Advertisement

Tailored Strategies in Carotid Artery Stenting to Avoid Periprocedural Complications

  • Yusuke Egashira
  • Yukiko Enomoto
  • Keita Yamauchi
  • Masanori Tsujimoto
  • Shinichi Yoshimura
  • Toru Iwama
Conference paper
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 129)

Abstract

Carotid artery stenting (CAS) has been widely accepted as a valuable therapeutic alternative to carotid endarterectomy (CEA) for high-grade carotid stenosis. Because carotid revascularization including CAS is usually performed in patients with minimal or no neurological deficits, utmost care should be taken to avoid periprocedural complications. The major concerns associated with CAS are embolic stroke, hyperperfusion syndrome (HPS), and perioperative myocardial infarction.

Plaque characteristics, cerebral blood flow (CBF) in the affected cerebral hemisphere, and concomitant coronary artery disease prior to CAS are all important to assess the risks of these complications and are routinely evaluated.

Tailored CAS is planned based on findings of preoperative evaluation, as follows. (1) If the plaque component is thought vulnerable, proximal embolic protection methods, use of a closed-cell-type stent, or referral to CEA should be considered to avoid embolic complications. (2) If patients have severe CBF impairment, staged angioplasty is an effective strategy to prevent postoperative HPS. (3) If concomitant cardiac diseases are present, the optimal treatment sequence should be discussed between cardiologists and neurointerventionalists.

These tailored strategies based on preoperative risk evaluations may lead to safer procedures and better clinical outcome in CAS patients.

Keywords

Carotid artery stenting Complication Preoperative evaluation Tailored strategy 

Abbreviations

CAS

Carotid artery stenting

CBF

Cerebral blood flow

CEA

Carotid endarterectomy

CVR

Cerebrovascular reserve

HPS

Hyperperfusion syndrome

MRA

Magnetic resonance angiography

MRI

Magnetic resonance imaging

PTA

Percutaneous transluminal angioplasty

SAP

Staged angioplasty

SPECT

Single-photon emission computed tomography

TOF

Time-of-flight

Notes

Conflict of Interest

We declare that we have no conflict of interest.

