Safety and efficacy of an open-cell stent and double-balloon protection for unstable plaques: Analysis of 184 consecutive carotid artery stentings

Yusuke Funakoshi, Hirotoshi Imamura, Shoichi Tani, Hidemitsu Adachi, Ryu Fukumitsu, Tadashi Sunohara, Yoshihiro Omura, Yuichi Matsui, Natsuhi Sasaki, Tatsumaru Fukuda, Ryo Akiyama, Kazufumi Horiuchi, Shinji Kajiura, Masashi Shigeyasu, Koji Iihara, Nobuyuki Sakai

Research output: Contribution to journalArticle

Abstract

Introduction: In our institute, most cases of carotid artery stenosis are treated by carotid artery stenting (CAS) with an open-cell stent and double-balloon protection, even if plaques are unstable. This study was performed to examine the outcome of CAS with an open-cell stent and double-balloon protection for unstable plaques. Methods: A total of 184 CAS procedures in our institute between October 2010 and February 2018 were assessed. Ultrasonography findings of low-echo plaques, plaque ulceration, or both were defined as unstable plaques. A plaque-to-muscle ratio (PMR) of >1.8 on T1-weighted black blood imaging using spin-echo was also defined as an unstable plaque. Seventy-four unstable plaques on ultrasonography and 86 unstable plaques evaluated by PMR were included. Open-cell stents and double-balloon protection (proximal balloon protection during lesion crossing and distal balloon protection after lesion crossing) were used in all cases. Results: On ultrasonography, perioperative asymptomatic thromboembolization was significantly more frequent in the unstable plaque group (39/74, 52.7%) than in the stable plaque group (41/110, 37.3%, p=0.0384). Asymptomatic thromboembolization was also significantly more frequent in the PMR >1.8 group (44/86, 51.2%) than in the PMR <1.8 group (36/98, 36.7%, p=0.0489). However, symptomatic thromboembolization was rare (n=5, 2.7%), and all of these patients had minor stroke. During the 4-year follow-up, the risk of ipsilateral stroke was 0.28% and 0.27% per year in patients with symptomatic and asymptomatic lesions, respectively. Conclusions: The outcomes of CAS with an open-cell stent and double-balloon protection are acceptable. This method is effective and safe, even if carotid artery stenosis comprises unstable plaques.

Original languageEnglish
JournalJournal of neurointerventional surgery
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Carotid Arteries
Stents
Safety
Ultrasonography
Muscles
Carotid Stenosis
Stroke
Magnetic Resonance Imaging

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Safety and efficacy of an open-cell stent and double-balloon protection for unstable plaques : Analysis of 184 consecutive carotid artery stentings. / Funakoshi, Yusuke; Imamura, Hirotoshi; Tani, Shoichi; Adachi, Hidemitsu; Fukumitsu, Ryu; Sunohara, Tadashi; Omura, Yoshihiro; Matsui, Yuichi; Sasaki, Natsuhi; Fukuda, Tatsumaru; Akiyama, Ryo; Horiuchi, Kazufumi; Kajiura, Shinji; Shigeyasu, Masashi; Iihara, Koji; Sakai, Nobuyuki.

In: Journal of neurointerventional surgery, 01.01.2019.

Research output: Contribution to journalArticle

Funakoshi, Y, Imamura, H, Tani, S, Adachi, H, Fukumitsu, R, Sunohara, T, Omura, Y, Matsui, Y, Sasaki, N, Fukuda, T, Akiyama, R, Horiuchi, K, Kajiura, S, Shigeyasu, M, Iihara, K & Sakai, N 2019, 'Safety and efficacy of an open-cell stent and double-balloon protection for unstable plaques: Analysis of 184 consecutive carotid artery stentings', Journal of neurointerventional surgery. https://doi.org/10.1136/neurintsurg-2019-015393
Funakoshi, Yusuke ; Imamura, Hirotoshi ; Tani, Shoichi ; Adachi, Hidemitsu ; Fukumitsu, Ryu ; Sunohara, Tadashi ; Omura, Yoshihiro ; Matsui, Yuichi ; Sasaki, Natsuhi ; Fukuda, Tatsumaru ; Akiyama, Ryo ; Horiuchi, Kazufumi ; Kajiura, Shinji ; Shigeyasu, Masashi ; Iihara, Koji ; Sakai, Nobuyuki. / Safety and efficacy of an open-cell stent and double-balloon protection for unstable plaques : Analysis of 184 consecutive carotid artery stentings. In: Journal of neurointerventional surgery. 2019.
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abstract = "Introduction: In our institute, most cases of carotid artery stenosis are treated by carotid artery stenting (CAS) with an open-cell stent and double-balloon protection, even if plaques are unstable. This study was performed to examine the outcome of CAS with an open-cell stent and double-balloon protection for unstable plaques. Methods: A total of 184 CAS procedures in our institute between October 2010 and February 2018 were assessed. Ultrasonography findings of low-echo plaques, plaque ulceration, or both were defined as unstable plaques. A plaque-to-muscle ratio (PMR) of >1.8 on T1-weighted black blood imaging using spin-echo was also defined as an unstable plaque. Seventy-four unstable plaques on ultrasonography and 86 unstable plaques evaluated by PMR were included. Open-cell stents and double-balloon protection (proximal balloon protection during lesion crossing and distal balloon protection after lesion crossing) were used in all cases. Results: On ultrasonography, perioperative asymptomatic thromboembolization was significantly more frequent in the unstable plaque group (39/74, 52.7{\%}) than in the stable plaque group (41/110, 37.3{\%}, p=0.0384). Asymptomatic thromboembolization was also significantly more frequent in the PMR >1.8 group (44/86, 51.2{\%}) than in the PMR <1.8 group (36/98, 36.7{\%}, p=0.0489). However, symptomatic thromboembolization was rare (n=5, 2.7{\%}), and all of these patients had minor stroke. During the 4-year follow-up, the risk of ipsilateral stroke was 0.28{\%} and 0.27{\%} per year in patients with symptomatic and asymptomatic lesions, respectively. Conclusions: The outcomes of CAS with an open-cell stent and double-balloon protection are acceptable. This method is effective and safe, even if carotid artery stenosis comprises unstable plaques.",
author = "Yusuke Funakoshi and Hirotoshi Imamura and Shoichi Tani and Hidemitsu Adachi and Ryu Fukumitsu and Tadashi Sunohara and Yoshihiro Omura and Yuichi Matsui and Natsuhi Sasaki and Tatsumaru Fukuda and Ryo Akiyama and Kazufumi Horiuchi and Shinji Kajiura and Masashi Shigeyasu and Koji Iihara and Nobuyuki Sakai",
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T1 - Safety and efficacy of an open-cell stent and double-balloon protection for unstable plaques

