Saw Carotid Artery Stenting: The Basics

1. Auflage 2009
ISBN: 978-1-60327-314-5
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 264 Seiten

Reihe: Contemporary Cardiology

Over the past three decades, carotid artery stenting has evolved to become a promising and viable alternative to carotid endarterectomy, especially for patients deemed to have high surgical risks. In Carotid Artery Stenting: The Basics, Jacqueline Saw and a panel of international experts on carotid artery stenting discuss in depth the details of all contemporary aspects of carotid stenting, while reviewing supporting studies, guidelines, technical perspectives, and peri-procedural management. This textbook serves as a learning resource on the multifaceted management of patients with carotid artery stenosis, with the key focus on extracranial carotid artery stenting. Additional sections detail the specifics of setting up and maintaining a laboratory and discuss the preparation of the carotid artery stenting procedure from both the patient and operator's perspective. Authoritative and highly practical, Carotid Artery Stenting: The Basics is an accessible guide and valuable resource for today's cardiologists, radiologists, and vascular surgeons.

Autoren/Hrsg.

Saw, Jacqueline

Inhaltsverzeichnis

1;PREFACE;7
2;CONTENTS;8
3;CONTRIBUTORS;10
4;I CAROTID ARTERY STENOSIS AND MANAGEMENT;12
4.1;Carotid Artery Stenosis Prevalence and Medical Therapy;13
4.1.1;Prevalence of Carotid Artery Stenosis (Extracranial and Intracranial);13
4.1.1.1;Incidence and Economic Burden;13
4.1.1.2;Etiology;14
4.1.1.3;Prevalence of Concomitant Coronary Artery Disease;15
4.1.1.4;Risk of Stroke with Coronary Artery Bypass Surgery;15
4.1.2;Correlation of Carotid Stenosis to Strokes;15
4.1.2.1;Significance of a Carotid Bruit;16
4.1.3;Typical Stroke Syndromes Associated with Extracranial Carotid Stenosis;17
4.1.4;Evidence-Based Medical Therapy for Patients with Carotid Stenosis;17
4.1.4.1;Primary Prevention of Traditional Cardiovascular Risk Factors;19
4.1.4.1.1;Antiplatelet Therapies;19
4.1.4.1.1.1;Aspirin;19
4.1.4.1.1.2;Aspirin and Acute Stroke;21
4.1.4.1.1.3;Dipyridamole;21
4.1.4.1.1.4;Clopidogrel;21
4.1.4.1.1.5;Summary of Antiplatelet Agents;22
4.1.4.1.2;Statins;23
4.1.4.1.2.1;Secondary Stroke Prevention;24
4.1.4.1.3;ACE Inhibitors;26
4.1.4.1.3.1;Secondary Stroke Prevention;26
4.1.4.1.4;Anticoagulants;26
4.1.5;Conclusions;27
4.1.6;References;27
4.2;Carotid Revascularization: Carotid Endarterectomy;30
4.2.1;Introduction;30
4.2.2;Preoperative Assessment;31
4.2.3;Indications for CEA;32
4.2.3.1;Symptomatic Carotid Artery Stenosis;32
4.2.3.2;Asymptomatic Carotid Stenosis Trials;33
4.2.3.3;Summary of the Indications ;34
4.2.4;Surgical Technique;35
4.2.4.1;Shunting or Not;37
4.2.4.2;CEA Under Local Anesthesia vs. General Anesthesia;37
4.2.4.3;Patch vs. Primary Closure;38
4.2.4.4;Type of Patch;38
4.2.4.5;A Variant Approach: Eversion Endarterectomy;38
4.2.5;Complications;39
4.2.5.1;Early Complications;39
4.2.5.1.1;Stroke or death;39
4.2.5.1.2;Hyperperfusion/cerebral hemorrhage;39
4.2.5.1.3;Cranial nerve injuries;40
4.2.5.1.4;Hemorrhage and infection;40
4.2.5.1.5;Systemic complications;40
4.2.5.2;Late Complications;40
