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109 results for “Carotid stenting;”
Enterprise Stent Implantation in the Treatment of Carotid Artery Stenosis With Ischemic Stroke
ClinicalTrials.gov study NCT02802072. IPD Sharing: UNDECIDED. Countries: 0. Publications: 0.
Smart Nitinol Stent System for the Treatment of Severe Atherosclerotic Carotid Stenosis
ClinicalTrials.gov study NCT02800174. IPD Sharing: UNDECIDED. Countries: 0. Publications: 0.
Emboshield® and Xact® Post Approval Carotid Stent Trial (The EXACT Study)
ClinicalTrials.gov study NCT00287508. IPD Sharing: Not stated. Countries: 0. Publications: 0.
Postapproval Trial On Carotid Stenting in Patients With High Risk Vs Standard Risk for Open Carotid Endarterectomy(REAL)
ClinicalTrials.gov study NCT02750644. IPD Sharing: UNDECIDED. Countries: 0. Publications: 0.
Data set from the article Settembrini AM, Mazzaccaro D, Modafferi A, Righini P, Malacrida G, Nano G. Carotid artery stenting in the elderly. Are there differences between open and closed cell stents? Ann Ital Chir. 2019;90:106-110. PMID: 31182697.
<p>data set from the article Settembrini AM, Mazzaccaro D, Modafferi A, Righini P, Malacrida G, Nano G. Carotid artery stenting in the elderly. Are there differences between open and closed cell stents? Ann Ital Chir. 2019;90:106-110. PMID: 31182697.</p> <p>This is the abstract</p> <p><strong>Introduction: </strong>We reviewed our experience of carotid artery stenting (CAS) in patients older than 75 years treated with open or closed cell stents. The aim of our paper is to evaluate if there are differences between the two groups in term of clinical outcomes, neurological impairment and survival.</p> <p><strong>Material and methods: </strong>CAS consecutively performed from March 2000 and December 2016 in elderly patients were rectrospectively collected. We classified them into two groups: closed cells (group A) and open cells stent (group B). Perioperative and long term events were observed (death, major cerebrovascular and cardiovascular events, in-stent restenosis).</p> <p><strong>Results: </strong>We collected 429 CAS, 259 (60.37%) male with median age of 79 years (range 77-82). Group A collects 247 (57.98%) patients, 142 (33.3%) in group B. The other 40 patients were treated with hybrid stents or just ballooning. In perioperative period we had not death but 2 patients (0.8%) in group A had a transient ischemic attack (TIA) due to immediate stent thrombosis, 2 patients (1 per group) had an ipsilateral major stroke and 8 patients had a TIA (3 in group A and 5 in group B). Median follow up was 686 days (IQR 267-1299 days). Freedom from complications at 12, 36 and 60 months was 99.4 ± 0.5%, 97 ± 1.5% and 90.08 ± 4.3% respectively. Survival at 12, 36 and 60 months was 77.4 ± 7.5%, 51.6 ± 8.9% and 16.1± 6.6% respectively.</p> <p><strong>Conclusion: </strong>Our data show CAS as a safe procedure also for people older than 75 years in terms of perioperative and long term complications and cerebral events without any significant difference between the different type of stent. Further studies are requested to better clarify its role in symptomatic patients.</p>
Data set from Mazzaccaro D, Modafferi A, Malacrida G, Nano G. Assessment of long-term survival and stroke after carotid endarterectomy and carotid stenting in patients older than 80 years. J Vasc Surg. 2019 Aug;70(2):522-529. doi: 10.1016/j.jvs.2018.10.121. Epub 2019 Mar 2. PMID: 30837178.
