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Scientific Session 4: Carotid Intervention
Higher dilutions caused considerable signal loss (due to T2*) and susceptibility-induced geometric distortion. In the canine, a 2% solution of Gd-DTPA provided the best images of the abdominal aorta and renal vessels. CONCLUSIONS: Inu'a-arterial contrast-enhanced 2D and 3D MR DSA can be successfully implemented using diluted Gd-DTPA. Higher Gd-DTPA concenu'ations were found to be optimal in vivo due to the use of shorter TE (reduced 1'2* signal loss) and due to additional dilution of the contrast agent as it mixes with the flowing blood. Dilution of the contrast agent permits the administration of many more injections per day compared with conventional intravenous Gd-DTPA-enhanced MR angiography without exceeding the 0.3 mmol/kg limit. It also permits rapid and selective imaging of the area of interest without the need for timing boluses or localizer scans. This technique may have application in MR-guided endovascular procedures.
Sunday, March 21, 1999 1:00 pm-2:30 pm Scientific Session 4 Carotid Intervention Moderator: Thomas O. McNamara, MD
1:00 pm
The total el atll and eli abling stroke rate was tberefore 6.3%. Complications after 30 days were; ] 4 deaths (l due to ipsiJareral troke), 3 non-d.isabling stroke, 5 TIA, and 2 retinal artery OCelli ions.
CONCLUSION The endovascular management of symptomatic carotitl disease is not a benign pracedme. The major complication rate is acceptable in a nonselecred group of patients. Further technical developments are required, anel a major randomized u'lal is mandatory. 1:15 pm
Abstract No. 20
Global Survey of Carotid Artery Stent Placement Michael H. Wholey, MD, Pittsburgh, PA • Mark H. Wholey, MD PURPOSE: To review the current status of carotid artery stent placement in the world. JIIL4 TERIALS AND METHODS: Surveys were sent to major interventional centers in Europe, North and South America, and Asia. Information from peer-reviewed journals also was included and supplemented the survey. The survey asked the various questions about the patients enrolled, procedure techniques, and results of carotid stenting including complications and restenosis. Of the centers sent surveys, 24 responded.
Abstract No. 19
FEATURED ABSTRACT Commentator: J. J. Connors III, MD Endovascular Carotid Intervention: A Single Center Audit Peter Gaines, MRcp, PReP, Shliffield, United Kingdom • Ti1?vor Cleuekmd, PRes, FRCR. Joanathon D. Beard, CL\!I, FRCS. Graham Venables, MRCP
PURPO 'E. To review the entire expeJience of this unit performing carotid angioplasry and stenting. JlllA TERIALS AND METHOD ': One hundred and fortytwo patients aged 45-82 years (97 men, 47 omen) with symptomatic carotid disease were prospectively investigated. One hundred and lhirty-four patients had de novo athero clero is, three had previous neck radiotherapy, five were urgica:l restenosi , and four had a repeat iot rvention. One patient had two separate lesions, and one had bilateral int rventions perfOlmed on s parate occasions. Pr senting symptoms were: amaurosis fugax = 56 patients, retinal artery a elusion = 6 patients, TIA = 55 patients, minor stroke = 12 p,ltients, nondisabling stroke = 15 patienr , and disabling sU'oke = 9 patients.
RESULTS: Complications at 30 day w re; 4 deaths (2 ipsilateral hemorrhage, 1 ipsilateral stroke, ] renal failure), 5 disabling stroke, 2 non-disabling stroke, 3 minor stroke, 16 TlA, 1 central and 3 branch retinal artery ocdusion , and 1 optic: ischemic neuropathy.
RESULTS: The total number of endovascular carotid stent procedures that have been performed worldwide to date included 2,957 cases with a technical success of 98.7%. Complications that occurred during the carotid stent placement or within a 30-day period after placement were recorded. Overall, there were 70 minor strokes with a rate of occurrence of 2.37%. The total number of major strokes was 39, for a rate of 1.32%. There were 29 deaths within a 30-day postprocedure period, resulting in a mortality rate of 0.98%. Restenosis rates of carotid stenting have been 2.30% at 6 months and 3.1% at 12 months. Neurologic sequelae were seen in 0.6% of the cases in the 6-12 month follow-up examinations. CONCLUSIONS: Endovascular stent treatment of carotid artery atherosclerotic disease is growing as 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.