4.2.5.2.1;Recurrent stenosis;40
4.2.5.2.2;False aneurysm;41
4.2.6;Conclusions;41
4.2.7;References;41
4.3;Carotid Stenting Registries and Randomized Trials;46
4.3.1;Introduction and Historical Background;46
4.3.2;Early Multi-Center Cas Registries;48
4.3.2.1;Pro-CAS;49
4.3.2.2;ELOCAS;49
4.3.2.3;The Global Carotid Artery Stent Registry;49
4.3.3;Contemporary High Surgical Risk Cas Registries;50
4.3.3.1;ARCHeR;50
4.3.3.2;BEACH;52
4.3.3.3;CABERNET;52
4.3.3.4;CREATE;53
4.3.3.5;MAVErIC;53
4.3.3.6;MO.MA;53
4.3.3.7;PASCAL;54
4.3.3.8;PRIAMUS;54
4.3.3.9;SECURITY;54
4.3.4;Trials of cas vs. Cea;54
4.3.4.1;The ‘Stopped’ Trial;55
4.3.4.2;CAVATAS;55
4.3.4.3;The Wallstent Trial;55
4.3.4.4;Community (Kentucky) Trial;56
4.3.4.5;CARESS;56
4.3.4.6;SAPPHIRE;57
4.3.4.7;EVA-3S;59
4.3.4.8;SPACE;61
4.3.4.9;Meta-analyses of CAS vs. CEA Trial Data;63
4.3.5;Post-Market Surveillance (Pms) Registries;64
4.3.5.1;CAPTURE;65
4.3.5.2;CASES-PMS;65
4.3.5.3;EXACT;66
4.3.6;Ongoing trials of cas vs. Cea;66
4.3.6.1;CREST;66
4.3.6.2;ICSS/CAVATAS-2;67
4.3.7;Act-1;68
4.3.7.1;ACST-2;68
4.3.7.2;TACIT;68
4.3.8;Conclusion;68
4.3.9;References;69
5;II LABORATORY SETUP AND BACKGROUND NONINVASIVE IMAGING;73
5.1;Catheterization Laboratory: X-Ray Equipment, Imaging Modalities and Programs, and Radiation Safety;74
5.1.1;Introduction;75
5.1.2;Imaging Equipment;75
5.1.3;Intravascular Contrast Agents;76
5.1.4;Imaging Modalities and Programs;77
5.1.5;Radiation Safety;81
5.1.6;Conclusions;82
5.1.7;References;82
5.2;Noninvasive Imaging of the Extracranial Carotid Circulation;83
5.2.1;Introduction;83
5.2.2;CT Angiography;83
5.2.2.1;CT Technique;84
5.2.2.1.1;Influence of Scan Speed;84
5.2.2.1.2;Contrast Injection Protocols;84
5.2.2.2;Image Reconstruction;84
5.2.2.3;Image Interpretation;88
5.2.2.4;CT Artifacts;88
5.2.2.5;Validation Studies of CT Angiography;88
5.2.3;MR Angiography;88
5.2.3.1;Time-of-Flight MRA;89
5.2.3.2;Contrast-Enhanced MRA;92
5.2.3.3;Gadolinium;92
5.2.3.4;MRA Validation;93
5.2.4;Carotid UltraSonography;93
5.2.4.1;Other Applications for Carotid Sonography;97
5.2.4.2;Carotid Near and Total Occlusion;98
5.2.5;Recommendations Regarding Imaging;98
5.2.6;References;98
6;III PATIENT AND OPERATOR PREPARATION FOR CAROTID STENTING;101
6.1;Pre-procedural Patient Preparation;102
6.1.1;Introduction;102
6.1.2;Baseline Neurological Examination;103
6.1.2.1;NIH Stroke Scale;103
6.1.3;Adjusting Medications Prior to the Procedure;107
6.1.3.1;Medication Adjustment Prior to Contrast Agents Use;107
6.1.3.2;Medication Adjustment Prior to Carotid Intervention;107
6.1.4;Use of Antiplatelet Agents Prior to and Following CAS;108
6.1.4.1;Aspirin;108
6.1.4.2;Thienopyridines;108
6.1.5;Use of Anticoagulants with CAS;109
6.1.5.1;Use of Unfractionated Heparin (UFH);109
6.1.5.2;Use of Low Molecular Weight Heparins (LMWH);110
6.1.5.3;Direct Thrombin Inhibitors;111
6.1.5.4;Use of Glycoprotein IIb/IIIa Inhibitors;112
6.1.6;Conclusion;112
6.1.7;References;112
6.2;Patient Selection for Carotid Stenting;115
6.2.1;Introduction;115
6.2.2;Atherothrombotic Risk Profile in Patients with Cerebrovascular Disease;116
6.2.3;Carotid Endarterectomy;117
6.2.4;Carotid Artery Stenting vs. Carotid Endarterectomy;118
6.2.5;Special Populations;120
6.2.6;Contraindications to Carotid Stenting;121
