Feasibility and Outcome of Endovascular Management of Carotid Artery Stenosis, Egyptian Multicentric Experience

Mohammed Alsagheer Alhewy; Mahmoud Galal; Abdelaziz Ahmed Abdelhafez

doi:doi:10.11648/j.ccr.20220602.14

| Peer-Reviewed

Feasibility and Outcome of Endovascular Management of Carotid Artery Stenosis, Egyptian Multicentric Experience

Mohammed Alsagheer Alhewy, Mahmoud Galal, Abdelaziz Ahmed Abdelhafez

Published in Cardiology and Cardiovascular Research (Volume 6, Issue 2)

Received: 2 May 2022 Accepted: 20 May 2022 Published: 26 May 2022

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Background: Internal carotid artery atherosclerotic stenosis is a common cause of transient ischemic attacks (TIAs) and ischemic strokes. The advance of percutaneous, endovascular therapies for vascular disease has been unremitting. Over the last several decades, but recently Endovascular management and stenting is considered one of the lines of treatment for carotid artery stenosis. Objectives: To report the outcome and follow up of internal carotid artery stenting. Patients and methods: 131 internal carotid artery stenting procedures were done for 131 patients with significant internal carotid artery stenosis at multiple centres, including neurovascular intervention units at Al-Azhar university hospitals (Al-Hussein and Assiut), Mostafa Mahmoud, and Kobbri Elkobba hospitals, Egypt, from February 2019 to March 2021, Patients were followed for 12 months after stenting. Results: Early post-interventional complications included stroke (3.8%), TIA (6.1%), transient bradycardia (3.8%) and local groin hematoma (2.3%). One month later, no new neurological deficits developed and carotid artery duplex showed no restenosis. At the end of follow-up, three patients developed stroke and three patients died (one from acute myocardial infarction and two patients died without known aetiology). The carotid artery duplex showed no cases of restenosis. Conclusion: Carotid artery stenting is a safe, feasible, and efficacious procedure with a low periprocedural risk of stroke or death. Furthermore, the risk of future stroke and rate of significant restenosis during mid-term follow-up appears to be low and carotid stenting can be considered an alternative to carotid endarterectomy, especially in high-risk patients.

Published in	Cardiology and Cardiovascular Research (Volume 6, Issue 2)
DOI	10.11648/j.ccr.20220602.14
Page(s)	75-80
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Atherosclerosis, Endovascular Stenting, Stroke, TIAs

