Clinical Analysis Comparing Efficacy between a Distal Filter Protection Device and Proximal Balloon Occlusion Device during Carotid Artery Stenting

Lee, Jong Hyeok,Sohn, Hee Eon,Chung, Seung Young,Park, Moon Sun,Kim, Seong Min,Lee, Do Sung The Korean Neurosurgical Society 2015 Journal of Korean neurosurgical society Vol.58 No.4

Objective : The main concern during transfemoral carotid artery stenting (CAS) is preventing cerebral embolus dislodgement. We compared clinical outcomes and intraprocedural embolization rates of CAS using a distal filter protection device or proximal balloon occlusion device. Methods : From January 2011 to March 2015, a series of 58 patients with symptomatic or asymptomatic internal carotid artery stenosis ${\geq}70%$ were treated with CAS with embolic protection device in single center. All patients underwent post-CAS diffusion-weighted magnetic resonance imaging (DW-MRI) to detect new ischemic lesions. We compared clinical outcomes and postprocedural embolization rates. Results : CAS was performed in all 61 patients. Distal filter protection success rate was 96.6% (28/29), whose mean age was 70.9 years, and mean stenosis was 81%. Their preprocedural infarction rate was 39% (11/28). Subsequent DW-MRI revealed 96 new ischemic lesions in 71% (20/28) patients. In contrast, the proximal balloon occlusion device success rate was 93.8% (30/32), whose mean age was 68.8 years and mean stenosis was 86%. Preprocedure infarction rate was 47% (14/30). DW-MRI revealed 45 new ischemic lesions in 57% (17/30) patients. Compared with distal filter protection device, proximal balloon occlusion device resulted in fewer ischemic lesions per patient (p=0.028). In each group, type of stent during CAS had no significant effect on number of periprocedural embolisms. Only 2 neurologic events occurred in the successfully treated patients (one from each group). Conclusion : Transfemoral CAS with proximal balloon occlusion device achieves good results. Compared with distal filter protection, proximal balloon occlusion might be more effective in reducing cerebral embolism during CAS.

Locking between a cerebral protection device and a stent-delivering catheter during carotid artery stenting.

Lee, Jong Hun,Youn, Sung Won,Kim, Ho Kyun Edizioni del Centauro 2014 Interventional neuroradiology Vol.20 No.1

<P>The cerebral protection device (CPD) itself may cause complications, including locking between the CPD and other devices, that may result in catastrophic outcomes requiring surgical removal of these locked devices. We describe a case of locking between a CPD and the stent-delivering catheter during carotid artery stenting, which was safely rescued by endovascular retrieval. The mechanism underlying locking with the CPD as well as preventive actions and maneuvers for rescuing the situation are discussed.</P>

Massive Cerebral Microemboli after Protected Carotid Artery Angioplasty and Stenting Using a Distal Filter Embolic Protection Device for a Vulnerable Plaque with a Lipid Rich Necrotic Core and Intraplaque Hemorrhage: A Case Report

김혜정,노명호 대한영상의학회 2020 대한영상의학회지 Vol.81 No.3

A major concern associated with carotid artery angioplasty and stenting (CAS) is a periprocedural distal cerebral embolization. To prevent distal embolization, embolic protection devices (EPDs) have been developed. However, the risk of cerebral embolism after protected CAS in patents with a vulnerable plaque is controversial and either a silent or a symptomatic stroke can occur despite the use of EPDs. Here, we report a case of a massive cerebral microemboli after a protected CAS using a distal filter EPD for a vulnerable plaque with a lipid rich necrotic core and intraplaque hemorrhage.

대퇴-대퇴동맥 우회 인조혈관 폐색에서 AngioJet Rheolytic Thrombectomy System과 색전보호기구를 이용한 혈전제거술: 증례 보고

강한솔,이상준,송순영,김응태,고성은,박성민 대한영상의학회 2021 대한영상의학회지 Vol.82 No.2

The authors report a successful thrombectomy using the AngioJet Rheolytic Thrombectomy System (AngioJet) and an embolic protection device in a patient with femorofemoral bypass graft occlusion. Lower extremity CT angiograms showed occlusion in the left-to-right femorofemoral bypass graft. A rheolytic thrombectomy using the AngioJet and balloon angioplasty restored blood flow to the right lower extremity, and distal embolization may be effectively prevented by placing an embolic protection device within the right superficial femoral artery during the procedure. 저자들은 대퇴-대퇴동맥 우회 인조혈관 폐색 환자에서 AngioJet Rheolytic Thrombectomy System (이하 AngioJet)과 색전보호기구를 이용하여 성공적으로 혈전제거술을 시행한 1예를 보고하고자 한다. 하지 혈관 전산화단층촬영에서 좌측에서 우측으로의 대퇴-대퇴 우회 인조혈관 폐색 소견을 보였다. AngioJet을 이용한 흐름 용해 혈전제거술과 풍선 혈관성형술을시행하여 우측 하지 혈류를 재개통 시켰으며, 시술 중 우측 표재성 대퇴동맥에 색전보호기구를 거치시켜 효과적으로 원위부 색전을 예방할 수 있었다.