6.2.7;Indications for Carotid Revascularization;121
6.2.8;Screening for Carotid Artery Disease;122
6.2.9;Reimbursement Considerations for Carotid Stenting;122
6.2.10;Considerations for Training and Credentialing;122
6.2.11;References;122
6.3;Operator Training and Accreditation;125
6.3.1;Introduction;126
6.3.2;Training Pathways;126
6.3.3;Preliminary Training;127
6.3.4;Cognitive Skills And Knowledge Base;128
6.3.5;Technical Skills;129
6.3.6;Cerebral Angiography;129
6.3.7;Carotid Intervention;130
6.3.8;Maintenance Of Continuing Quality Of Care;132
6.3.9;Role Of Simulation;132
6.3.10;Summary;132
6.3.11;References;133
7;IV TECHNICAL APPROACH OF CAROTID ARTERY STENTING;134
7.1;Vascular Access: Femoral, Radial, Brachial, and Direct Carotid Approach;135
7.1.1;Introduction;135
7.1.2;General Principles;136
7.1.3;Femoral Access;137
7.1.3.1;Indications/Contraindications;137
7.1.3.2;Methods;137
7.1.3.2.1;Landmarks;137
7.1.3.2.2;Puncture;138
7.1.3.2.3;Hemostasis;140
7.1.3.2.4;Closure;140
7.1.3.3;Complications;141
7.1.4;Radial Access;141
7.1.4.1;Indications/Contraindications;141
7.1.4.2;Methods;142
7.1.4.3;Complications;144
7.1.5;Brachial Access;144
7.1.5.1;Indications/Contraindications;144
7.1.5.2;Methods;145
7.1.5.3;Complications;146
7.1.6;Direct Carotid Access;146
7.1.6.1;Indications/Contraindications;146
7.1.6.2;Methods;147
7.1.6.3;Complications;148
7.1.7;Summary;148
7.1.8;References;149
7.2;Aortic Arch and Cerebrovascular Anatomy and Angiography;151
7.2.1;Introduction;151
7.2.2;Great Vessel and Cerebrovascular Anatomy;152
7.2.2.1;The Aortic Arch;152
7.2.2.2;The Subclavian Arteries;154
7.2.2.3;The Anterior Circulation;154
7.2.2.3.1;Common Carotid Arteries (CCA);154
7.2.2.3.2;External Carotid Artery (ECA);155
7.2.2.3.3;Internal Carotid Artery (ICA);156
7.2.2.3.4;Middle Cerebral Artery (MCA);158
7.2.2.3.5;Anterior Cerebral Artery (ACA);158
7.2.2.4;The Posterior Circulation;160
7.2.2.4.1;Vertebral Arteries;160
7.2.2.4.1.1;Basilar Artery;162
7.2.2.4.1.2;Posterior Cerebral Artery (PCA);165
7.2.2.4.1.3;Circle of Willis;165
7.2.3;Great Vessel and Cerebrovascular Angiography;166
7.2.3.1;Basic Principles;166
7.2.3.2;Arterial Access;166
7.2.3.3;Anticoagulation, Catheter Preparation and Contrast Agents;167
7.2.3.4;Aortic Arch Angiography;167
7.2.3.5;Selective Carotid Angiography;168
7.2.3.6;Vertebral Angiography;169
7.2.3.7;Reverse-Curve Diagnostic Catheters;170
7.2.3.8;Complications of Cerebrovascular Angiography;170
7.2.4;Conclusions;170
7.2.5;References;171
7.3;Extracranial Carotid Stent Interventional Approach;172
7.3.1;Introduction;172
7.3.2;Carotid Artery Stenting Procedure;173
7.3.2.1;Arterial Access;173
7.3.2.2;Anticoagulation;173
7.3.2.3;Baseline Diagnostic Carotid and Cerebral Angiography;173
7.3.2.4;Sheath or Guide Approach;176
7.3.2.4.1;Sheath Approach;177
7.3.2.4.2;Guide Approach;179
7.3.2.4.3;Direct Guide Approach;180
7.3.2.5;Emboli Protection Device;180
7.3.2.5.1;Filter EPD;180
7.3.2.5.2;Balloon Occlusion EPD;182
7.3.2.6;Balloon Pre-dilatation;185
7.3.2.7;Stent Placement;186
7.3.2.8;Balloon Post-dilatation;188
7.3.2.9;Retrieval of EPD;188
7.3.2.10;Final Carotid and Cerebral Angiography;190
7.3.3;Post-Procedural Monitoring;190
7.3.4;Contralateral Carotid Stenosis;192
