Local Anesthesia in Carotid Angioplasty

Purpose: To determine the safety and efficacy of local anesthesia for percutaneous carotid angioplasty and stenting performed via a direct common carotid access. Methods: Deep cervical plexus blockade was used for anesthesia in 22 of 32 patients (26 males; mean age 66 years) undergoing percutaneous carotid balloon angioplasty and/or stenting via direct carotid puncture. Local anesthesia was selected according to patient preference (n = 9); advanced age (n = 4); ischemic heart disease (n = 4); intended extracorporeal circulation for unstable angina (n = 3); and an incompetent circle of Willis (n = 2). The technique involved injection of bupivacaine hydrochloride along the C2, C3, and C4 transverse processes. No superficial cervical plexus blockade was used. Results: No complications of anesthesia were observed, though there were cases in which surgery became necessary under local anesthesia for angioplasty-related complications. These conversions were accomplished without difficulty. Conclusions: Cervical nerve blockade appears to be a safe and effective anesthetic method for endovascular carotid interventions performed percutaneously through direct carotid puncture.

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Safety and Efficacy of Flow Reversal in Acute and Elective Carotid Angioplasty and Stenting Using the Mo.Ma Device with Short-Term Follow-Up

Interventional Neurology ◽

10.1159/000499045 ◽

2019 ◽

Vol 8 (2-6) ◽

pp. 196-205

Author(s):

Ambooj Tiwari ◽

Ryan Bo ◽

Keithan Sivakumar ◽

Karthikeyan M. Arcot ◽

Philip Ye ◽

...

Keyword(s):

Flow Reversal ◽

Carotid Angioplasty ◽

Short Term ◽

Safety And Efficacy ◽

Carotid Revascularization ◽

Subacute Stroke ◽

Angioplasty And Stenting ◽

Carotid Angioplasty And Stenting ◽

Radiographic Data

Objective: To determine the safety and efficacy of flow reversal following proximal flow arrest as an embolic protection strategy for carotid angioplasty and stenting (CAS) with short-term follow-up. Method: We performed a retrospective review of our CAS database for patients who underwent stent-supported carotid revascularization in the setting of acute/subacute stroke or TIA. We reviewed clinical and radiographic data during a 36-month period. Primary outcome was clinical evidence of ipsilateral stroke in the first 30 days. Secondary outcomes include clinical outcomes and sonographic and/or angiographic follow-up over 6 months, 6-month functional scale, and all-cause mortality. Results: Fifty-five patients underwent CAS using flow reversal: 26 females and 29 males with a mean age of 69.7 years. Median time to treatment from index event was 3 days. 11% underwent stenting as part of hyperacute stroke therapy. Average luminal stenosis was 86%. The 9-Fr Mo.Ma device was used in combination with Penumbra aspiration in all cases. There were no ipsilateral strokes. Incidence of any ischemic event was 3.64%, but only 1 (1.82%) patient had a postoperative stroke. Clinical follow-up was available for 94.5%, while lesion follow-up was available for 73% of patients. Three patients had evidence of restenosis, but none were symptomatic. Luminal restenosis was ≤30% in all three. Median pre- and post-NIHSS were 1 and 1, respectively. Conclusion: Flow reversal using the Mo.Ma device is a safe and effective strategy in preventing distal embolization during carotid artery revascularization.

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E-073 safety and efficacy of flow reversal in carotid angioplasty and stenting using mo. ma device

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011917.148 ◽

2015 ◽

Vol 7 (Suppl 1) ◽

pp. A74.1-A74

Author(s):

R Bo ◽

A Tiwari ◽

K Arcot ◽

H Dababneh ◽

J Farkas

Keyword(s):

Flow Reversal ◽

Carotid Angioplasty ◽

Safety And Efficacy ◽

Angioplasty And Stenting ◽

Carotid Angioplasty And Stenting

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Safety and efficacy of simultaneous bilateral carotid angioplasty and stenting

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-013-0920-1 ◽

2013 ◽

Vol 37 (2) ◽

pp. 202-209 ◽

Cited By ~ 6

Author(s):

Yongkun Li ◽

Wenshan Sun ◽

Qin Yin ◽

Yinzhou Wang ◽

Qiankun Cai ◽

...

Keyword(s):

Carotid Angioplasty ◽

Safety And Efficacy ◽

Bilateral Carotid ◽

Angioplasty And Stenting ◽

Carotid Angioplasty And Stenting

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Safety and efficacy of carotid angioplasty and stenting for radiation-associated carotid artery stenosis

Journal of Vascular Surgery ◽

10.1016/j.jvs.2009.07.015 ◽

2009 ◽

Vol 50 (6) ◽

pp. 1308-1313 ◽

Cited By ~ 25

Author(s):

Mikel Sadek ◽

Neal S. Cayne ◽

Hyun J. Shin ◽

Irene C. Turnbull ◽

Michael L. Marin ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Carotid Angioplasty ◽

Safety And Efficacy ◽

Angioplasty And Stenting ◽

Carotid Angioplasty And Stenting

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Safety and Efficacy of Carotid Angioplasty and Stenting in High-Risk Patients

The American Surgeon ◽

10.1177/000313480607200807 ◽

2006 ◽

Vol 72 (8) ◽

pp. 694-699 ◽

Cited By ~ 2

Author(s):

Rabih A. Chaer ◽

Brian G. Derubertis ◽

Susan M. Trocciola ◽

Stephanie C. Lin ◽

Robert Hynecek ◽

...

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Confidence Interval ◽

Carotid Angioplasty ◽

Safety And Efficacy ◽

High Risk Patients ◽

Risk Patients ◽

Angioplasty And Stenting ◽

Carotid Angioplasty And Stenting

Performance of carotid endarterectomy (CEA) may be associated with an increased risk in patients with significant comorbid medical conditions, neck irradiation, or previous CEA. This study compared the results of CEA with carotid angioplasty and stenting (CAS) in high-risk patients treated for carotid stenosis. Five hundred forty-five patients who underwent CEA and 148 patients who underwent CAS were evaluated. For patients undergoing CEA, general anesthesia was used in 91 per cent, electroencephalographic monitoring was used in 63 per cent, and shunting was performed in 19.8 per cent. Cerebral protection devices were used in 145/148 of CAS cases, and self-expanding stents were used in all cases. Evaluated end points included major cardiovascular events, and a composite of death, stroke, or myocardial infarction for the duration of the follow-up. Mean follow-up was 18 months for CAS and 23 months for CEA. Significant differences were present in patient age (CAS, 75 ± 11.0 years vs CEA, 71 ± 9 years, P = 0.012), however, there were no significant differences ( P = NS) in gender or smoking history. The mean modified Goldman Score was significantly higher for CAS (21.1 ± 14.8 [95% confidence interval = 18, 24]) than for CEA (6.3 ± 6.8 [95% confidence interval = 5.7, 6.9]; P = 0.0001) patients. The incidence of periprocedural complications did not vary significantly between patients treated with CAS (CVA, 1.4%; myocardial infarction [MI], 1.4%; death, 0.7%; CVA/MI/death, 3.4%) compared with CEA (CVA, 1.8%; MI, 1.1%; death, 0.4%; CVA/MI/death, 4.0%). CAS is equivalent to CEA in safety and efficacy, even when performed in patients who may be at increased surgical risk.

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