| Safety of embolic protection device-assisted and unprotected intravascular ultrasound in evaluating carotid artery atherosclerotic lesions. | |
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MedLine Citation:
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PMID: 22293887 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Background: Significant atherosclerotic stenosis of internal carotid artery (ICA) origin is common (5-10% at ≥60 years). Intravascular ultrasound (IVUS) enables high-resolution (120 µm) plaque imaging, and IVUS-elucidated features of the coronary plaque were recently shown to be associated with its symptomatic rupture/thrombosis risk. Safety of the significant carotid plaque IVUS imaging in a large unselected population is unknown.<br /> Material/Methods: We prospectively evaluated the safety of embolic protection device (EPD)-assisted vs. unprotected ICA-IVUS in a series of consecutive subjects with ≥50% ICA stenosis referred for carotid artery stenting (CAS), including 104 asymptomatic (aS) and 187 symptomatic (S) subjects (age 47-83 y, 187 men). EPD use was optional for IVUS, but mandatory for CAS.<br /> Results: Evaluation was performed of 107 ICAs (36.8%) without EPD and 184 with EPD. Lesions imaged under EPD were overall more severe (peak-systolic velocity 2.97±0.08 vs. 2.20±0.08m/s, end-diastolic velocity 1.0±0.04 vs. 0.7±0.03 m/s, stenosis severity of 85.7±0.5% vs. 77.7±0.6% by catheter angiography; mean ±SEM; p<0.01 for all comparisons) and more frequently S (50.0% vs. 34.6%, p=0.01). No ICA perforation or dissection, and no major stroke or death occurred. There was no IVUS-triggered cerebral embolization. In the procedures of (i) unprotected IVUS and no CAS, (ii) unprotected IVUS followed by CAS (filters - 39, flow reversal/blockade - 3), (iii) EPD-protected (filters - 135, flow reversal/blockade - 48) IVUS+CAS, TIA occurred in 1.5% vs. 4.8% vs. 2.7%, respectively, and minor stroke in 0% vs. 2.4% vs. 2.1%, respectively. EPD intolerance (on-filter ICA spasm or flow reversal/blockade intolerance) occurred in 9/225 (4.0%). IVUS increased the procedure duration by 7.27±0.19 min.<br /> Conclusions: Carotid IVUS is safe and, for the less severe lesions in particular, it may not require mandatory EPD use. High-risk lesions can be safely evaluated with IVUS under flow reversal/blockade.<br /> |
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Authors:
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Piotr Musialek; Piotr Pieniazek; Wieslawa Tracz; Lukasz Tekieli; Tadeusz Przewlocki; Anna Kablak-Ziembicka; Rafal Motyl; Zbigniew Moczulski; Jakub Stepniewski; Mariusz Trystula; Wojciech Zajdel; Agnieszka Roslawiecka; Krzysztof Zmudka; Piotr Podolec |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Medical science monitor : international medical journal of experimental and clinical research Volume: 18 ISSN: 1643-3750 ISO Abbreviation: Med. Sci. Monit. Publication Date: 2012 Feb |
Date Detail:
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Created Date: 2012-02-01 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9609063 Medline TA: Med Sci Monit Country: Poland |
Other Details:
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Languages: eng Pagination: MT7-18 Citation Subset: IM |
Affiliation:
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Department of Cardiac and Vascular Diseases, Jagiellonian University, Cracow, Poland. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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