7.3.5;Conclusion;192
7.3.6;References;192
7.4;Equipment for Extracranial Carotid Artery Stenting;194
7.4.1;Introduction;194
7.4.2;Guidewires;195
7.4.2.1;0.014" or 0.018" Guidewires;195
7.4.2.2;0.035" Peripheral Guidewires;195
7.4.2.2.1;Flexible Peripheral Wires;195
7.4.2.2.2;Hydrophilic Peripheral Wires;197
7.4.2.2.3;Stiff Peripheral Wires;197
7.4.3;Catheters and Sheaths;198
7.4.3.1;Diagnostic Catheters: Types I and II Aortic Arch;198
7.4.3.2;Diagnostic Catheters: Type III Aortic Arch;199
7.4.3.3;Guide Catheters;199
7.4.3.4;Sheaths;199
7.4.4;Angioplasty Balloons;200
7.4.4.1;Pre-dilatation Balloons;200
7.4.4.2;Post-dilatation Balloons;201
7.4.5;Carotid Stents and EPD;201
7.4.5.1;Open Versus Closed Strut Stent Design and Rationale;202
7.4.5.2;ACCULINKtrade, RX-ACCULINKtrade Stents and ACCUNETtrade EPD;204
7.4.5.3;XACTreg Stent and Emboshieldreg EPD;205
7.4.5.4;Protégéreg GPStrade, Protégéreg RX Stents, and SPIDERtrade EPD;207
7.4.5.5;PRECISEtrade Stent and Angioguardreg XP EPD;208
7.4.5.6;Nexstentreg Stent and Filterwire EZtrade EPD;209
7.4.5.7;Exponentreg OTX, Exponentreg RX, and Guardwiretrade EPD;209
7.4.6;Aspiration Catheters;211
7.4.7;Proximal Balloon Occlusion Emboli Protection Devices;211
7.4.8;Conclusion;213
7.4.9;References;214
7.5;The Endovascular Treatment of Acute Ischemic Stroke;215
7.5.1;Introduction;215
7.5.2;The Uniqueness of the Cerebrovascular Circulation;216
7.5.3;Acute Ischemic Stroke Treatment;217
7.5.3.1;Patient Selection;218
7.5.4;Interventional Approach;221
7.5.4.1;Diagnostic Angiography;221
7.5.4.2;Access;222
7.5.4.3;Recanalization Technique;224
7.5.4.4;Adjunctive Pharmacotherapy;226
7.5.4.5;Clot Disruption;226
7.5.4.6;Clot Extraction;227
7.5.4.7;Peri-procedural Medical Management;231
7.5.5;Conclusion;234
7.5.6;References;234
8;V COMPLICATIONS AND POST-PROCEDURAL MONITORING;237
8.1;Complications Related to Carotid Stenting;238
8.1.1;Introduction;238
8.1.2;Factors Affecting Complication Rates Of Carotid Revascularization;239
8.1.3;Overall Complication Rates;240
8.1.3.1;Prevalence of Major Complications (Death, Stroke, and MI);240
8.1.4;Procedural Complications;242
8.1.4.1;Vascular Access Complications;242
8.1.4.2;Ischemic Embolization;244
8.1.4.3;Slow Flow/No Reflow/Abrupt Vessel Closure;246
8.1.4.4;Retinal Artery Embolization;248
8.1.4.5;Reflex Bradycardia and Hypotension;249
8.1.5;Post-Procedural Complications;250
8.1.5.1;Delirium;250
8.1.5.2;The Hyperperfusion Syndrome;251
8.1.5.3;Stent Thrombosis;251
8.1.5.4;Late Distal Embolization;252
8.1.5.5;Restenosis;252
8.1.5.6;Contrast-Induced Nephropathy;253
8.1.5.7;Stent Deformity;255
8.1.6;Conclusion;255
8.1.7;References;256
8.2;Post-Procedural Monitoring and Follow-Up;260
8.2.1;Introduction;260
8.2.2;Procedural And Early Post-Procedural Monitoring;261
8.2.2.1;Cardiovascular Hemodynamic Monitoring;262
8.2.2.1.1;Reflex Hypotension;263
8.2.2.1.2;Reflex Bradycardia;263
8.2.2.1.3;Hyperperfusion Syndrome;263
8.2.2.2;Neurological Monitoring;264
8.2.2.2.1;Neurological Complications;265
8.2.2.2.2;Retinal Embolization;265
8.2.3;Pre-Discharge Investigations, Medications, And Follow-Up;265
8.2.3.1;Carotid Doppler;265
8.2.3.2;Medications;266
8.2.4;Conclusion;266
8.2.5;References;266
9;INDEX;268