT angiography detection of coronary artery stenosis, the accuracy of meniscal tear detection on MRI, ......
POSTED 12/31/2009 at 06:00 PM --
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Access complications during endovascular aortic repair.
This article will discuss a multitude of access related complications and their treatment. Preoperative imaging is paramount to the success of endovascular procedures. Intraoperative adjuncts, such as iliac artery angioplasty/stenting, the "pull-down" technique, and aorto mono iliac/femoral systems will be discussed. Occasionally, challenging iliac or femoral anatomy may preclude access through these vessels and the endovascular specialist may need to gain direct access through the aorta or via the carotid artery. In addition, the advantages and disadvantages of an entirely percutaneous technique will be discussed. Finally, peri-operative complications such as rupture, dissection, pseudoaneurysm and infection will be discussed and various treatment modalities reviewed. As stent graft techn......
POSTED 12/31/2009 at 06:00 PM --
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Carotid Artery Stenting for Stenosis Following Cervical Radiotherapy: Report of Early Failure With Associated Stent Fracture
We report the case of a 64-year-old man who was treated with bilateral CAS for stenoses, which developed 7 years following thyroidectomy, neck dissection, and radiotherapy. Although long considered an ideal alternative to CE in this clinical setting, CAS in this case was complicated by multiple episodes of recurrent stenosis in his left carotid, managed by balloon angioplasty. Severe, early recurrence in his right carotid associated with a type III stent fracture was managed by CE. Close surveillance and intervention prevented neurologic morbidity. This case, combined with emerging published experience, argues for reappraisal of the general consensus that CAS is an ideal alternative to CE for radiotherapy-associated carotid stenoses. (Source: Vascular and Endovascular Surgery)...
POSTED 12/29/2009 at 11:49 PM --
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Retinal Embolization During Carotid Angioplasty and Stenting: Periprocedural Data and Follow-Up
Abstract The purpose of this study was to prospectively evaluate the incidence of retinal emboli during carotid angioplasty and stenting
(CAS) and to correlate emboli with clinical findings and transcranial Doppler (TCD)-detected cerebral embolic load. Between
2001 and 2005, 33 CAS procedures in 32 patients (23 [72%] male, 19 [58%] symptomatic, mean age 72.5 years [range 54.6 to 83.9])
scheduled for CAS were included in this study. Bilateral fundoscopy with retinal photography was performed by an experienced
ophthalmologist immediately before, immediately after (fundoscopy only), and 1 day after the procedure and again at long-term
follow-up (mean 37 months). Visual field testing was performed before CAS and again at long-term follow-up. TCD-detected cerebral......
POSTED 12/24/2009 at 01:56 PM --
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Biaxial mechanical properties of intact and layer-dissected human carotid arteries at physiological and supra-physiological loadings.
Authors: Sommer G, Regitnig P, Költringer L, Holzapfel GA
Specimens of intact wall tubes of human common carotid arteries (CCA), internal carotid arteries (ICA) (n = 11, age 77.6 yrs, SD 6.3) and related adventitia and media-intima tubes are mechanically examined. Cyclic, quasi-static extension-inflation tests at different axial stretches are performed on pre-conditioned tube specimens. Stress-free configurations show significant stress releases in the circumferential direction of the intact CCA and ICA walls and in the axial directions of the intact CCA walls and the CCA and ICA adventitias. All investigated tissues exhibit strong nonlinear, pseudo-elastic mechanical behavior with small hysteresis. The 'inversion'-feature where the pressure/axial stretch relationship becomes a ve......
POSTED 12/23/2009 at 06:00 PM --
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[Atherosclerotic carotid stenosis in women.]
Authors: Woimant F
Atherosclerotic carotid stenosis is a risk factor for myocardial infarction, for vascular death, and for stroke. Medical treatment for atherosclerotic carotid stenosis routinely includes screening for and treatment of both risk factors and other atherosclerotic sites, the prescription of antiplatelets drugs, and patient education about transient ischemic accidents. The benefits of carotid surgery have been demonstrated in symptomatic stenoses with stenosis of 70% or more. In women, the benefits of surgery are slight for asymptomatic stenosis exceeding > 60% and for moderate symptomatic stenosis (50-69%). The treatment decision requires consideration of individual factors such as age, characteristics of the stenosis, and the type of symptoms (hemispheric or retinal......
POSTED 12/21/2009 at 06:00 PM --
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Most Carotid Stenosis Cases Treatable with Medical Therapy (CME/CE)
Treating carotid stenosis with intensive medical therapy may eliminate the need for either angioplasty or endarterectomy, a new study suggests. (Source: MedPage Today Cardiovascular)...
POSTED 12/14/2009 at 02:00 PM --
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Predicting embolic potential during carotid angioplasty and stenting: Analysis of captured particulate debris, ultrasound characteristics, and prior carotid endarterectomy
Conclusions: Considerable variation exists in the number and size of embolic particles generated during CAS. Embolic potential is positively correlated with lesion GSM and the combination of lesion echogenicity, heterogenicity, and irregularity. Restenosis after prior CEA is associated with minimal embolic particulate generation, suggesting that embolic protection may not be necessary for CAS of restenotic lesions. (Source: Journal of Vascular Surgery)...
POSTED 12/13/2009 at 06:00 PM --
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Periadventitial delivery of anti-EGF receptor antibody inhibits neointimal macrophage accumulation after angioplasty in a hypercholesterolaemic rabbit
Monocyte recruitment and their differentiation into macrophages are both early events in native and accelerated atherosclerosis that follows angioplasty. We have investigated the putative functional role of the epidermal growth factor receptor (EGFR) present on rabbit monocytes/macrophages. The impact of periadventitial delivery of an EGFR-specific, blocking monoclonal antibody (ICR62, which inhibits EGF-binding to its receptor) was investigated in a rabbit model of accelerated atherosclerosis induced by a combination of carotid injury and 4 weeks of a 2% cholesterol-diet. Two weeks after the initiation of the diet, a balloon-catheter angioplasty of the left common carotid artery was performed and a collar placed around the injured carotid artery immediately, for the delivery of ICR62 anti......
POSTED 12/11/2009 at 06:00 PM --
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Gender differences in carotid imaging and revascularization following stroke
Conclusions: Although women with ischemic stroke or TIA are less likely than men to undergo carotid screening and revascularization, this difference is largely explained by potential contraindications to surgery and by sex differences in the severity of carotid disease. (Source: Neurology)...
POSTED 12/07/2009 at 03:01 PM --
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