The Experts below are selected from a list of 5649 Experts worldwide ranked by ideXlab platform
Michael H Wholey - One of the best experts on this subject based on the ideXlab platform.
-
Modified Technique for Using Vascular Sheaths in Carotid Artery Stent Placement
2016Co-Authors: Michael H Wholey, Mba Boulos Toursarkissian, Steven BaileyAbstract:l l Purpose: To report a technical modification that will prevent sheath kinking in acutely an-gled vessels during Carotid Stent placement. Technique: If a long vascular sheath kinks when engaging an acutely angled common Carotid or innominate Artery, the sheath is pulled caudally approximately 2 cm while a 0.014-inch guidewire, supported by a coronary balloon catheter, is advanced toward the internal Carotid Artery (ICA). Alternatively, to avoid kinking, the original 0.035-inch super stiff wire is maintained within the sheath until the 0.014-inch wire and coronary balloon have exited the sheath’s distal tip. Conclusions: If an aortic arch is tortuous and the angle of the common Carotid Artery is unfavorable, a guiding catheter is preferable to a long vascular sheath for accessing the ICA during Carotid Stent procedures. J Endovasc Ther 2001;8:576–578 Key words: vascular sheath, guiding catheter, vessel tortuosity, common Carotid Artery
-
updated review of the global Carotid Artery Stent registry
Catheterization and Cardiovascular Interventions, 2003Co-Authors: Nadim Almubarek, Michael H WholeyAbstract:The purpose of this article was to review and update the current status of Carotid Artery Stent placement in the world. Surveys of major interventional centers in Europe, North and South America, and Asia were initially completed in June 1997. Subsequent updates from these 24 centers in addition to 29 new centers have been obtained to bring up to date the information. The survey asked the various questions regarding the patients enrolled, procedure techniques, and results of Carotid Stenting, including complications and restenosis. The total number of endovascular Carotid Stent procedures that have been performed worldwide to date included 12,392 procedures involving 11,243 patients. There was a technical success of 98.9% with 12,254 Carotid arteries treated. Complications that occurred during the Carotid Stent placement or within a 30-day period following placement were recorded. Overall, there was transient ischemic attack rate of 3.07%, minor strokes of 2.14%, major strokes of 1.20%, and procedure-related deaths of 0.64%. The combined minor and major strokes and procedure-related death rate was 3.98% based on procedure number. With nonprocedure-related death rate of 0.77%, the total stroke and death rate was 4.75%. Subsets of questions were directed at the new use of distal embolic protection devices; there were 6,753 cases done without protection and which incurred a 5.29% rate of strokes and procedure-related deaths. In the 4,221 cases with cerebral protection, there was a 2.23% rate of strokes and procedure-related deaths. Restenosis rates of Carotid Stenting have been 2.7%, 2.6%, and 2.4% at 1, 2, and 3 years, respectively. The rate of neurologic events after Stent placement has been 1.2%, 1.3%, and 1.7% at 1, 2, and 3 years, respectively. Endovascular Stent treatment of Carotid Artery atherosclerotic disease is growing as an alternative for vascular surgery, especially for patients who are high risk for standard Carotid endarterectomy. The periprocedure risks for major and minor strokes and death are generally acceptable at this early stage of development and have shown an improvement with technological developments, including distal embolic protection. Catheter Cardiovasc Interv 2003;60:259-266
-
global experience in cervical Carotid Artery Stent placement
Catheterization and Cardiovascular Interventions, 2000Co-Authors: Gary S Roubin, Michael H Wholey, P Bergeron, Edward B Diethrich, Michel Henry, Klaus Mathias, Steven R Bailey, Gerry Dorros, Gustave ElesAbstract:The purpose of this article is to review and update the current status of Carotid Artery Stent placement in the world. Surveys to major interventional centers in Europe, North and South America, and Asia were initially completed in June 1997. Subsequent information from these 24 centers in addition to 12 new centers has been obtained to update the information. The survey asked the various questions regarding the patients enrolled, procedure techniques, and results of Carotid Stenting, including complications and restenosis. The total number of endovascular Carotid Stent procedures that have been performed worldwide to date included 5,210 procedures involving 4,757 patients. There was a technical success of 98.4% with 5,129 Carotid arteries treated. Complications that occurred during the Carotid Stent placement or within a 30-day period following placement were recorded. Overall, there were 134 transient ischemic attacks (TIAs) for a rate of 2.82%. Based on the total patient population, there were 129 minor strokes with a rate of occurrence of 2.72%. The total number of major strokes was 71 for a rate of 1.49%. There were 41 deaths within a 30-day postprocedure period resulting in a mortality rate of 0.86%. The combined minor and major strokes and procedure-related death rate was 5.07%. Restenosis rates of Carotid Stenting have been 1.99% and 3.46% at 6 and 12 months, respectively. The rate of neurologic events after Stent placement has been 1.42% at 6–12-month follow-up. Endovascular Stent treatment of Carotid Artery atherosclerotic disease is growing as an alternative for vascular surgery, especially for patients that are high risk for standard Carotid endarterectomy. The periprocedure risks for major and minor strokes and death are generally acceptable at this early stage of development and have not changed significantly since the first survey results. Cathet. Cardiovasc. Intervent. 50:160–167, 2000. ©2000 Wiley–Liss,Inc.