References

[1]	Roger VL, Go AS, Lloyd-Jones DM et al.; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation 2012; 125 (1): e2–e220.
[2]	Wabnitz AM, Turan, TN. Symptomatic Carotid Artery Stenosis: Surgery, Stenting, or Medical Therapy? Curr Treat Options Cardiovasc Med. 2017 Aug; 19 (8): 62.
[3]	Jim J, Rubin BG, Ricotta JJ et al. OuctomesCommittee.; Society for Vascular Surgery (SVS) Vascular Registry evaluation of comparative effectiveness of carotid revascularization procedures stratified by Medicare age. J Vasc Surg 2012. 55 (5): 1313–21.
[4]	Brott TG, Hobson RW, 2nd, Howard G, et al. Stenting versus endarterectomy for treatment of carotid artery stenosis. N Engl J Med. 2010; 363: 11–23. [PMC free article] [PubMed].
[5]	Brott TG, Howard G, Roubin GS, Meschia JF, Mackey A, Brooks W, et al. Long-term results of stenting versus endarterectomy for carotid artery stenosis. N Engl J Med 2016; 374: 1021-31.
[6]	Obeid T, Arhuidese I, Qazi U, Black J, Perler B, Malas MB. Post-stent ballooning is associated with increased periprocedural stroke and death rate in carotid artery stenting. J Vasc Surg 2015; 62: 616-23.
[7]	Hye RJ, Voeks JH, Malas MB, Tom M, Longson S, Blackshear JL, et al. Anesthetic type and risk of myocardial infarction after carotid endarterectomy in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). J Vasc Surg 2016; 64: 3-8.
[8]	Li Y, Yang JJ, Zhu SH, Xu B, Wang L. Long-term efficacy and safety of carotid artery stenting versus endarterectomy: a meta-analysis of randomized controlled trials. PloS One 2017; 12: e0180804.
[9]	Moresoli P, Habib B, Reynier P, Secrest MH, Eisenberg MJ, Filion KB. CarotidStenting Versus Endarterectomy for Asymptomatic Carotid Artery Stenosis: ASystematic Review and Meta-Analysis. Stroke. 2017 Aug; 48 (8): 2150-2157.
[10]	Cui L, Han Y, Zhang S, Liu X, Zhang J. Safety of Stenting and Endarterectomy for Asymptomatic Carotid Artery Stenosis: A Meta-Analysis of RandomisedControlled Trials. Eur J VascEndovasc Surg. 2018 May; 55 (5): 614-624.
[11]	Yuan G, Zhou S, Wu W, Zhang Y, Lei J, Huang B. Carotid Artery Stenting VersusCarotid Endarterectomy for Treatment of Asymptomatic Carotid Artery Stenosis. IntHeart J. 2018 May 30; 59 (3): 550-558.
[12]	Yadav JS, Wholey MH, Kuntz RE, et al.: Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med2004; 351: 1493–501.
[13]	Harrigan M R, Deveikis J P: Handbook of Cerebrovascular Disease and Neurointerventional Technique Humana Press, Springer Science 2009 DOI 10.1007/978-1-60327-125-7.
[14]	Ahn SH, Prince EA, Dubel GJ. Carotid artery stenting: a review of technique and update of recent literature. Semin Intervent Radiol. 2013; 30: 288–296. DOI: 10.1055/s-0033-1353482.
[15]	Werner N, Zeymer U, Mark B, et al.: Carotid Artery Stenting in Clinical Practice: Does Sex Matter? Clin. Cardiol. 2012. 35, 2, 111–118.
[16]	Tokuda R, Yoshimura S, Uchida K, Yamada K, Satow T, Iihara K, Sakai N; Japanese Registry of NeuroEndovascular Therapy (JR-NET) investigators. Real-world experience of Carotid Artery Stenting in Japan: Analysis of 8458 Cases from the JR-NET3 Nationwide Retrospective Multi-center Registries. Neurol Med Chir (Tokyo). 2019 Apr 15; 59 (4): 117-125.
[17]	Wieker CM, Demirel S, Attigah N, Hakimi M, Hinz U, Böckler D. Outcome of carotid artery stenting in the hands of vascular surgeons. Langenbecks Arch Surg. 2017 Aug; 402 (5): 805-810.
[18]	DakourAridi H, Locham S, Nejim B, Malas MB. Comparison of 30-day readmission rates and risk factors between carotid artery stenting and endarterectomy. J Vasc Surg 2017 Nov; 66 (5): 1432-1444.e7.
[19]	Qureshi AI, Janardhan V, Memon MZ, et al.: Initial experience in establishing an academic neuroendovascular service: program building, procedural types, and outcomes. J Neuroimaging. 2008; 19 (1): 72–9.
[20]	Setacci C, Chisci E, Setacci F, et al.: carotid artery stenting score: a risk modeling study for individual patients. Stroke 2010; 41 (6): 1259–6.
[21]	Gray WA, Yadav JS, Verta P, et al.: The CAPTURE registry: predictors of outcomes in carotid artery stenting with embolic protection for high surgical risk patients in the early post-approval setting. Catheter Cardiovasc Interv. 2007: 70 (7): 1025– 33.
[22]	Bosiers M, Peeters P, Deloose K, et al.: Does carotid artery stenting work on the long run: 5-year results in high-volume centers (ELOCAS Registry). J Cardiovasc Surg (Torino) 2007; 46: 241–247.
[23]	Jim J, Rubin BG, Landis GS, et al.: Society for Vascular Surgery Vascular Registry evaluation of stent cell design on carotid artery stenting outcomes. J Vasc Surg. 2011; 54 (1): 71–9.
[24]	Timaran CH, Rosero EB, Higuera A, et al.: Randomized clinical trial of open-cell vs. closed-cell stents for carotid stenting and effects of stent design on cerebral embolization. J Vasc Surg 2011. 54, Issue 5: 1310–1316.e1.
[25]	Morr S, Lin N, Siddiqui R, A Carotid artery stenting: current and emerging options Medical Devices: Evidence and Research. 2014: 7 343–355.

Cite This Article

Plain Text BibTeX RIS

APA Style

Mohammed Alsagheer Alhewy, Mahmoud Galal, Abdelaziz Ahmed Abdelhafez. (2022). Feasibility and Outcome of Endovascular Management of Carotid Artery Stenosis, Egyptian Multicentric Experience. Cardiology and Cardiovascular Research, 6(2), 75-80. https://doi.org/10.11648/j.ccr.20220602.14

Copy | Download

ACS Style

Mohammed Alsagheer Alhewy; Mahmoud Galal; Abdelaziz Ahmed Abdelhafez. Feasibility and Outcome of Endovascular Management of Carotid Artery Stenosis, Egyptian Multicentric Experience. Cardiol. Cardiovasc. Res. 2022, 6(2), 75-80. doi: 10.11648/j.ccr.20220602.14

Copy | Download

AMA Style

Mohammed Alsagheer Alhewy, Mahmoud Galal, Abdelaziz Ahmed Abdelhafez. Feasibility and Outcome of Endovascular Management of Carotid Artery Stenosis, Egyptian Multicentric Experience. Cardiol Cardiovasc Res. 2022;6(2):75-80. doi: 10.11648/j.ccr.20220602.14

