Document Detail


Predictors of difficult carotid stenting as determined by aortic arch angiography.
MedLine Citation:
PMID:  18460700     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Although different aortic arch classifications exist to help determine carotid artery stenting (CAS) difficulty, they are not validated. We compared quantitative angiographic characteristics of aortic arch between easy and difficult CAS. METHODS: We defined difficult procedures as requiring the longest fluoroscopy time (FT) (90th percentile) and easy procedures as the shortest FT (10th percentile) from our CAS database. We excluded patients undergoing additional procedures, intraprocedural complications or those with difficult vascular access. RESULTS: We analyzed 24 patients with difficult CAS (median fluoroscopy time of 58 minutes) and 24 with easy CAS (median fluoroscopy time of 19 minutes). The two groups were similar with respect to demographics, comorbidities and clinical presentation at the time of CAS. Patients with difficult procedures had a longer distance from the origin of treated artery to the beginning of the descending aorta (D1; 50 +/- 17 mm vs. 40 +/- 16 mm; p = 0.04), severe tortuosity (T) of the common carotid and internal carotid vessels (T; 50.0% vs. 16.7%; p = 0.03) and a trend in the presence of a Type 3 arch (33.3% vs. 25.0%; p = 0.18) and angulated takeoff (20.8% vs. 4.3%; p = 0.19). There was no difference in the severity of stenosis or index lesion calcification, ulceration and eccentricity between the two groups. On multivariate analysis, independent predictors of procedural difficulty were D1 (odds ratio 1.04 per mm; 95% CI, 1.01-1.09; p = 0.04), and T (odds ratio 4.77; 95% CI 1.3-42.9; p = 0.03). CONCLUSIONS: Distance from the origin of the treated artery to the beginning of the D1 and target vessel T determine prolonged fluoroscopy time during CAS.
Authors:
Surabhi Madhwal; Vivek Rajagopal; Deepak L Bhatt; Christopher T Bajzer; Patrick Whitlow; Samir R Kapadia
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  20     ISSN:  1557-2501     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-07     Completed Date:  2008-07-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  200-4     Citation Subset:  IM    
Affiliation:
Cleveland Clinic, F25, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angiography
Aorta, Thoracic / anatomy & histology*,  radiography*
Blood Vessel Prosthesis Implantation*
Carotid Arteries / surgery*
Female
Fluoroscopy
Humans
Male
Middle Aged
Prognosis
Stents*
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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