-
current global status of Carotid Artery Stent placement
Catheterization and Cardiovascular Diagnosis, 1998Co-Authors: Michael H Wholey, P Bergeron, Edward B Diethrich, Michel Henry, Jean C Laborde, Klaus Mathias, Subbarao Myla, Gary S RoubinAbstract:Our purpose was to review the current status of Carotid Artery Stent placement throughout the world. Surveys were sent to major interventional centers in Europe, North and South America, and Asia. Information from peer-reviewed journals was also included and supplemented the survey. The survey asked various questions regarding the patients enrolled, procedure techniques, and results of Carotid Stenting, including complications and restenosis. Of the centers which were sent surveys, 24 responded. The total number of endovascular Carotid Stent procedures that have been performed worldwide to date included 2,048 cases, with a technical success of 98.6%. Complications that occurred during Carotid Stent placement or within a 30-day period following placement were recorded. Overall, there were 63 minor strokes, with a rate of occurrence of 3.08%. The total number of major strokes was 27, for a rate of 1.32%. There were 28 deaths within a 30-day postprocedure period, resulting in a mortality rate of 1.37%. Restenosis rates of Carotid Stenting have been 4.80% at 6 mo. Endovascular Stent treatment of Carotid Artery atherosclerotic disease is growing as an alternative to vascular surgery, especially for patients that are at high risk for standard Carotid endarterectomy. The periprocedural risks for major and minor strokes and death are generally acceptable at this early stage of development. Cathet. Cardiovasc. Diagn. 44:1–6, 1998. ©1998 Wiley-Liss, Inc.
Stefan Mullerhulsbeck - One of the best experts on this subject based on the ideXlab platform.
-
initial clinical experience with the micromesh roadsaver Carotid Artery Stent for the treatment of patients with symptomatic Carotid Artery disease
Journal of Endovascular Therapy, 2015Co-Authors: Silke Hopfjensen, Leonardo Marques, Michael Preis, Stefan MullerhulsbeckAbstract:Purpose: To assess the effectiveness, technical aspects, handling, and safety of the micromesh Roadsaver Carotid Artery Stent in the treatment of atherosclerotic Carotid Artery stenosis and tandem lesions in ischemic stroke patients. Methods: Seven patients (5 men; mean age 75±11.4 years, range 53–86) suffering from symptomatic internal Carotid Artery (ICA) stenosis (mean 76% diameter reduction) were treated with the dual layer closed-cell Stent without embolic protection. Postdilation was performed in 6 of 7 patients. Two patients were treated in the context of ischemic stroke and concurrent middle cerebral Artery occlusion. Mean National Institutes of Health Stroke Scale score at admission was 12.8±5. Results: All devices were deployed satisfactorily. One wall-adherent thromboembolus in a proximal ICA was covered with the Roadsaver Stent in a tandem lesion setting. The modified Rankin Scale (mRS) declined from 3.7±0.7 to 2.4±0.8 in hospital, showing an improvement in clinical symptoms. No complications ...
Gary S Roubin - One of the best experts on this subject based on the ideXlab platform.
