Focal ischemia of the brain after neuroprotected carotid artery stenting

AbstractObjectivesThis study sought to assess the incidence of cerebral ischemia in nonselected patients undergoing neuroprotected carotid angioplasty and stenting (CAS) without preceding multiple-vessel diagnostic angiography.BackgroundProtection devices to prevent distal embolization during CAS are presently under clinical investigation. Diffusion-weighted magnetic resonance imaging (MRI) visualizes recent ischemia of the brain and may aid in assessing the efficacy of protection devices.MethodsElective CAS was performed in 42 consecutive patients (15 female, 27 male; mean age, 67 ± 9 years) using six different types of cerebral protection systems. All patients underwent MRI of the brain before and after a total of 44 interventions.ResultsPlacement and retrieval of the devices and stent deployment was achieved in all procedures. New ischemic foci were seen on postinterventional MRI in 10 cases (22.7%). One patient had sustained a major stroke, whereas no adverse neurological sequelae were associated with the other nine procedures. In the latter, one to three foci (maximum area 43.0 mm2) were detected in cerebral regions subtended by the ipsilateral carotid artery in eight cases and by the contralateral carotid artery in one case. In the stroke patient, 12 ischemic foci (maximum area 84.5 mm2) were exclusively located in the contralateral hemisphere. Follow-up MRI at 4.1 months (median, n = 7) identified residuals of cerebral ischemia only in this patient.ConclusionsNeuroprotected CAS is associated in about 25% of cases with predominantly silent cerebral ischemia. Our findings suggest manipulation of endoluminal equipment in the supraaortic vessels to be a major risk factor for cerebral embolism during neuroprotected CAS

Improved renal function and blood pressure control following renal artery angioplasty : the renal artery angioplasty in patients with renal insufficiency and hypertension using a dedicated renal stent device study (PRECISION)

AIMS: To evaluate the technical performance of a dedicated renal stent device and the clinical outcome. METHODS AND RESULTS: Fifty patients with 55 renal artery stenoses (RAS) <70% (66 +/- 12 years, 58% male) were included in this non-randomised, prospective, multicentre registry. Primary endpoint was the primary patency rate at one year defined as < or =70% as determined by duplex ultrasound. Major secondary endpoints were procedural success, 30 days MACE rate, the impact of the intervention on renal function, blood pressure control, and on B-type natriuretic peptide (BNP) level. Procedural success rate was 100% and 30 days MACE rate was 0%. Restenosis rate (primary endpoint) and target lesion revascularisation rate after 12 months were 3.5% and 1.8%, respectively. After one year estimated glomerular filtration rate increased from 51 +/- 26 ml/min to 61 +/- 28 ml/min (P=0.004). Mean ambulatory blood pressure was reduced from 102 +/- 14 mmHg to 93 +/- 9 mmHg (P=0.001). Mean daily dose of antihypertensive drugs decreased from 3.0 +/- 1.7 to 2.7 +/- 1.4 (P=0.09). Mean BNP decreased from 251 +/- 282 pg/ml to 188 +/- 219 pg/ml (P=0.046) before discharge. CONCLUSIONS: Technical outcome of the tested device is favourable. The impact of the stent revascularisation on renal function and blood pressure control was promising

Sirolimus-Eluting Stents for Treatment of Infrapopliteal Arteries Reduce Clinical Event Rate Compared to Bare-Metal Stents Long-Term Results From a Randomized Trial

ObjectivesThe study investigated the long-term clinical impact of sirolimus-eluting stents (SES) in comparison with bare-metal stents (BMS) in treatment of focal infrapopliteal lesions.BackgroundThere is evidence that SES reduce the risk of restenosis after percutaneous infrapopliteal artery revascularization. No data from randomized trials are available concerning the clinical impact of this finding during long-term follow-up.MethodsThe study extended the follow-up period of a prospective, randomized, multicenter, double-blind trial comparing polymer-free SES with placebo-coated BMS in the treatment of focal infrapopliteal de novo lesions. The main study endpoint was the event-free survival rate defined as freedom from target limb amputation, target vessel revascularization, myocardial infarction, and death. Secondary endpoints include amputation rates, target vessel revascularization, and changes in Rutherford-Becker class.ResultsThe trial included 161 patients. The mean target lesion length was 31 ± 9 mm. Thirty-five (23.3%) patients died during a mean follow-up period of 1,016 ± 132 days. The event-free survival rate was 65.8% in the SES group and 44.6% in the BMS group (log-rank p = 0.02). Amputation rates were 2.6% and 12.2% (p = 0.03), and target vessel revascularization rates were 9.2% and 20% (p = 0.06), respectively. The median (interquartile range) improvement in Rutherford-Becker class was –2 (–3 to –1) in the SES group and –1 (–2 to 0) in the BMS group, respectively (p = 0.006).ConclusionsLong-term event-free survival, amputation rates, and changes in Rutherford-Becker class after treatment of focal infrapopliteal lesions are significantly improved with SES in comparison with BMS. (YUKON-Drug-Eluting Stent Below the Knee - Randomised Double-Blind Study [YUKON-BTX]; NCT00664963