Copy | Download

@article{10.11648/j.ccr.20220602.14,
  author = {Mohammed Alsagheer Alhewy and Mahmoud Galal and Abdelaziz Ahmed Abdelhafez},
  title = {Feasibility and Outcome of Endovascular Management of Carotid Artery Stenosis, Egyptian Multicentric Experience},
  journal = {Cardiology and Cardiovascular Research},
  volume = {6},
  number = {2},
  pages = {75-80},
  doi = {10.11648/j.ccr.20220602.14},
  url = {https://doi.org/10.11648/j.ccr.20220602.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20220602.14},
  abstract = {Background: Internal carotid artery atherosclerotic stenosis is a common cause of transient ischemic attacks (TIAs) and ischemic strokes. The advance of percutaneous, endovascular therapies for vascular disease has been unremitting. Over the last several decades, but recently Endovascular management and stenting is considered one of the lines of treatment for carotid artery stenosis. Objectives: To report the outcome and follow up of internal carotid artery stenting. Patients and methods: 131 internal carotid artery stenting procedures were done for 131 patients with significant internal carotid artery stenosis at multiple centres, including neurovascular intervention units at Al-Azhar university hospitals (Al-Hussein and Assiut), Mostafa Mahmoud, and Kobbri Elkobba hospitals, Egypt, from February 2019 to March 2021, Patients were followed for 12 months after stenting. Results: Early post-interventional complications included stroke (3.8%), TIA (6.1%), transient bradycardia (3.8%) and local groin hematoma (2.3%). One month later, no new neurological deficits developed and carotid artery duplex showed no restenosis. At the end of follow-up, three patients developed stroke and three patients died (one from acute myocardial infarction and two patients died without known aetiology). The carotid artery duplex showed no cases of restenosis. Conclusion: Carotid artery stenting is a safe, feasible, and efficacious procedure with a low periprocedural risk of stroke or death. Furthermore, the risk of future stroke and rate of significant restenosis during mid-term follow-up appears to be low and carotid stenting can be considered an alternative to carotid endarterectomy, especially in high-risk patients.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Feasibility and Outcome of Endovascular Management of Carotid Artery Stenosis, Egyptian Multicentric Experience
AU  - Mohammed Alsagheer Alhewy
AU  - Mahmoud Galal
AU  - Abdelaziz Ahmed Abdelhafez
Y1  - 2022/05/26
PY  - 2022
N1  - https://doi.org/10.11648/j.ccr.20220602.14
DO  - 10.11648/j.ccr.20220602.14
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 75
EP  - 80
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20220602.14
AB  - Background: Internal carotid artery atherosclerotic stenosis is a common cause of transient ischemic attacks (TIAs) and ischemic strokes. The advance of percutaneous, endovascular therapies for vascular disease has been unremitting. Over the last several decades, but recently Endovascular management and stenting is considered one of the lines of treatment for carotid artery stenosis. Objectives: To report the outcome and follow up of internal carotid artery stenting. Patients and methods: 131 internal carotid artery stenting procedures were done for 131 patients with significant internal carotid artery stenosis at multiple centres, including neurovascular intervention units at Al-Azhar university hospitals (Al-Hussein and Assiut), Mostafa Mahmoud, and Kobbri Elkobba hospitals, Egypt, from February 2019 to March 2021, Patients were followed for 12 months after stenting. Results: Early post-interventional complications included stroke (3.8%), TIA (6.1%), transient bradycardia (3.8%) and local groin hematoma (2.3%). One month later, no new neurological deficits developed and carotid artery duplex showed no restenosis. At the end of follow-up, three patients developed stroke and three patients died (one from acute myocardial infarction and two patients died without known aetiology). The carotid artery duplex showed no cases of restenosis. Conclusion: Carotid artery stenting is a safe, feasible, and efficacious procedure with a low periprocedural risk of stroke or death. Furthermore, the risk of future stroke and rate of significant restenosis during mid-term follow-up appears to be low and carotid stenting can be considered an alternative to carotid endarterectomy, especially in high-risk patients.
VL  - 6
IS  - 2
ER  -

Copy | Download

Author Information

Mohammed Alsagheer Alhewy

Vascular and Endovascular Surgery Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
Mahmoud Galal

Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Abdelaziz Ahmed Abdelhafez

Vascular and Endovascular Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Mohammed Alsagheer Alhewy, Mahmoud Galal, Abdelaziz Ahmed Abdelhafez. (2022). Feasibility and Outcome of Endovascular Management of Carotid Artery Stenosis, Egyptian Multicentric Experience. Cardiology and Cardiovascular Research, 6(2), 75-80. https://doi.org/10.11648/j.ccr.20220602.14

