CAROTID ARTERY HAEMODYNAMICS AND ANATOMICAL CHALENGES

Transcription

1 CAROTID ARTERY HAEMODYNAMICS AND ANATOMICAL CHALENGES Athanasios D. Giannoukas MD, MSc(Lond.), PhD(Lond.), FEBVS Professor of Vascular Surgery Faculty of Medicine, School of Health Sciences, University of Thessaly, Greece Chairman, Dept. of Vascular Surgery, University Hospital of Larissa Larissa, Greece

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3 Pathophysiology of carotid atherosclerosis

4 Ultrasonic imaging of carotid bifurcation

5 Χαρακτήρες πλάκας Type 1 Type 2 Type 3 Type 4 Type 5

6 CAROTID STENTING

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8 CAROTID STENTING

9 Brain Protection Device

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11 CAROTID STENTING

12 Carotid stenting

13 CAROTID ARTERY REMODELING AFTER STENTING

14 Carotid bifurcation geometry

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16 Neck movements

17 Stent fracture classification

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20 Carotid stent fracture J Vasc Surg May;51(5): Clinical relevance and treatment of carotid stent fractures. Sfyroeras GS, Koutsiaris A, Karathanos C, Giannakopoulos A, Giannoukas AD. Carotid stent fractures are mainly reported in self-expandable nitinol stents. Plaque calcification may be a risk factor for stent fractures. No difference was observed between open and closed-cell design. Stent fractures were often associated with restenosis and usually were asymptomatic. The actual incidence, clinical relevance, and optimal treatment remain to be clarified from larger prospective studies designed to investigate the issue.

21 Carotid stent fracture J Vasc Surg Jun;51(6): Carotid artery stent fracture identification and clinical relevance. Coppi G 1, Moratto R, Veronesi J, Nicolosi E, Silingardi R. Stent fracture prevalence was 3.4% at 12 months (95% confidence interval, 1.7%-6.1%). Restenosis was significantly associated with stent fracture (P <.001). Multivariate analysis evidenced that type III calcification (OR, 3.90; P =.029) and angulation >45 degrees (OR, 4.69; P =.026) were important risk factors for carotid stent fracture.

22 Carotid stent fracture J Vasc Surg Sep;54(3): Prevalence and clinical significance of stent fracture and deformation following carotid artery stenting. Chang CK 1, Huded CP, Nolan BW, Powell RJ. One hundred sixteen stents (57 closed cell, 59 open cell). There were five stent fractures (4%) and 27 deformed stents (23%). Rate of stent fracture or deformation was 15% at 2 years and 50% at 4 years. Deformations were significantly more common in open cell stents than in closed cell stents (58% vs 5% at 4 years, P <.00005). Presence of calcified plaque on plain film was significantly associated with increased rate of stent fracture or deformation (P =.0006). At median follow-up of 25 months, restenosis requiring treatment occurred in four (5%) and late stroke in one (1%). Neither stent fracture nor deformation was associated with late stroke or reintervention.

23 Carotid stent fracture Cardiovasc Intervent Radiol Apr;35(2): Are carotid stent fractures clinically significant? Garcia-Toca M, Rodriguez HE, Naughton PA, Keeling A, Phade SV, Morasch MD, Kibbe MR, Eskandari MK. Follow-up imaging was completed on 106 self-expanding nitinol stents (26 closed-cell and 80 open-cell stents). Eight fractures (7.5%) were detected. No associated clinical sequelae were observed among the patients with fractures, and only 1 patient had an associated significant restenosis ( 80%) requiring reintervention. Late stent fatigue after CAS is an uncommon event and rarely clinically relevant. Although cell design does not appear to influence the occurrence of fractures, lesion characteristics may be associated risk factors.

24 CAROTID STENTS

25 CAROTID STENTS

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27 Roadsaver by Terumo Nitinol double braided material for flexibility such as an open-cell Micromesh containing the smallest cell size

28 GORE Scaffold The new Gore device combines the flexible properties of a traditional open-cell, nitinol stent design with a 500 micron pore size eptfe lattice which offers the plaque retention and stabilization benefits traditionally seen in a closed cell stent design. Additionally, the permanently bound heparin may offer a local advantage seen with other Gore devices that utilize bound heparin.

29 InspireMD - CGuardTM System The proprietary CGuard carotid embolic protection system uses the same MicroNet technology featured on the MGuard and MGuard Prime coronary embolic protection systems. The MicroNet technology is a single fiber knitted mesh wrapped on an open cell stent platform designed to trap debris that can dislodge and travel downstream after a patient is treated with traditional stenting methods. This technology seeks to protect patients from plaque debris and blood clots breaking off and which can lead to life threatening strokes. The size, or aperture, of the MicroNet pore is only microns in order to maximize protection against the potentially dangerous plaque and thrombus within the carotid artery.

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