The Use of Protection Device in Landmark-wire Technique of Symptomatic Subclavian Artery Occlusion with Combined Approach via Trans-femoral vs. Trans-brachial Arteries: Technical note

Park, Soonchan,Kwak, Jae Hyuk,Baek, Hye Jin,Park, Jee Won,Kim, Jong Sung,Suh, Dae Chul Korean Society of Interventional Neuroradiology 2011 Neurointervention Vol.6 No.2

<P><B>Purpose</B></P><P>Since we reported about a landmark technique to reopen an occluded subclavian artery, we have faced difficulty in using protection devices in the vertebral artery to protect against thromboembolism from the reversed steal phenomenon after angioplasty and stenting. Therefore, we are presenting an optimal solution in using a protection device while recanalizing the occluded subclavian artery.</P><P><B>Materials and Methods</B></P><P>Among 21 cases of stenting for subclavian artery steno-occlusion, we applied the landmark technique at the opposite end of an occluded segment in 4 patients and used a protection device in two patients. Because the embolic protection device was placed in the vertebral artery via the brachial artery, optimal angioplasty and stenting via the brachial route were limited. Therefore, angioplasty via the trans-brachial approach was needed to be followed by stenting through a trans-femoral approach. We estimated the safe and optimal steps for placement and retrieval of the protection devices in addition to stenting.</P><P><B>Results</B></P><P>The procedure was safely performed when a stent was introduced via the femoral artery and a protection device was used via the brachial artery. However, in cases when a guidewire wasn't passed via the transfemoral route, simultaneous use of two systems via the brachial route could cause friction of devices or trapping of protection devices in a stent. When a protection device was trapped in a deployed stent, we retrieved the protection device with a 4F angiocatheter by selectively rotating the catheter tip. To avoid such procedural difficulty, we recommend using a transbrachial angioplasty followed by trans-femoral stenting while placing the protection device in the vertebral artery via the trans-brachial route.</P><P><B>Conclusion</B></P><P>If a guidewire is not passed through using a trans-femoral approach while performing the landmark technique, changing the stenting route from brachial to the femoral artery can be useful after securing the lumen in the occluded subclavian artery after angioplasty via the brachial artery.</P>

심혈관 중재술에서 원위부 색전 방지 기구의 역할과 임상적 유용성

한승환,강웅철,안태훈,신익균 대한순환기학회 2003 Korean Circulation Journal Vol.33 No.9

The Safety of Protected Carotid Artery Stenting in Patients with Unstable Plaque on Carotid High-Resolution MR Imaging

정재영,곽효성,황승배,정경호 대한영상의학회 2018 대한영상의학회지 Vol.78 No.6

Purpose: The aim of this study was to determine the safety of the carotid artery stenting (CAS) procedure, using an embolic protection device which is based on the presence of unstable plaques on carotid MR imaging in patients who presented with severe carotid artery stenosis. Materials and Methods: This prospective study assessed 102 consecutive patients who had been noted with severe carotid stenosis. These patients underwent a preprocedural carotid MR imaging, and a periprocedural diffusion-weighted imaging (DWI) after the CAS. The unstable plaque on the carotid MR imaging was defined as characterized as intraplaque hemorrhage (IPH), thin/ruptured fibrous caps, or ulcers. We analyzed the incidence of the noted periprocedural ipsilateral ischemic events on the DWI, and noted the primary outcomes within 30 days of the CAS. Results: In the study, it is noted that 50 patients (49.0%) had IPH, 84 patients (82.4%) had thin/ruptured fibrous caps, and 43 patients (42.2%) had ulcers as seen on the carotid plaque MR imaging. The IPH was more common in the symptomatic group than in the asymptomatic group (58.7% vs. 41.1%, p = 0.12). Overall, the DWI was positive after CAS in 25.5% of cases. Additionally, the combined rate of 30-day stroke, myocardial infarction, or death was recorded at 3.9%. The new periprocedural ischemic lesions on the DWI were characteristically more frequently observed in the symptomatic group (17/46, 37.0%) than in the asymptomatic group (9/56, 16.1%) (p = 0.03). There was no significant difference in the primary outcome of the CAS, based on the type of unstable plaque of IPH, thin/ruptured fibrous caps, or ulcers. Conclusion: The protected CAS appears to be safe, regardless of the noted unstable plaque findings as seen on the carotid MR imaging. In this case, because of the higher risk of periprocedural ipsilateral ischemic events, it is therefore recommended that the symptomatic patients should receive more careful treatment during the CAS placement going forward.