1:30 pm
Abstract No. 21
The Effects of Carotid Intervention on Blood Pressure Peter Gaines, MRCP, FRCR, Sheffield, United Kingdom. Arul Sivaguru, MRCP. jonathan Beard, CLM, FRCS. Treuor Cleveland, FRCR, FRCS PURPOSE: A decrease in blood pressure has been observed after endovascular carotid intervention. We investigated whether this effect was sustained compared with results after surgery.
213
MATERIALS AND METHODS: Eighty patients randomized
in a study comparing the endovascular and surgical management of symptomatic carotid disease were investigated. All patients had symptomatic carotid disease with> 70% stenosis. Forty-five patients had endovascular treatment and 35 patients had carotid endarterectomy (CEA). All patients had 24-hour ambulatory BP measurements before intervention and at 1 month.
one mild compression of a Palmaz stent and six restenoses (4%). One symptomatic and five asymptomatic restenoses were treated by new PTA alone (n = 3), new PTA + stent (n = 1), surgery (n = 1), and medical treatment (n = 1). Maximum follow-up period: 40 months, mean: 14.7 ::'::: 9.3 months. No ipsilateral neurologic complication were seen. Primary patency was 96% at 3 years, and secondary was 99%.
RESULTS: In the PTA group there was no sustained difference in BP (mean change -2,1 mm Hg, 95% CI +0.4 to -4.6). In the carotid endarterectomy group there was a significant difference in the systolic BP (P < 0.01), diastolic BP (P < 0.05), and mean BP (p < 0.01).
CONCLUSION Carotid angioplasty with the use of stents seems safe, effective, and can be considered as an alternative to surgical treatment of atherosclerotic stenoses at least in some specific indications. Randomized studies will be necessary.
CONCLUSION The results suggest no sustained difference in BP after endovascular carotid intervention, but a significant difference after surgery. The findings may have a bearing on stroke and cardiovascular prophylaxis.
1:45 pm
Abstract No. 22
Angioplasty and Stenting of Extracranial Carotid Arteries in High-Risk Patients Michel Henry, MD, Essey Les Nancy, France. Max Amor, MD. Zukai Chati, MD. Isabelle Henry, MD. Isabelle Masson, MD PURPOSE: To study feasibility/safety of endovascular
treatment (angioplasty + stents) of atherosclerotic stenosis of the extracranial carotid artery to determine if it could be an alternative to surgical endarterectomy. MATERIALS AND METHODS: Carotid angioplasty at-
tempted in 205 arteries in 192 patients (M:144, F:48, mean age: 71.1 ::'::: 9.7 years, range: 47-93 years). Mean lesion length: 14.7 ::'::: 4.1 mm. Mean arterial e: 5.6 ::'::: 0.7 mm. In 11 patients, contralateral carotid artery was thrombosed. Thirty-five percent of the patients were symptomatic, 65% were asymptomatic (55% of the patients had severe coronary disease, 34% had peripheral vascular diseases). Stents were deployed in all carotids but one: Palmaz (n = 138), Wallstent (n = 66), other stents (n = 9). Without cerebral protection, 149 carotid arteries were treated (fem. approach: 134, direct puncture: 13, brachial approach: 2). Fifty-five were treated with cerebral protection (three techniques were used: Theron's technique, PercuSurge, and a new device we developed). Neurologic examination, CT-scan, Dupplex scan, angiography were performed before and after the procedure and at the 6-month follow-up evaluation.