Copy | Download

ACS Style

Mohammed Alsagheer Alhewy; Mahmoud Galal; Abdelaziz Ahmed Abdelhafez. Feasibility and Outcome of Endovascular Management of Carotid Artery Stenosis, Egyptian Multicentric Experience. Cardiol. Cardiovasc. Res. 2022, 6(2), 75-80. doi: 10.11648/j.ccr.20220602.14

Copy | Download

AMA Style

Mohammed Alsagheer Alhewy, Mahmoud Galal, Abdelaziz Ahmed Abdelhafez. Feasibility and Outcome of Endovascular Management of Carotid Artery Stenosis, Egyptian Multicentric Experience. Cardiol Cardiovasc Res. 2022;6(2):75-80. doi: 10.11648/j.ccr.20220602.14

Copy | Download

@article{10.11648/j.ccr.20220602.14,
  author = {Mohammed Alsagheer Alhewy and Mahmoud Galal and Abdelaziz Ahmed Abdelhafez},
  title = {Feasibility and Outcome of Endovascular Management of Carotid Artery Stenosis, Egyptian Multicentric Experience},
  journal = {Cardiology and Cardiovascular Research},
  volume = {6},
  number = {2},
  pages = {75-80},
  doi = {10.11648/j.ccr.20220602.14},
  url = {https://doi.org/10.11648/j.ccr.20220602.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20220602.14},
  abstract = {Background: Internal carotid artery atherosclerotic stenosis is a common cause of transient ischemic attacks (TIAs) and ischemic strokes. The advance of percutaneous, endovascular therapies for vascular disease has been unremitting. Over the last several decades, but recently Endovascular management and stenting is considered one of the lines of treatment for carotid artery stenosis. Objectives: To report the outcome and follow up of internal carotid artery stenting. Patients and methods: 131 internal carotid artery stenting procedures were done for 131 patients with significant internal carotid artery stenosis at multiple centres, including neurovascular intervention units at Al-Azhar university hospitals (Al-Hussein and Assiut), Mostafa Mahmoud, and Kobbri Elkobba hospitals, Egypt, from February 2019 to March 2021, Patients were followed for 12 months after stenting. Results: Early post-interventional complications included stroke (3.8%), TIA (6.1%), transient bradycardia (3.8%) and local groin hematoma (2.3%). One month later, no new neurological deficits developed and carotid artery duplex showed no restenosis. At the end of follow-up, three patients developed stroke and three patients died (one from acute myocardial infarction and two patients died without known aetiology). The carotid artery duplex showed no cases of restenosis. Conclusion: Carotid artery stenting is a safe, feasible, and efficacious procedure with a low periprocedural risk of stroke or death. Furthermore, the risk of future stroke and rate of significant restenosis during mid-term follow-up appears to be low and carotid stenting can be considered an alternative to carotid endarterectomy, especially in high-risk patients.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Feasibility and Outcome of Endovascular Management of Carotid Artery Stenosis, Egyptian Multicentric Experience
AU  - Mohammed Alsagheer Alhewy
AU  - Mahmoud Galal
AU  - Abdelaziz Ahmed Abdelhafez
Y1  - 2022/05/26
PY  - 2022
N1  - https://doi.org/10.11648/j.ccr.20220602.14
DO  - 10.11648/j.ccr.20220602.14
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 75
EP  - 80
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20220602.14
AB  - Background: Internal carotid artery atherosclerotic stenosis is a common cause of transient ischemic attacks (TIAs) and ischemic strokes. The advance of percutaneous, endovascular therapies for vascular disease has been unremitting. Over the last several decades, but recently Endovascular management and stenting is considered one of the lines of treatment for carotid artery stenosis. Objectives: To report the outcome and follow up of internal carotid artery stenting. Patients and methods: 131 internal carotid artery stenting procedures were done for 131 patients with significant internal carotid artery stenosis at multiple centres, including neurovascular intervention units at Al-Azhar university hospitals (Al-Hussein and Assiut), Mostafa Mahmoud, and Kobbri Elkobba hospitals, Egypt, from February 2019 to March 2021, Patients were followed for 12 months after stenting. Results: Early post-interventional complications included stroke (3.8%), TIA (6.1%), transient bradycardia (3.8%) and local groin hematoma (2.3%). One month later, no new neurological deficits developed and carotid artery duplex showed no restenosis. At the end of follow-up, three patients developed stroke and three patients died (one from acute myocardial infarction and two patients died without known aetiology). The carotid artery duplex showed no cases of restenosis. Conclusion: Carotid artery stenting is a safe, feasible, and efficacious procedure with a low periprocedural risk of stroke or death. Furthermore, the risk of future stroke and rate of significant restenosis during mid-term follow-up appears to be low and carotid stenting can be considered an alternative to carotid endarterectomy, especially in high-risk patients.
VL  - 6
IS  - 2
ER  -

Copy | Download