Percutaneous Thrombectomy with a Half-Deployed Stent for the Treatment of Acute Inferior Vena Cava Thrombosis

Hyejin Mo,Young Ho So,정인목 대한혈관외과학회 2020 Vascular Specialist International Vol.36 No.3

Inferior vena cava (IVC) thrombosis, a type of deep vein thrombosis (DVT), is a relatively rare and poorly known disease compared to lower extremity DVT. We present a case of a 68-year-old woman with abdominal pain and mild lower leg swelling due to IVC thrombosis extending from the common iliac vein to the infrahepatic IVC. The thrombus was removed using a 14-mm Niti-S stent (Taewoong Medical, Korea) inserted via the right internal jugular vein. The stent was partially deployed and gently advanced to cover the thrombus, and then retracted through a vascular sheath capturing the thrombus. This case presents a therapeutic approach for the treatment of IVC thrombosis using a half-deployed stent as a filter and a basket. Follow-up evaluation after 5 years revealed a patent IVC and common iliac vein.

Array Comparative Genomic Hybridization as the First-line Investigation for Neonates with Congenital Heart Disease: Experience in a Single Tertiary Center

최보금,황수경,권정은,김여향 대한심장학회 2018 Korean Circulation Journal Vol.48 No.3

Background and Objectives: Neurologic intolerance (NI) is defined as the occurrenceof neurological symptoms during carotid artery stenting (CAS). Because NI is inevitableproblem, it may be helpful to anticipate its occurrence. So, we studied factors associated withNI during proximal protected CAS. Methods: We retrospectively analyzed all consecutive patients underwent proximal protectedCAS from August 2012 to January 2017. Results: We included total 123 patients (109 males, 72±8 years old). The total proceduretime was 43±12 minutes, and mean occlusion time was 4.8±1.2 minutes. We divided CASpatients into 2 groups according to presence of NI; neurologic tolerance (NT; n=74, 60%) andNI (n=49, 40%) groups. After the univariate analysis, symptomatic carotid artery stenosis(p=0.003), absence of anterior communicating artery (p=0.015) and low common carotidartery occlusion pressure (CCAOP, p<0.001) were associated with NI. After the multivariateanalysis, NI was significantly associated with symptomatic carotid artery stenosis (odds ratio[OR], 5.549; p=0.014) and systolic CCAOP≤42 mmHg (OR, 6.461; p<0.001). In NI group, 43patients (88%) recovered right after the balloon deflation and 2 patients were normalizedwithin 2 hours. However, 1 had major stroke and 3 had minor strokes in 4 patients withpersistent NI ≥24 hours. Conclusion: About 40% showed NI during the CAS. Most of them (88%, 43 of 49 patients)recovered after the balloon deflation, but stroke incidence was significantly higher in NIgroup. Symptomatic carotid artery stenosis and systolic CCAOP ≤42 mmHg were significantlyassociated with the development of NI during proximal protected CAS.

Risk Factors for Developing Large Emboli Following Carotid Artery Stenting

Kwon, Sae Min,Cheong, Jin Hwan,Lee, Sang Kook,Park, Dong Woo,Kim, Jae Min,Kim, Choong Hyun The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.53 No.3

Objective : The introduction and development of the embolic protecting device (EPD) has resulted in a decreased rate of stroke after carotid artery stenting (CAS). The authors performed a retrospective study to investigate the risk factors for developing large emboli after CAS which can lead to ischemic events. Methods : A total of 35 consecutive patients who underwent CAS between January 2009 and March 2012 were included in this study. Patients were divided into two groups including those with small emboli (group A; grade 1, 2) and those with large emboli (group B; grade 3, 4). The size and number of emboli were assigned one of four grades (1=no clots, 2=1 or 2 small clots, 3=more than 3 small clots, 4=large clots) by microscopic observation of the EPD after CAS. We compared demographic characteristics, medical history, and angiographic findings of each group. Results : Thirty-five patients underwent CAS, and technical success was achieved in all cases. Twenty-three patients were included in group A and 12 patients in group B. Our results demonstrated that advanced age [odds ratio (OR) 1.24; 95% confidence interval (CI) 1.01-1.52; p=0.044] and smoking (OR 42.06; CI 2.828-625.65, p=0.006) were independent risk factors for developing large emboli after CAS. Conclusion : In patients with carotid artery stenosis treated with CAS, advanced age and smoking increased the number and size of emboli. Although use of an EPD is controversial, it may be useful in CAS in patients with risk factors for large emboli in order to reduce the risk of ischemic events.