214
RESULTS: Immediate technical success: 2041205. Mean percentage of stenosis decreased from 83.8 ::'::: 2.9 to 2.9::'::: 7. There were 10 neurologic complications (4.9%): four TIAs, three minor, three major strokes. Seven appeared after Palmaz stent implantation (5.6%) and three after Wallstent (4.6%). Four appeared despite cerebral protection. There were three access site hematomas. No deaths and no myocardial infarctions occurred. At 6 months, 151 patients were followed up. We observed
2:00 pm
Abstract No. 23
Carotid Stents for Treatment of Carotid Artery Bifurcation Lesions Barry T Katzen, MD, Miami, FL. Gary j. Becker, MD • James F. Benenati, MD. Gerald Zemel, MD • Ira F. Braun, MD PURPOSE: To assess the feasibility and preliminary safety and efficacy of carotid bifurcation stenting (CBS) as a definitive method to prevent stroke. MATERIALS AND METHODS: Thirty-four patients with
either symptomatic (>60% stenosis) or asymptomatic (>85%) carotid bifurcation stenosis (NASCET angiographic measurement criteria) underwent CBS as the definitive treatment method to prevent stroke. All were evaluated before and after the procedure by a neurologist, vascular surgeon, and interventionalist. Twenty-six (76.4%) of 34 patients were considered > high risk according to NASCET enrollment/exclusion criteria. Wallstents, Palmaz, and Integra stents were utilized. All patients were entered into IRB-approved protocols. Pretreatment included ticlopidine and aspirin. The percutaneous transfemoral approach was used in all patients, with coaxial sheaths (n = 33) or gUiding catheters (n = 1) placed in the common carotid artery. An ACT of 250 seconds was achieved with heparin before engaging the carotid. Predilation with 3.5-mm balloons preceded stent deployment. In the postprocedure period, the ACT was allowed to normalize, and sheaths were removed. Postprocedure management included ticlopidine (250 mg bid X 30 days) and aspirin (325 g po qd indefinitely). Neurologic evaluation was repeated within 24 hours of implant. Discharge was within 1 day, and follow-up . evaluation proceeded according to the particular protocol. RESULTS: All patients had successful stent deployment based on intention to treat. Two major strokes and subsequent deaths occurred (two patients) during the 30 days after the procedure in patients considered high risk for carotid endarterectomy. No delayed neurologic events were documented in follow-up (mean, 12.7 months). Restenosis resulting in stent explant and saphenous internal carotid bypass occurred in one patient.
CONCLUSION CBS is feasible and effective in providing luminal improvement. Although the 30-day combined stroke and death rate in this preliminary study may exceed those of published multicenter endarterectomy trials, approximately three fourths of our stent-treated patients would have been excluded from NASCET because of high risk. Further study is warranted to evaluate the role of CBS in stroke prevention. 2:15 pm
Abstract No. 24
Carotid Stent Supported Angioplasty of Internal Carotid Arteries Chester R. jarmolowski, MD, Pittsburgh, PA • Mark H. Wholey, MD. Gustav R. Eles, DO • john Bechtel, RN PURPOSE To demonstrate the technical results and efficacy of endovascular placement of the )&) Palmaz stent for internal carotid occlusive disease. MA 7ERlALS AND METHODS: The series consists of 177 patients (102 men and 75 women, average age 69.8 years) with angiographicaUy significant «70%) lesions of the internal carotid arteries. The mean stenosis rate was 86%. There were a total of 187 lesions attempted (10 patients with bilateral stents). One hundred eighty-two lesions were successfuUy stented for a technical success rate of 97 .3%. Neurologic complications consisted of two (1%) TlAs, one (0.5%) major stroke, and five (2.7%) minor strokes. Neurologic and doppler foUow-up evaluation at 1 month (94%), 6 months (82%), ] year (76%), and 2 years (70%) demonstrated no ipsilateral neurologic events. There were eight (4.3%) greater than 50% restenoses on ultrasound; two of these had angiograms that were normal; one patient had a stenosis proximal to the stent. There was one irregularly shaped stent deployed at another institution that we angioplastied. There was one stent deformation, found at 26 months, of approximately 50% stenosis that we did not treat. CONCLUSION Carotid stent-supported angioplasty with the Palmaz endovascular balloon expandable stent is a procedure with high technical success rates and a limited number of complications, suggesting that this treatment option is a viable alternative in the treatment of carotid artery occlusive disease.