<p>Data set from Mazzaccaro D, Modafferi A, Malacrida G, Nano G. Assessment of long-term survival and stroke after carotid endarterectomy and carotid stenting in patients older than 80 years. J Vasc Surg. 2019 Aug;70(2):522-529. doi: 10.1016/j.jvs.2018.10.121. Epub 2019 Mar 2. PMID: 30837178.</p> <p> </p> <p>This is the abstract:</p> <p><strong>Objective: </strong> The objective of this study was to analyze preoperative risk factors affecting long-term survival and the occurrence of stroke in patients older than 80 years undergoing either carotid endarterectomy (CEA) or carotid artery stenting (CAS) for carotid stenosis.</p> <p><strong>Methods: </strong> Data of all consecutive patients treated from January 1999 to December 2017 were retrospectively reviewed and outcomes analyzed. Kaplan-Meier analysis was used to estimate long-term survival and the risk of stroke for both groups. Cox proportional hazards analysis was used to assess the relative risk of all-cause mortality and long-term stroke for patients in the presence of selected comorbidities, including preoperative symptoms, coronary artery disease, chronic renal failure, atrial fibrillation (AF), hypertension, diabetes mellitus, and dyslipidemia. A P value <.05 was considered statistically significant.</p> <p><strong>Results: </strong> A total of 473 patients older than 80 years (298 men [63%]) underwent either CEA (n = 178) or CAS. At 30 days, one patient died in the CEA group of unrelated causes; no deaths were recorded after CAS (0.6% vs 0%; P = .18). At 5 years, survival was 67.6% ± 4.9% after CEA and 90.2% ± 2.3% after CAS (P < .0001). The main cause of death after CEA and CAS was a neoplasm. Estimated freedom from any stroke at 5 years was 97.3% ± 0.5% after CEA and 93.2% ± 1.2% after CAS (P = .07). The presence of preoperative AF significantly affected long-term mortality after CAS (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.34-1.98; P = .04) as well as being classified as American Society of Anesthesiologists class 3 at evaluation of the preoperative anesthesiology risk. The presence of preoperative AF was the only factor that significantly affected the occurrence of long-term stroke after both CAS (HR, 2.28; 95% CI, 1.86-5.63; P = .001) and CEA (HR, 3.45; 95% CI, 2.29-8.19; P = .005).</p> <p><strong>Conclusions: </strong> Both CEA and CAS showed low 30-day mortality and any-stroke rates in patients older than 80 years. In the long term, survival was significantly better after CAS; however, deaths after CEA and CAS were mainly unrelated to the procedure. No significant differences were recorded in the occurrence of any stroke in the long term. The presence of preoperative AF significantly affected long-term survival after CAS as well as being classified as American Society of Anesthesiologists class 3 at evaluation of the preoperative anesthesiology risk. The presence of preoperative AF also significantly affected long-term risk of stroke after both CAS and CEA.</p> <p> </p>
Poor concordance between definitions of type III arch and implications for risk prediction and assessment for carotid artery stenting
<p>Dataset from Marrocco-Trischitta MM, Vitale R, Nava G, Baroni I, Boveri S, Nano G, Secchi F. Poor concordance between definitions of type III arch and implications for risk prediction and assessment for carotid artery stenting. J Vasc Surg. 2021 Apr;73(4):1277-1281. doi: 10.1016/j.jvs.2020.08.142. Epub 2020 Sep 25. PMID: 32987147.</p> <p>Abstract</p> <p><strong>Objective: </strong>The type III arch configuration has been inconsistently reported as a stroke risk factor during carotid artery stenting. However, at least three different methods for the definition of type III arch can be identified in the literature, related to the level of the origin of the innominate artery (IA). According to Casserly's definition, a type III arch presents with an origin of the IA below the horizontal plane of the inner curvature. According to Madhwal's definition, a type III arch has a distance greater than twice the diameter of the left common carotid artery between the highest point of the arch and the origin of the IA. According to MacDonald's definition, a type III arch presents with a distance of ≥2 cm between the highest point of the arch and the origin of the IA. Our aim was to assess the level of concordance between these different methods.</p> <p><strong>Methods: </strong>Anonymized thoracic computed tomography scans of 100 healthy patients were reviewed. Two of us independently stratified the selected cases as a type I to III arch, according to the three considered definitions. The interobserver level of concordance for each type III arch classification and level of concordance among the three definitions were assessed.</p> <p><strong>Results: </strong>The 100 selected patients (64% male) were 76 ± 7 years old. For each definition, the interobserver repeatability was almost perfect for all three (Madhwal, κ = 0.81; 95% confidence interval [CI], 0.71-0.99; MacDonald, κ = 0.82; 95% CI, 0.72-0.92; Casserly, κ = 0.84; 95% CI, 0.74-0.93). The level of concordance among the different definitions was very low (Madhwal vs MacDonald, 85% [P = .002]; 33% for type III arch; Madhwal vs Casserly, 60% [P < .0001]; 12% for type III arch; MacDonald vs Casserly, 75% [P < .0001]; 12% for type III arch).</p> <p><strong>Conclusions: </strong>The three definitions of the type III arch have a very low level of concordance, which might account for the varying clinical relevance of this configuration. Our findings have relevant implications for risk prediction for carotid artery stenting based on the presence of a type III arch, for comparisons of the results from different studies, and for comparisons of different datasets from multicenter trials.</p>
