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. 2018 Aug 3;57(2):85-88.
doi: 10.29399/npa.23239. eCollection 2020 Jun.

Carotid Near-Occlusion Stent Experiences

Yılmaz İnanç  1 , Yusuf İnanç  2
Affiliations

Carotid Near-Occlusion Stent Experiences

Yılmaz İnanç et al. Noro Psikiyatr Ars. .

Abstract

Introduction: Treatment strategy for near-occlusions (NO) of the internal carotid artery (ICA) is still controversial. In this study, we aimed to present the clinical results of stent placement in 50 patients with carotid artery (NO) stenosis that presented to our center, and upon which revascularization will be performed.

Methods: Between 2014 and 2017, 50 patients with (NO) from 180 patients who had stents in the Interventional Vascular Neurology clinic were retrospectively studied. All the patients whether using or not using the proximal and distal protection device during the procedure were included. Patients had clinical neurologic evaluation, and underwent carotid artery radiologic imaging before the carotid artery stent (CAS) procedure. Balloon dilatation was applied before the stent procedure for patients that had advanced stenosis. Post-dilatation was applied with a balloon of appropriate size in case of residual narrowing. Findings such as bradycardia, hypotension, reperfusion hemorrhage during and after the stent placement procedure, as well as patients that developed restenosis within 12 months were recorded.

Results: This study includes 50 (30 males, 20 females) patients that underwent carotid stent placement. The mean age of patients was 65 (28-81). Reperfusion hemorrhage was seen in 1 (2%) patient and the patient died in week 3. Ten (20%) patients complained of chills and tremor lasting less than 3 hours after the procedure. One (2%) patient had encephalopathy and agitation for less than 24 hours. Two (4%) patients had hypotension, and 15 (30%) patients had a headache for less than 24 hours. Three patients developed local hematoma at the site of the sheath, and were treated by applying compression. Restenosis signs in the stent site was observed in 6 patients (12%) in color Doppler ultrasonography of the carotid performed in the 6th and 12th months.

Conclusion: Although the innate process of ICA NO is not well known, it might be more frequent than currently considered. Especially after the diagnosis of ICA stenosis, it is important to make the right diagnosis in patients that have new ipsilateral symptoms. After the diagnosis is made, CAS, when performed by an experienced neuro-interventional team, seems beneficial with low complication rates.

Keywords: internal carotid artery; near-occlusion; revascularization; stent.

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Conflict of interest statement

Conflict of Interest: Authors have declared that they have no conflict of interest.

Figures

Figure 1. a-d
Figure 1. a-d
Right internal carotid artery (ICA) near-occlusion (NO) before endovascular procedure (a). Ballon pre-dilatation before carotid artery stenting (b). ICA angiogram after stent placement (c, d).
See this image and copyright information in PMC

References

    1. Hasan TF, Rabinstein AA, Middlebrooks EH, Haranhalli N, Silliman SL, Meschia JF, Tawk RG. Diagnosis and Management of Acute Ischemic Stroke. Mayo Clin Proc. 2018;9:523–538. - PubMed
    1. Fox AJ, Eliasziw M, Rothwell PM, Schmidt MH, Warlow CP, Barnett HJ. Identification, prognosis, and management of patients with carotid artery near occlusion. AJNR Am J Neuroradiol. 2005;26:2086–2094. - PMC - PubMed
    1. Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of 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 of Neuro Interventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Circulation. 2011;124:54–130. - PubMed
    1. Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clement D, Collet JP, Cremonesi A, Carlo MD, Erbel R, Fowkes FG, Heras M, Kownator S, Minar E, Ostergren J, Poldermans D, Riambau V, Roffi M, Rother J, Sievert H, Sambeek MV, Zeller T, Bax J, Auricchio A, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Knuuti J, Kolh P, McDonagh T, Moulin C, Poldermans D, Popescu B, Reiner Z, Sechtem U, Sirnes PA, Torbicki A, Vahanian A, Windecker S, Kolh P, Torbicki A, Agewall S, Blinc A, Bulvas M, Cosentino F, De Backer T, Gottsater A, Gulba D, Guzik TJ, Jonsson B, Kesmarky G, Kitsiou A, Kuczmik W, Larsen ML, Madaric J, Mas JL, Mc JJV Murray, Micari A, Mosseri M, Muller C, Naylor R, Norrving B, Oto O, Pasierski T, Plouin PF, Ribichini F, Ricco JB, Ruilope L, Schmid JP, Schwehr U, Sol BGM, Sprynger M, Tiefenbacher C, Tsioufis C, Van Damme H. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases:Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries:the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC) Eur Heart J. 2011;32:2851–2906. - PubMed
    1. Akkan K, Ilgit E, Onal B, Cindil E, Solak EP, Oncu F, Geylan DE. Endovascular Treatment for Near Occlusion of the Internal Carotid Artery. Clin Neuroradiol. 2016;28:245–252. - PubMed

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