New possibilities in the endovascular treatment of supraaortic vessels

Research output: Contribution to journalArticle

Abstract

Cerebrovascular disease, including stroke, represents the third-leading cause of death in Hungary and a leading cause of disability among the elderly population. The majority of all strokes are ischemic, mostly secondary to thromboembolic disease of the supraaortic vessels. We investigated new therapeutic methods in the endovascular treatment of these diseases. Surgical revascularization of supraaortic trunk stenosis is associated with high morbidity and mortality rates. Balloon angioplasty has become an increasingly accepted treatment of stenoocclusive supraaortic arterial disease. Natural history data and treatment guidelines do not exist for innominate and proximal common carotid artery lesions. We have confirmed in a large series of innominate artery angioplasties that it is a safe and effective procedure with an excellent initial success rate, with a lower complication rate than the surgical option and with a similar long-term patency rate as for surgery.In the largest published study on transfemoral angioplasty of ostial and proximal common carotid artery stenosis we have proved that endovascular treatment has high success rate with low stroke/death rate. Carotid stenting (CAS) is an evolving alternative to surgery in the treatment of patients with carotid stenosis. Stent selection is influenced by several factors, including the carotid anatomy and lesion characteristics. We examined the wall adaptability of a new closed-cell carotid stent (NexStent), which was designed for carotid bifurcation treatment. Data obtained from angiographic and computed tomographic images indicate that the stent provides adequate expansion and adaptation to the carotid bifurcation.There are two types of restenosis after carotid artery interventions: the early restenosis develops mainly within the first 24 months after the revascularization procedure and its pathological background is myointimal hyperplasia; on the other hand late restenosis is rather due to progression of primary atherosclerosis and occurs more than 2 years after carotid endarterectomy (CEA). We compared the early restenosis rate in a consecutive series of CAS versus CEA patients at a single cardiovascular institution. The data suggest that the incidence of restenosis after stenting was less common than after surgery.Our results may help vascular surgeons and interventional radiologists to consider risk versus benefit when deciding treatment options for supraaortic arterial stenosis.

Original languageEnglish
Pages (from-to)223-234
Number of pages12
JournalInterventional Medicine and Applied Science
Volume3
Issue number4
DOIs
Publication statusPublished - Dec 1 2011

Fingerprint

Stents
Carotid Endarterectomy
Carotid Stenosis
Stroke
Therapeutics
Angioplasty
Pathologic Constriction
Brachiocephalic Trunk
Cerebrovascular Disorders
Balloon Angioplasty
Mortality
Hungary
Common Carotid Artery
Natural History
Carotid Arteries
Hyperplasia
Blood Vessels
Cause of Death
Anatomy
Atherosclerosis

Keywords

  • angioplasty
  • carotid artery
  • carotid restenosis
  • carotid stent design
  • carotid stenting
  • cerebrovascular disease
  • innominate artery
  • stroke
  • supraaortic intervention

ASJC Scopus subject areas

  • Medicine(all)

Cite this

New possibilities in the endovascular treatment of supraaortic vessels. / Nemes, B.

In: Interventional Medicine and Applied Science, Vol. 3, No. 4, 01.12.2011, p. 223-234.

Research output: Contribution to journalArticle

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