Poor concordance between definitions of type III arch and implications for risk prediction and assessment for carotid artery stenting
<p>Dataset from Marrocco-Trischitta MM, Vitale R, Nava G, Baroni I, Boveri S, Nano G, Secchi F. Poor concordance between definitions of type III arch and implications for risk prediction and assessment for carotid artery stenting. J Vasc Surg. 2021 Apr;73(4):1277-1281. doi: 10.1016/j.jvs.2020.08.142. Epub 2020 Sep 25. PMID: 32987147.</p> <p>Abstract</p> <p><strong>Objective: </strong>The type III arch configuration has been inconsistently reported as a stroke risk factor during carotid artery stenting. However, at least three different methods for the definition of type III arch can be identified in the literature, related to the level of the origin of the innominate artery (IA). According to Casserly's definition, a type III arch presents with an origin of the IA below the horizontal plane of the inner curvature. According to Madhwal's definition, a type III arch has a distance greater than twice the diameter of the left common carotid artery between the highest point of the arch and the origin of the IA. According to MacDonald's definition, a type III arch presents with a distance of ≥2 cm between the highest point of the arch and the origin of the IA. Our aim was to assess the level of concordance between these different methods.</p> <p><strong>Methods: </strong>Anonymized thoracic computed tomography scans of 100 healthy patients were reviewed. Two of us independently stratified the selected cases as a type I to III arch, according to the three considered definitions. The interobserver level of concordance for each type III arch classification and level of concordance among the three definitions were assessed.</p> <p><strong>Results: </strong>The 100 selected patients (64% male) were 76 ± 7 years old. For each definition, the interobserver repeatability was almost perfect for all three (Madhwal, κ = 0.81; 95% confidence interval [CI], 0.71-0.99; MacDonald, κ = 0.82; 95% CI, 0.72-0.92; Casserly, κ = 0.84; 95% CI, 0.74-0.93). The level of concordance among the different definitions was very low (Madhwal vs MacDonald, 85% [P = .002]; 33% for type III arch; Madhwal vs Casserly, 60% [P < .0001]; 12% for type III arch; MacDonald vs Casserly, 75% [P < .0001]; 12% for type III arch).</p> <p><strong>Conclusions: </strong>The three definitions of the type III arch have a very low level of concordance, which might account for the varying clinical relevance of this configuration. Our findings have relevant implications for risk prediction for carotid artery stenting based on the presence of a type III arch, for comparisons of the results from different studies, and for comparisons of different datasets from multicenter trials.</p>
Clopidogrel Resistance and Ticagrelor Replacement in Dual Antiplatelet Therapy for Carotid Artery Stenting
<p>Mazzaccaro D, Giannetta M, Ranucci M, Righini P, Di Dedda U, Baryshnikova E, Milani V, Nano G. Clopidogrel Resistance and Ticagrelor Replacement in Dual Antiplatelet Therapy for Carotid Artery Stenting. Ann Vasc Surg. 2022 Oct 19:S0890-5096(22)00640-9. doi: 10.1016/j.avsg.2022.09.063. Epub ahead of print. PMID: 36270550.</p> <p>Abstract</p> <p><strong>Backgrounds: </strong>Resistance to the pharmacological effect of clopidogrel in patients undergoing dual antiplatelet therapy for carotid stenting may increase the risk of periprocedural neurological events. The purpose of the study was to describe the phenomenon of clopidogrel resistance in a series of patients undergoing carotid stenting.</p> <p><strong>Methods: </strong>Data of patients who consecutively underwent carotid stenting from November 2016 to December 2020 for a significant stenosis and who underwent a dual antiplatelet therapy using acetyl-salicylic acid and clopidogrel were prospectively collected. Patients who were already taking a different thienopyridine were excluded. The effectiveness of antiplatelet drugs was assessed by the impedance aggregometry test. Primary endpoint was to evaluate the incidence of clopidogrel resistance and the effectiveness of ticagrelor as alternative therapy. P values < 0.05 were considered statistically significant.</p> <p><strong>Results: </strong>Two-hundred patients (80 females, 40%) underwent stenting for carotid stenosis (94% asymptomatic). The phenomenon of clopidogrel resistance was observed in 38 patients (19%), in whom clopidogrel was replaced by ticagrelor (90 mg/bis in die) with 100% effectiveness at aggregometry test. Platelet counts was associated to clopidogrel resistance (P = 0.001). There was no stent thrombosis at 30 days, neither major hemorrhagic events; a total of 12/200 major adverse cardiovascular events occurred (6%), including 1 in the group of patients who took ticagrelor and 11 in group of patients under clopidogrel (2.6% versus 6.7%, P = 0.55).</p> <p><strong>Conclusions: </strong>Clopidogrel was ineffective in 19% of patients undergoing carotid stenting. Platelet count seemed to affect this phenomenon. In these patients, clopidogrel was effectively replaced by ticagrelor.</p>
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