T2 - Analysis of 184 consecutive carotid artery stentings

AU - Funakoshi, Yusuke

AU - Imamura, Hirotoshi

AU - Tani, Shoichi

AU - Adachi, Hidemitsu

AU - Fukumitsu, Ryu

AU - Sunohara, Tadashi

AU - Omura, Yoshihiro

AU - Matsui, Yuichi

AU - Sasaki, Natsuhi

AU - Fukuda, Tatsumaru

AU - Akiyama, Ryo

AU - Horiuchi, Kazufumi

AU - Kajiura, Shinji

AU - Shigeyasu, Masashi

AU - Iihara, Koji

AU - Sakai, Nobuyuki

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: In our institute, most cases of carotid artery stenosis are treated by carotid artery stenting (CAS) with an open-cell stent and double-balloon protection, even if plaques are unstable. This study was performed to examine the outcome of CAS with an open-cell stent and double-balloon protection for unstable plaques. Methods: A total of 184 CAS procedures in our institute between October 2010 and February 2018 were assessed. Ultrasonography findings of low-echo plaques, plaque ulceration, or both were defined as unstable plaques. A plaque-to-muscle ratio (PMR) of >1.8 on T1-weighted black blood imaging using spin-echo was also defined as an unstable plaque. Seventy-four unstable plaques on ultrasonography and 86 unstable plaques evaluated by PMR were included. Open-cell stents and double-balloon protection (proximal balloon protection during lesion crossing and distal balloon protection after lesion crossing) were used in all cases. Results: On ultrasonography, perioperative asymptomatic thromboembolization was significantly more frequent in the unstable plaque group (39/74, 52.7%) than in the stable plaque group (41/110, 37.3%, p=0.0384). Asymptomatic thromboembolization was also significantly more frequent in the PMR >1.8 group (44/86, 51.2%) than in the PMR <1.8 group (36/98, 36.7%, p=0.0489). However, symptomatic thromboembolization was rare (n=5, 2.7%), and all of these patients had minor stroke. During the 4-year follow-up, the risk of ipsilateral stroke was 0.28% and 0.27% per year in patients with symptomatic and asymptomatic lesions, respectively. Conclusions: The outcomes of CAS with an open-cell stent and double-balloon protection are acceptable. This method is effective and safe, even if carotid artery stenosis comprises unstable plaques.

AB - Introduction: In our institute, most cases of carotid artery stenosis are treated by carotid artery stenting (CAS) with an open-cell stent and double-balloon protection, even if plaques are unstable. This study was performed to examine the outcome of CAS with an open-cell stent and double-balloon protection for unstable plaques. Methods: A total of 184 CAS procedures in our institute between October 2010 and February 2018 were assessed. Ultrasonography findings of low-echo plaques, plaque ulceration, or both were defined as unstable plaques. A plaque-to-muscle ratio (PMR) of >1.8 on T1-weighted black blood imaging using spin-echo was also defined as an unstable plaque. Seventy-four unstable plaques on ultrasonography and 86 unstable plaques evaluated by PMR were included. Open-cell stents and double-balloon protection (proximal balloon protection during lesion crossing and distal balloon protection after lesion crossing) were used in all cases. Results: On ultrasonography, perioperative asymptomatic thromboembolization was significantly more frequent in the unstable plaque group (39/74, 52.7%) than in the stable plaque group (41/110, 37.3%, p=0.0384). Asymptomatic thromboembolization was also significantly more frequent in the PMR >1.8 group (44/86, 51.2%) than in the PMR <1.8 group (36/98, 36.7%, p=0.0489). However, symptomatic thromboembolization was rare (n=5, 2.7%), and all of these patients had minor stroke. During the 4-year follow-up, the risk of ipsilateral stroke was 0.28% and 0.27% per year in patients with symptomatic and asymptomatic lesions, respectively. Conclusions: The outcomes of CAS with an open-cell stent and double-balloon protection are acceptable. This method is effective and safe, even if carotid artery stenosis comprises unstable plaques.

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