Sunday, March 21, 1999
1:00 pm-2:30 pm
PURPOSE This study describes our 10-year experience in treating venous occlusions or stenosis above the diaphragm using endovascular stents. MATERIALS AND METHODS: From 1988 to 1998, 50 venous sites were treated with metal stents for 36 stenoses and/or occlusions in 36 patients. Stent sites included superior vena cava (SVC; 11) and upper extremity (39: subclavian 23, innominate 11, axillary vein 5). The most common indications for stent placement were stenoses/ occlusions associated with malignancy (n = 8), thoracic outlet syndrome (TOS; (n = 8), central line related (n = 11), and other causes (n = 5). Pretreatment and posttreatment symptom severity was assessed and graded from 0 (asymptomatic) to 3 (severe symptoms with swelling, pain, and local ulceration). Clinical evaluation and duplex examinations were performed at regular intervals. RESULTS: Average foUow-up time was 5.1 months and
16.8 months, respectively, for the superior vena cava and upper extremity stents. Symptoms were Significantly decreased by 1 week in both groups of patients (mean change: 1.7, P = 0.003; 1.3, P < 0.0001). LifetabJe analysis of superior vena cava stents showed 100% primary and secondary I-month patency rates and 67% primaly and secondary 6-month patency rates. Primary and secondary 6-month patency rates for the upper extremities treated without superior vena cava involvement were 75% and 78%, respectively, with I-year primary and secondary patency rates of 55% and 78%, respectively. Eight patients died within 3 months after stent placement. The incidence of major complications was 19%. CONCLUSION Stents are valuable tools in the treatment of upper extremity and superior vena cava venous obstructive disease. The patency is good, and the symptomatic relief is substantial. 1:15 pm
Abstract No. 26
Expandable Metallic Stents in the Treatment of Superior Vena Cava Syndrome Miguel A. De Gregorio, PhD, Zaragoza, Spain. Marcos Herrera, PhD. jose E. Mata, PhD. jose A. Fernandez, PhD. Eduardo R. Alfonso, PhD. joaquin Medrano, PhD PURPOSE: The purpose of this study was to evaluate the results of treatment of superior vena cava syndrome (SVCS) in patients with both benign and malignant disease using metaUic stents.
Scientific Session 5 Central Venous Stents Moderator: Kevin L. SuUivan, MD 1:00 pm
Haraldur Bjarnason, MD, Minneapolis, MN. Gwen K. Nazarian, MD • Michael S. Rosenberg, MD. Charles A. Dietz, jr., MD. David W. Hunter, MD
Abstract No. 25
Treatment of Superior Vena Caval and Upper Extremity Venous Obstructive Disease Using Metal Stents: Ten-Year Experience
J\llA7ERlALS AND METHODS· Between)anuary 1995 and March 1997,67 expandable stents were implanted in 62 patients (49 men and 13 women) with a mean age of 52.6 years (range, 39-77 years) for the treatment of SVCS. Superior vena cava syndrome was defined as
215
Sunday, March 21, 1999 1:00 pm-2:30 pm Scientific Session 4 Carotid Intervention Moderator: Thomas O. McNamara, MD
1:00 pm
The total el atll and eli abling stroke rate was tberefore 6.3%. Complications after 30 days were; ] 4 deaths (l due to ipsiJareral troke), 3 non-d.isabling stroke, 5 TIA, and 2 retinal artery OCelli ions.
CONCLUSION The endovascular management of symptomatic carotitl disease is not a benign pracedme. The major complication rate is acceptable in a nonselecred group of patients. Further technical developments are required, anel a major randomized u'lal is mandatory. 1:15 pm
Abstract No. 20
Global Survey of Carotid Artery Stent Placement Michael H. Wholey, MD, Pittsburgh, PA • Mark H. Wholey, MD PURPOSE: To review the current status of carotid artery stent placement in the world. JIIL4 TERIALS AND METHODS: Surveys were sent to major interventional centers in Europe, North and South America, and Asia. Information from peer-reviewed journals also was included and supplemented the survey. The survey asked the various questions about the patients enrolled, procedure techniques, and results of carotid stenting including complications and restenosis. Of the centers sent surveys, 24 responded.