-
Carotid Artery Stent placement with distal balloon protection technical considerations
American Journal of Neuroradiology, 2005Co-Authors: Jiri J Vitek, Sriram S Iyer, Nadim Almubarak, Gary S RoubinAbstract:BACKGROUND AND PURPOSE: Most neurologic events that complicate the Carotid Artery Stent placement procedure are embolic. Strategies are being developed and evaluated for their ability to minimize the clinical embolic risk. The purpose of this study was to determine the feasibility, safety, and technical considerations of performing Carotid Artery Stent placement with use of a distal balloon antiembolization system. METHODS: Carotid Artery Stent placement with use of a commercially available distal balloon antiembolization system was performed in 303 patients (325 vessels). Clinical neurologic complications were adjudicated at the time of intervention and at 1 month. RESULTS: Technical success was achieved in all but one case, with reduction of the mean percentage Carotid Artery stenosis from 79 ± 9% to 3 ± 8%. Intolerance to internal Carotid Artery occlusion occurred in 11 patients (3.6%); in one patient the procedure was aborted, and in 10 the procedures were expeditiously completed with no adverse neurologic events. The 30-day combined rate of all occurrences of stroke and death was 2%. These events included three (0.9%) retinal emboli, three (0.9%) minor strokes, and one (0.3%) fatal stroke from brain hemorrhage, all of which occurred during the procedure with no events occurring after discharge. In addition, two (0.6%) transient ischemic attacks and three (0.9%) reperfusion syndromes occurred, with the patients experiencing complete recovery. CONCLUSION: Carotid Artery Stent placement with use of the distal balloon protection system is feasible and safe, and the short-term outcomes appear to be favorable. Optimal application of proper technique is important.
-
global experience in cervical Carotid Artery Stent placement
Catheterization and Cardiovascular Interventions, 2000Co-Authors: Gary S Roubin, Michael H Wholey, P Bergeron, Edward B Diethrich, Michel Henry, Klaus Mathias, Steven R Bailey, Gerry Dorros, Gustave ElesAbstract:The purpose of this article is to review and update the current status of Carotid Artery Stent placement in the world. Surveys to major interventional centers in Europe, North and South America, and Asia were initially completed in June 1997. Subsequent information from these 24 centers in addition to 12 new centers has been obtained to update the information. The survey asked the various questions regarding the patients enrolled, procedure techniques, and results of Carotid Stenting, including complications and restenosis. The total number of endovascular Carotid Stent procedures that have been performed worldwide to date included 5,210 procedures involving 4,757 patients. There was a technical success of 98.4% with 5,129 Carotid arteries treated. Complications that occurred during the Carotid Stent placement or within a 30-day period following placement were recorded. Overall, there were 134 transient ischemic attacks (TIAs) for a rate of 2.82%. Based on the total patient population, there were 129 minor strokes with a rate of occurrence of 2.72%. The total number of major strokes was 71 for a rate of 1.49%. There were 41 deaths within a 30-day postprocedure period resulting in a mortality rate of 0.86%. The combined minor and major strokes and procedure-related death rate was 5.07%. Restenosis rates of Carotid Stenting have been 1.99% and 3.46% at 6 and 12 months, respectively. The rate of neurologic events after Stent placement has been 1.42% at 6–12-month follow-up. Endovascular Stent treatment of Carotid Artery atherosclerotic disease is growing as an alternative for vascular surgery, especially for patients that are high risk for standard Carotid endarterectomy. The periprocedure risks for major and minor strokes and death are generally acceptable at this early stage of development and have not changed significantly since the first survey results. Cathet. Cardiovasc. Intervent. 50:160–167, 2000. ©2000 Wiley–Liss,Inc.
-
current global status of Carotid Artery Stent placement
Catheterization and Cardiovascular Diagnosis, 1998Co-Authors: Michael H Wholey, P Bergeron, Edward B Diethrich, Michel Henry, Jean C Laborde, Klaus Mathias, Subbarao Myla, Gary S RoubinAbstract:Our purpose was to review the current status of Carotid Artery Stent placement throughout the world. Surveys were sent to major interventional centers in Europe, North and South America, and Asia. Information from peer-reviewed journals was also included and supplemented the survey. The survey asked various questions regarding the patients enrolled, procedure techniques, and results of Carotid Stenting, including complications and restenosis. Of the centers which were sent surveys, 24 responded. The total number of endovascular Carotid Stent procedures that have been performed worldwide to date included 2,048 cases, with a technical success of 98.6%. Complications that occurred during Carotid Stent placement or within a 30-day period following placement were recorded. Overall, there were 63 minor strokes, with a rate of occurrence of 3.08%. The total number of major strokes was 27, for a rate of 1.32%. There were 28 deaths within a 30-day postprocedure period, resulting in a mortality rate of 1.37%. Restenosis rates of Carotid Stenting have been 4.80% at 6 mo. Endovascular Stent treatment of Carotid Artery atherosclerotic disease is growing as an alternative to vascular surgery, especially for patients that are at high risk for standard Carotid endarterectomy. The periprocedural risks for major and minor strokes and death are generally acceptable at this early stage of development. Cathet. Cardiovasc. Diagn. 44:1–6, 1998. ©1998 Wiley-Liss, Inc.
Carlo Briguori - One of the best experts on this subject based on the ideXlab platform.