References

  1. 1.
    Rosenfield K, Matsumura JS, Chaturvedi S, Riles T, Ansel GM, Metzger DC, Wechsler L, Jaff MR, Gray W, Investigators AI. Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med. 2016;374:1011–20.  https://doi.org/10.1056/NEJMoa1515706.CrossRefPubMedGoogle Scholar
  2. 2.
    Silver FL, Mackey A, Clark WM, Brooks W, Timaran CH, Chiu D, Goldstein LB, Meschia JF, Ferguson RD, Moore WS, Howard G, Brott TG, Investigators C. Safety of stenting and endarterectomy by symptomatic status in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). Stroke. 2011;42:675–80.  https://doi.org/10.1161/STROKEAHA.110.610212.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Miyachi S, Taki W, Sakai N, Nakahara I, Japanese CASSI. Historical perspective of carotid artery stenting in Japan: analysis of 8,092 cases in the Japanese CAS survey. Acta Neurochir. 2012;154:2127–37.  https://doi.org/10.1007/s00701-012-1508-9.CrossRefPubMedGoogle Scholar
  4. 4.
    Yoshimura S, Yamada K, Kawasaki M, Asano T, Kanematsu M, Takamatsu M, Hara A, Iwama T. High-intensity signal on time-of-flight magnetic resonance angiography indicates carotid plaques at high risk for cerebral embolism during stenting. Stroke. 2011;42:3132–7.  https://doi.org/10.1161/STROKEAHA.111.615708.CrossRefPubMedGoogle Scholar
  5. 5.
    Yoshimura S, Yamada K, Kawasaki M, Asano T, Kanematsu M, Miyai M, Enomoto Y, Egashira Y, Iwama T. Selection of carotid artery stenting or endarterectomy based on magnetic resonance plaque imaging reduced periprocedural adverse events. J Stroke Cerebrovasc Dis. 2013;22:1082–7.  https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.07.018.CrossRefPubMedGoogle Scholar
  6. 6.
    Kaku Y, Yoshimura S, Kokuzawa J. Factors predictive of cerebral hyperperfusion after carotid angioplasty and stent placement. AJNR Am J Neuroradiol. 2004;25:1403–8.PubMedGoogle Scholar
  7. 7.
    Enomoto Y, Yoshimura S, Yamada K, Kawasaki M, Nishigaki K, Minatoguchi S, Iwama T. Silent coronary artery disease in Japanese patients undergoing carotid artery stenting. J Stroke Cerebrovasc Dis. 2013;22:1163–8.  https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.12.013.CrossRefPubMedGoogle Scholar
  8. 8.
    Cano MN, Kambara AM, de Cano SJ, Pezzi Portela LA, Paes AT, Costa JR Jr, Abizaid AA, Moreira SM, Sousa AG, Sousa JE. Randomized comparison of distal and proximal cerebral protection during carotid artery stenting. JACC Cardiovasc Interv. 2013;6:1203–9.  https://doi.org/10.1016/j.jcin.2013.07.006.CrossRefPubMedGoogle Scholar
  9. 9.
    Bijuklic K, Wandler A, Hazizi F, Schofer J. The PROFI study (Prevention of Cerebral Embolization by Proximal Balloon Occlusion Compared to Filter Protection During Carotid Artery Stenting): a prospective randomized trial. J Am Coll Cardiol. 2012;59:1383–9.  https://doi.org/10.1016/j.jacc.2011.11.035.CrossRefPubMedGoogle Scholar
  10. 10.
    Montorsi P, Caputi L, Galli S, Ciceri E, Ballerini G, Agrifoglio M, Ravagnani P, Trabattoni D, Pontone G, Fabbiocchi F, Loaldi A, Parati E, Andreini D, Veglia F, Bartorelli AL. Microembolization during carotid artery stenting in patients with high-risk, lipid-rich plaque. A randomized trial of proximal versus distal cerebral protection. J Am Coll Cardiol. 2011;58:1656–63.  https://doi.org/10.1016/j.jacc.2011.07.015.CrossRefPubMedGoogle Scholar
  11. 11.
    Timaran CH, Rosero EB, Higuera A, Ilarraza A, Modrall JG, Clagett GP. Randomized clinical trial of open-cell vs closed-cell stents for carotid stenting and effects of stent design on cerebral embolization. J Vasc Surg. 2011;54:1310–1316.e1311.; discussion 1316.  https://doi.org/10.1016/j.jvs.2011.05.013.CrossRefPubMedGoogle Scholar
  12. 12.
    Yoshimura S, Kitajima H, Enomoto Y, Yamada K, Iwama T. Staged angioplasty for carotid artery stenosis to prevent postoperative hyperperfusion. Neurosurgery. 2009;64:ons122–8.; discussion ons128–129.  https://doi.org/10.1227/01.NEU.0000334046.41985.BB.CrossRefPubMedGoogle Scholar
  13. 13.
    Shindo S, Fujii K, Shirakawa M, Uchida K, Sugiura Y, Saito S, Ando Y, Yoshimura S. Three-dimensional optical frequency domain imaging evaluation of novel dual-layered carotid stent implantation for vulnerable carotid plaque. J Stroke Cerebrovasc Dis. 2016;25:e31–2.  https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.11.019.CrossRefPubMedGoogle Scholar
  14. 14.
    Gargiulo G, Sannino A, Stabile E, Perrino C, Trimarco B, Esposito G. New cerebral lesions at magnetic resonance imaging after carotid artery stenting versus endarterectomy: an updated meta-analysis. PLoS One. 2015;10:e0129209.  https://doi.org/10.1371/journal.pone.0129209.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Biasi GM, Froio A, Diethrich EB, Deleo G, Galimberti S, Mingazzini P, Nicolaides AN, Griffin M, Raithel D, Reid DB, Valsecchi MG. Carotid plaque echolucency increases the risk of stroke in carotid stenting: the Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study. Circulation. 2004;110:756–62.  https://doi.org/10.1161/01.CIR.0000138103.91187.E3.CrossRefPubMedGoogle Scholar
  16. 16.
    Egashira Y, Yoshimura S, Sakai N, Enomoto Y, Japanese Registry of Neuroendovascular Therapy I. Real-world experience of carotid artery stenting in Japan: analysis of 7,134 cases from JR-NET1 and 2 nationwide retrospective multi-center registries. Neurol Med Chir (Tokyo). 2014;54:32–9.CrossRefGoogle Scholar
  17. 17.
    Ogasawara K, Sakai N, Kuroiwa T, Hosoda K, Iihara K, Toyoda K, Sakai C, Nagata I, Ogawa A, Japanese Society for Treatment at Neck in Cerebrovascular Disease Study G. Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review of 4494 patients. J Neurosurg. 2007;107:1130–6.  https://doi.org/10.3171/JNS-07/12/1130.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Yusuke Egashira
    • 1
  • Yukiko Enomoto
    • 1
  • Keita Yamauchi
    • 1
  • Masanori Tsujimoto
    • 1
  • Shinichi Yoshimura
    • 2
  • Toru Iwama
    • 1
  1. 1.Department of NeurosurgeryGifu University Graduate School of MedicineGifuJapan
  2. 2.Department of NeurosurgeryHyogo College of MedicineNishinomiyaJapan

Personalised recommendations