Abstract No. 19
FEATURED ABSTRACT Commentator: J. J. Connors III, MD Endovascular Carotid Intervention: A Single Center Audit Peter Gaines, MRcp, PReP, Shliffield, United Kingdom • Ti1?vor Cleuekmd, PRes, FRCR. Joanathon D. Beard, CL\!I, FRCS. Graham Venables, MRCP
PURPO 'E. To review the entire expeJience of this unit performing carotid angioplasry and stenting. JlllA TERIALS AND METHOD ': One hundred and fortytwo patients aged 45-82 years (97 men, 47 omen) with symptomatic carotid disease were prospectively investigated. One hundred and lhirty-four patients had de novo athero clero is, three had previous neck radiotherapy, five were urgica:l restenosi , and four had a repeat iot rvention. One patient had two separate lesions, and one had bilateral int rventions perfOlmed on s parate occasions. Pr senting symptoms were: amaurosis fugax = 56 patients, retinal artery a elusion = 6 patients, TIA = 55 patients, minor stroke = 12 p,ltients, nondisabling stroke = 15 patienr , and disabling sU'oke = 9 patients.
RESULTS: Complications at 30 day w re; 4 deaths (2 ipsilateral hemorrhage, 1 ipsilateral stroke, ] renal failure), 5 disabling stroke, 2 non-disabling stroke, 3 minor stroke, 16 TlA, 1 central and 3 branch retinal artery ocdusion , and 1 optic: ischemic neuropathy.
RESULTS: The total number of endovascular carotid stent procedures that have been performed worldwide to date included 2,957 cases with a technical success of 98.7%. Complications that occurred during the carotid stent placement or within a 30-day period after placement were recorded. Overall, there were 70 minor strokes with a rate of occurrence of 2.37%. The total number of major strokes was 39, for a rate of 1.32%. There were 29 deaths within a 30-day postprocedure period, resulting in a mortality rate of 0.98%. Restenosis rates of carotid stenting have been 2.30% at 6 months and 3.1% at 12 months. Neurologic sequelae were seen in 0.6% of the cases in the 6-12 month follow-up examinations. CONCLUSIONS: Endovascular stent treatment of carotid artery atherosclerotic disease is growing as 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.
1:30 pm
Abstract No. 21
The Effects of Carotid Intervention on Blood Pressure Peter Gaines, MRCP, FRCR, Sheffield, United Kingdom. Arul Sivaguru, MRCP. jonathan Beard, CLM, FRCS. Treuor Cleveland, FRCR, FRCS PURPOSE: A decrease in blood pressure has been observed after endovascular carotid intervention. We investigated whether this effect was sustained compared with results after surgery.
213
MATERIALS AND METHODS: Eighty patients randomized
in a study comparing the endovascular and surgical management of symptomatic carotid disease were investigated. All patients had symptomatic carotid disease with> 70% stenosis. Forty-five patients had endovascular treatment and 35 patients had carotid endarterectomy (CEA). All patients had 24-hour ambulatory BP measurements before intervention and at 1 month.
one mild compression of a Palmaz stent and six restenoses (4%). One symptomatic and five asymptomatic restenoses were treated by new PTA alone (n = 3), new PTA + stent (n = 1), surgery (n = 1), and medical treatment (n = 1). Maximum follow-up period: 40 months, mean: 14.7 ::'::: 9.3 months. No ipsilateral neurologic complication were seen. Primary patency was 96% at 3 years, and secondary was 99%.
RESULTS: In the PTA group there was no sustained difference in BP (mean change -2,1 mm Hg, 95% CI +0.4 to -4.6). In the carotid endarterectomy group there was a significant difference in the systolic BP (P < 0.01), diastolic BP (P < 0.05), and mean BP (p < 0.01).
CONCLUSION Carotid angioplasty with the use of stents seems safe, effective, and can be considered as an alternative to surgical treatment of atherosclerotic stenoses at least in some specific indications. Randomized studies will be necessary.
CONCLUSION The results suggest no sustained difference in BP after endovascular carotid intervention, but a significant difference after surgery. The findings may have a bearing on stroke and cardiovascular prophylaxis.