-
acute kidney injury in patients with chronic kidney disease undergoing internal Carotid Artery Stent implantation
Jacc-cardiovascular Interventions, 2015Co-Authors: Michael Donahue, Gabriella Visconti, Amelia Focaccio, Lucio Selvetella, Maria Pia Baldassarre, Chiara Viviani Anselmi, Carlo BriguoriAbstract:Abstract Objectives This study sought to investigate acute kidney injury (AKI) following Carotid Artery Stenting (CAS). Background Few data exist on AKI following CAS. Methods This study evaluated 126 chronic kidney disease (CKD) patients who underwent CAS. The risk for contrast-induced AKI was defined by the Mehran score. Hemodynamic depression (i.e., periprocedural systolic blood pressure Results AKI occurred in 26 patients (21%). Although baseline kidney function and contrast volume were similar in the AKI group and the non-AKI group, the risk score was higher (10 ± 3 vs. 8 ± 3; p = 0.032), and hemodynamic depression (mostly due to hypotension) (65.5% vs. 35%; p = 0.005) was more common in the AKI group. The threshold of hemodynamic depression duration for AKI development was 2.5 min (sensitivity 54%, specificity 82%). Independent predictors of AKI were hemodynamic depression (odds ratio [OR]: 4.01; 95% confidence interval [CI]: 1.07 to 15.03; p = 0.009), risk score (OR: 1.29; 95% CI: 1.03 to 1.60; p = 0.024), and male sex (OR: 6.07; 95% CI: 1.18 to 31.08; p = 0.021). Independent predictors of 30-day major adverse events that occurred more often in the AKI group (19.5% vs. 7%; p = 0.058) were AKI (HR: 4.83; 95% CI: 1.10 to 21.24; p = 0.037) and hemodynamic depression (HR: 5.58; 95% CI: 1.10 to 28.31; p = 0.038). Conclusions AKI in CKD patients undergoing CAS is mostly due to hemodynamic depression and is associated with a higher 30-day major adverse events rate.
Maria Antonella Ruffino - One of the best experts on this subject based on the ideXlab platform.
-
incidence of new ischaemic brain lesions after Carotid Artery Stenting with the micromesh roadsaver Carotid Artery Stent a prospective single centre study
CardioVascular and Interventional Radiology, 2016Co-Authors: Maria Antonella Ruffino, Riccardo Faletti, Laura Bergamasco, Paolo Fonio, Dorico RighiAbstract:Aims Several randomized trials of patients with Carotid stenosis show increased adverse neurological events with Stenting versus endarterectomy in the 30-day post-procedure. This study examines the incidence of new ischaemic lesions in patients treated in our centre using the new Roadsaver Stent.
-
Carotid Artery Stenting with a new generation double mesh Stent in three high volume italian centres clinical results of a multidisciplinary approach
Eurointervention, 2016Co-Authors: Roberto Nerla, Maria Antonella Ruffino, Fausto Castriota, Antonio Micari, Paolo Sbarzaglia, Gioel Gabrio Secco, Gianmarco De Donato, Carlo Setacci, Alberto CremonesiAbstract:Aims Carotid Artery Stenting (CAS) is still associated with higher periprocedural cerebrovascular events (CEs) compared to vascular surgery. The Roadsaver Carotid Artery Stent is a double layer micromesh Stent which reduces plaque prolapse and embolisation by improving plaque coverage. Its clinical impact on neurological outcome was unknown. The aim of this study was therefore to report the clinical results of a large real-world population from three different centres receiving a Roadsaver Stent to treat Carotid Artery disease. Methods and results One hundred and fifty (150) patients (age 74±8 yrs, 75% male, symptomatic 29%) treated with CAS using the Roadsaver Carotid Stent in three high-volume Italian centres were included in the study. Intraprocedural optical coherence tomography (OCT) evaluation was performed in 26 patients, with an off-line analysis by a dedicated core laboratory. All patients underwent duplex ultrasound and neurological evaluation at 24 hours and at 30 days. CAS was technically successful in all cases (Stent diameter: 8.6±0.8 mm, Stent length: 25.0±4.5 mm). No in-hospital or 30-day CEs were observed. OCT evaluation detected a low rate of plaque prolapse (two patients, 7.7%). Duplex ultrasound showed Stent and external Carotid Artery patency in all cases both before discharge and at 30-day follow-up. Conclusions The Roadsaver Stent is a safe and promising technology for CAS, with a low percentage of plaque prolapse and good short-term clinical outcome. Larger studies with longer follow-up are necessary to confirm this favourable clinical outcome.