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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Carotid Artery Stenting for Heavily Calcified Lesions Using a Scoring Balloon: A Report of 2 Cases
Yohei Takenobu1,2, Noriko Nomura1, Yoshito Sugita3
1Department of Neurology Osaka Red Cross Hospital Osaka Japan.
Insights
Carotid artery stenting for heavily calcified lesions can be challenging. Using a scoring balloon for predilation proved successful in two cases, improving stenosis and offering a potential solution for complex cases.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
- Medical Devices
Background:
- Heavily calcified carotid artery lesions pose significant challenges for stenting.
- Calcium burden is linked to poor stent expansion, complications, and restenosis.
Purpose of the Study:
- To report the successful use of scoring balloons for carotid artery stenting in heavily calcified lesions.
- To evaluate the efficacy of scoring balloons in improving dilatation and outcomes.
Main Methods:
- Two patients with severe carotid artery stenosis and heavy calcification underwent stenting.
- Predilation was performed using scoring balloons (NSE PTA balloon) at rated burst pressure prior to stent deployment.
- Stent deployment (Precise Pro RX) and postdilatation were performed.
Main Results:
- Successful dilatation was achieved in both cases despite severe calcification (95% and 86% stenosis).
- Post-stenting, stenosis was reduced to 21% and 23%.
- One patient experienced transient bradycardia and hypotension, managed medically. Both patients remained asymptomatic.
Conclusions:
- Carotid artery stenting with scoring balloon predilation is effective for heavily calcified lesions.
- This technique offers a viable option for revascularization in complex carotid artery disease.
Objective:
Carotid artery stenting for heavily calcified lesions is challenging for interventionists. A calcium burden is associated with suboptimal dilatation, periprocedural complications, high rates of restenosis, and poor outcomes. We describe the first report of 2 cases of successful carotid artery stenting for heavily calcified lesions using a scoring balloon.
Case Presentation:
The patients were both aged 75 years, 1 male and 1 female, who had experienced ipsilateral stroke prior to the procedures. They had dense calcifications at the lesions, stenosis rates of 95% (near occlusion) and 86% according to the North American Symptomatic Carotid Endarterectomy Trial criteria, and calcification arcs of 270° and 360°, respectively. Considering the heavy calcification, predilation with scoring balloons (NSE PTA balloon; Nipro, Osaka, Japan) at the rated burst pressure was performed in both cases. Sufficient dilatation was achieved, followed by carotid stent deployment (Precise Pro RX; Cordis, Miami Lakes, FL, USA). After postdilatation, the stenosis rates decreased to 21% and 23%, respectively. Although 1 patient experienced prolonged bradycardia and hypotension, they were well managed with anticholinergic and vasoconstrictive agents. Both patients remained asymptomatic.
Conclusion:
Carotid artery stenting using a scoring balloon obtained acceptable improvements in severe stenosis with heavily calcified lesions. This method could be a useful option for the revascularization of heavily calcified lesions.
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