1:45 pm
Abstract No. 22
Angioplasty and Stenting of Extracranial Carotid Arteries in High-Risk Patients Michel Henry, MD, Essey Les Nancy, France. Max Amor, MD. Zukai Chati, MD. Isabelle Henry, MD. Isabelle Masson, MD PURPOSE: To study feasibility/safety of endovascular
treatment (angioplasty + stents) of atherosclerotic stenosis of the extracranial carotid artery to determine if it could be an alternative to surgical endarterectomy. MATERIALS AND METHODS: Carotid angioplasty at-
tempted in 205 arteries in 192 patients (M:144, F:48, mean age: 71.1 ::'::: 9.7 years, range: 47-93 years). Mean lesion length: 14.7 ::'::: 4.1 mm. Mean arterial e: 5.6 ::'::: 0.7 mm. In 11 patients, contralateral carotid artery was thrombosed. Thirty-five percent of the patients were symptomatic, 65% were asymptomatic (55% of the patients had severe coronary disease, 34% had peripheral vascular diseases). Stents were deployed in all carotids but one: Palmaz (n = 138), Wallstent (n = 66), other stents (n = 9). Without cerebral protection, 149 carotid arteries were treated (fem. approach: 134, direct puncture: 13, brachial approach: 2). Fifty-five were treated with cerebral protection (three techniques were used: Theron's technique, PercuSurge, and a new device we developed). Neurologic examination, CT-scan, Dupplex scan, angiography were performed before and after the procedure and at the 6-month follow-up evaluation.
214
RESULTS: Immediate technical success: 2041205. Mean percentage of stenosis decreased from 83.8 ::'::: 2.9 to 2.9::'::: 7. There were 10 neurologic complications (4.9%): four TIAs, three minor, three major strokes. Seven appeared after Palmaz stent implantation (5.6%) and three after Wallstent (4.6%). Four appeared despite cerebral protection. There were three access site hematomas. No deaths and no myocardial infarctions occurred. At 6 months, 151 patients were followed up. We observed
2:00 pm
Abstract No. 23
Carotid Stents for Treatment of Carotid Artery Bifurcation Lesions Barry T Katzen, MD, Miami, FL. Gary j. Becker, MD • James F. Benenati, MD. Gerald Zemel, MD • Ira F. Braun, MD PURPOSE: To assess the feasibility and preliminary safety and efficacy of carotid bifurcation stenting (CBS) as a definitive method to prevent stroke. MATERIALS AND METHODS: Thirty-four patients with
either symptomatic (>60% stenosis) or asymptomatic (>85%) carotid bifurcation stenosis (NASCET angiographic measurement criteria) underwent CBS as the definitive treatment method to prevent stroke. All were evaluated before and after the procedure by a neurologist, vascular surgeon, and interventionalist. Twenty-six (76.4%) of 34 patients were considered > high risk according to NASCET enrollment/exclusion criteria. Wallstents, Palmaz, and Integra stents were utilized. All patients were entered into IRB-approved protocols. Pretreatment included ticlopidine and aspirin. The percutaneous transfemoral approach was used in all patients, with coaxial sheaths (n = 33) or gUiding catheters (n = 1) placed in the common carotid artery. An ACT of 250 seconds was achieved with heparin before engaging the carotid. Predilation with 3.5-mm balloons preceded stent deployment. In the postprocedure period, the ACT was allowed to normalize, and sheaths were removed. Postprocedure management included ticlopidine (250 mg bid X 30 days) and aspirin (325 g po qd indefinitely). Neurologic evaluation was repeated within 24 hours of implant. Discharge was within 1 day, and follow-up . evaluation proceeded according to the particular protocol. RESULTS: All patients had successful stent deployment based on intention to treat. Two major strokes and subsequent deaths occurred (two patients) during the 30 days after the procedure in patients considered high risk for carotid endarterectomy. No delayed neurologic events were documented in follow-up (mean, 12.7 months). Restenosis resulting in stent explant and saphenous internal carotid bypass occurred in one patient.
