Retrograde Use of Gore Hybrid Vascular Graft for a Complex Carotid Tandem Lesion.

BACKGROUND: Successful treatment of tandem lesions of carotid arteries may represent a challenging goal for the vascular specialist. In the "endovascular era," a hybrid approach may represent a viable option. CASE REPORT: We describe the case of a 65-year-old patient with severe postcarotid endarterectomy recurrent stenosis of the internal carotid artery (ICA) associated with primitive stenosis of the proximal common carotid artery (CCA) treated with retrograde stenting and carotid bypass using the Gore Hybrid Vascular Graft (GHVG). CONCLUSIONS: We demonstrated the effectiveness of the hybrid technique using GHVG in treating carotid tandem lesions involving CCA and ICA.

Early Carotid Endarterectomy Provides a Better Neurological Outcome in Symptomatic Patients: A Single-Center Experience.

BACKGROUND: Many studies confirmed the role of early carotid endarterectomy (CEA) to prevent recurrent stroke or transient ischemic attack; however, the mid-long-term neurological benefit is still not completely investigated. The purpose of the study was to evaluate the role of early CEA on the perioperative and postoperative stroke/death complications of patients with a symptomatic carotid stenosis. METHODS: Ninety consecutive patients were referred to our center for a symptomatic carotid stenosis. They were divided into 2 groups according to the time to surgery: G1 within 2 weeks (39 patients) and G2 from 2 weeks to thereafter (51 patients). Neurological assessment was performed with the National Institutes of Health Stroke Scale (NIHSS) at presentation and at follow-up. Echo color Doppler ultrasound was performed at 1-6 months and then yearly. RESULTS: The presentation of neurological symptoms differed significantly between the 2 groups; in fact, minor stroke was more frequent in G1, whereas transient ischemic attack was more frequent in G2 (P value = 0.027). No significant differences emerged between the 2 groups on the surgical intervention or perioperative complications. The study showed a significant improvement of the neurological impairment (evaluated with a reduction of NIHSS score) of patients in G1 compared with G2 (P value = 0.01). CONCLUSIONS: Neurological recovery after a symptomatic carotid stenosis is strictly correlated to the variable "time to surgery." A higher sensitization of the general population on the early recognition of the symptoms and a strict collaboration with neurologists is mandatory to reduce time to CEA and improve clinical outcomes.

Proximal Embolic Protection Devices in Complicated Carotid Artery Stenting.

The most frequent complication during carotid artery stenting (CAS) is intraoperative distal embolization. Three categories of embolic protection devices (EPDs) are routinely used through a transfemoral or transcervical approach: distal occlusion devices, distal EPDs with flow preservation using filters, and the proximal occlusive protective systems. We report the case of the internal carotid artery (ICA) plaque rupture during CAS using a proximal EPD (the Mo.Ma system; INVATEC), treated with immediate surgery. The proximal occlusive protective system permitted the common carotid artery and ICA endoclamping for the time necessary to prepare the patient for the carotid endarterectomy. The EPDs should always be chosen considering the patient's and lesion's characteristics. This knowledge allows their use even as "bridge" endovascular devices.

Preoperative and Postoperative Evaluation of New Double Mesh Carotid Stents with Contrast-Enhanced Ultrasound and Diffusion-Weighted Imaging.

In this case series, we selected 4 patients with asymptomatic severe carotid stenosis due to unstable plaques, which were identified with contrast-enhanced ultrasound. These patients underwent carotid stenting with a new generation double mesh stent. Diffusion-weighted magnetic resonance imaging (DW-MRI) was executed before and after the procedure to detect early cerebral microembolizations. No early neurological complications occurred nor cerebral microembolizations were detected at DW-MRI. New double mesh carotid stents appear to be a safe option also in asymptomatic patients with unstable plaques at high risk for surgery.