CONCLUSION CBS is feasible and effective in providing luminal improvement. Although the 30-day combined stroke and death rate in this preliminary study may exceed those of published multicenter endarterectomy trials, approximately three fourths of our stent-treated patients would have been excluded from NASCET because of high risk. Further study is warranted to evaluate the role of CBS in stroke prevention. 2:15 pm
Abstract No. 24
Carotid Stent Supported Angioplasty of Internal Carotid Arteries Chester R. jarmolowski, MD, Pittsburgh, PA • Mark H. Wholey, MD. Gustav R. Eles, DO • john Bechtel, RN PURPOSE To demonstrate the technical results and efficacy of endovascular placement of the )&) Palmaz stent for internal carotid occlusive disease. MA 7ERlALS AND METHODS: The series consists of 177 patients (102 men and 75 women, average age 69.8 years) with angiographicaUy significant «70%) lesions of the internal carotid arteries. The mean stenosis rate was 86%. There were a total of 187 lesions attempted (10 patients with bilateral stents). One hundred eighty-two lesions were successfuUy stented for a technical success rate of 97 .3%. Neurologic complications consisted of two (1%) TlAs, one (0.5%) major stroke, and five (2.7%) minor strokes. Neurologic and doppler foUow-up evaluation at 1 month (94%), 6 months (82%), ] year (76%), and 2 years (70%) demonstrated no ipsilateral neurologic events. There were eight (4.3%) greater than 50% restenoses on ultrasound; two of these had angiograms that were normal; one patient had a stenosis proximal to the stent. There was one irregularly shaped stent deployed at another institution that we angioplastied. There was one stent deformation, found at 26 months, of approximately 50% stenosis that we did not treat. CONCLUSION Carotid stent-supported angioplasty with the Palmaz endovascular balloon expandable stent is a procedure with high technical success rates and a limited number of complications, suggesting that this treatment option is a viable alternative in the treatment of carotid artery occlusive disease.
Sunday, March 21, 1999
1:00 pm-2:30 pm
PURPOSE This study describes our 10-year experience in treating venous occlusions or stenosis above the diaphragm using endovascular stents. MATERIALS AND METHODS: From 1988 to 1998, 50 venous sites were treated with metal stents for 36 stenoses and/or occlusions in 36 patients. Stent sites included superior vena cava (SVC; 11) and upper extremity (39: subclavian 23, innominate 11, axillary vein 5). The most common indications for stent placement were stenoses/ occlusions associated with malignancy (n = 8), thoracic outlet syndrome (TOS; (n = 8), central line related (n = 11), and other causes (n = 5). Pretreatment and posttreatment symptom severity was assessed and graded from 0 (asymptomatic) to 3 (severe symptoms with swelling, pain, and local ulceration). Clinical evaluation and duplex examinations were performed at regular intervals. RESULTS: Average foUow-up time was 5.1 months and
16.8 months, respectively, for the superior vena cava and upper extremity stents. Symptoms were Significantly decreased by 1 week in both groups of patients (mean change: 1.7, P = 0.003; 1.3, P < 0.0001). LifetabJe analysis of superior vena cava stents showed 100% primary and secondary I-month patency rates and 67% primaly and secondary 6-month patency rates. Primary and secondary 6-month patency rates for the upper extremities treated without superior vena cava involvement were 75% and 78%, respectively, with I-year primary and secondary patency rates of 55% and 78%, respectively. Eight patients died within 3 months after stent placement. The incidence of major complications was 19%. CONCLUSION Stents are valuable tools in the treatment of upper extremity and superior vena cava venous obstructive disease. The patency is good, and the symptomatic relief is substantial. 1:15 pm
Abstract No. 26
Expandable Metallic Stents in the Treatment of Superior Vena Cava Syndrome Miguel A. De Gregorio, PhD, Zaragoza, Spain. Marcos Herrera, PhD. jose E. Mata, PhD. jose A. Fernandez, PhD. Eduardo R. Alfonso, PhD. joaquin Medrano, PhD PURPOSE: The purpose of this study was to evaluate the results of treatment of superior vena cava syndrome (SVCS) in patients with both benign and malignant disease using metaUic stents.
Scientific Session 5 Central Venous Stents Moderator: Kevin L. SuUivan, MD 1:00 pm
Haraldur Bjarnason, MD, Minneapolis, MN. Gwen K. Nazarian, MD • Michael S. Rosenberg, MD. Charles A. Dietz, jr., MD. David W. Hunter, MD
Abstract No. 25
Treatment of Superior Vena Caval and Upper Extremity Venous Obstructive Disease Using Metal Stents: Ten-Year Experience
J\llA7ERlALS AND METHODS· Between)anuary 1995 and March 1997,67 expandable stents were implanted in 62 patients (49 men and 13 women) with a mean age of 52.6 years (range, 39-77 years) for the treatment of SVCS. Superior vena cava syndrome was defined as
215