ABSTRACT
Since the publication of the first edition of Korean clinical practice guidelines of secondary stroke prevention, encouraging data from recent large clinical trials and meta-analysis have led us to consider many therapeutic options in the treatment of symptomatic extracranial carotid stenosis. Accordingly, the writing group of Clinical Research Center for Stroke decided to provide recent views on the therapeutic revascularization of extracranial carotid stenosis, and timely evidence-based recommendations. In this updated version, new evidences about carotid angioplasty/stenting, treatment timing, and perioperative preparation are given, and qualifying conditions for operator are elucidated. This refinement was based on current consensus between Korean Society of Intravascular Neurosurgery, Korean Society of Interventional Neuroradiology, and Korean Society of Cerebrovascular Surgery and approved by Korean Stroke Society, Korean Neurological Association, and Korean Society of Geriatric Neurology. These recommendations are subject to future correction based on new evidences from ongoing and future studies.
Subject(s)
Carotid Arteries , Carotid Stenosis , Consensus , Endarterectomy, Carotid , Neurology , Neurosurgery , Publications , Secondary Prevention , Stroke , WritingABSTRACT
To evaluate the feasibility, safety and efficacy of percutaneous stent implantation for treating left main coronary artery (LMCA) stenosis. Methods Consecutive patients with unprotected left main coronary artery disease treated by stent-based percutaneous intervention (PCI) at 6 medical centers in China were enrolled. Procedural data and clinical outcomes were obtained from all patients. Results From January 2001 to December 2004, 138 patients (79 males and 59 females; mean age: 69.7±5.8 years)underwent PCI for LMCA stenosis. Bare metal stents (BMS) were implanted in 51 patients with non-bifurcational lesions and in 5 patients with bifurcational lesions from January of 2001 to June of 2003 (BMS group);. Drug eluting stents (DES) were used unselectively to cover both bifurcational and non-bifurcational lesions in 86 patients from July of 2003 to December of 2004 (DES group). Procedural success rate of the 138 cases was 98% (135/138). One patient (0.7%) with bifurcation lesion who was treated with DES died from severe heart failure 2 weeks after the procedure. During a mean follow up period of 21.3 ± 5.6 months, one patient died from renal failure, one from sudden cardiac death, 4 underwent target lesion revascularization (TLR) in the BMS group, which all occurred in patients with bifurcational lesions; whereas in the DES group no deaths occurred and only one patient with bifurcational lesion had TLR. Conclusions (1) PCI is feasible and relatively safe to treat unprotected left main coronary artery disease in elderly patients at medical centers with experienced professionals. (2) BMS and DES have similar immediate and long-term efficacy in the treatment of ostium and shaft lesions of the LMCA. (3) DES are strongly suggested in the therapy of distal bifurcation lesion of unprotected LMCA.
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60 years old with coronary artery disease in hospital from Jan.2002 to Aug 2004 who accepted coronary intervention.They were divided into Tansradial group(TRA,n=382) and Transfemoral group(TRF,n=382).The success rate and time of puncture,x-ray exposure time,procedure duration,dose of dye,complication in puncture site and pulmonary embolism were observed in the two groups.Results 368 out of 382 cases success in TRA group and 372 cases in TRF group.The success rate was not different.The success rate of puncture,x-ray exposure time,procedure duration and dose of dye had no difference between the two groups.But the complication in puncture site and pulmonary embolism were more in TRF group than in TRA group.The coronary intravascular ultrasound and cutting balloon technique were successfully done in two groups.The mean in-hospital time was less in TRA group (2.1?0.6 days) than in TRF group (4.2?1.6days,P
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Objective To explore the practicability of self-expanding stent placement treatment in the management of carotid artery stenosis. Methods 14 self-expanding stent treatments were performed at 10 sites carotid artery stenosis in 9 patients with TIA and 70%-95% carotid stenosis. Results All patients were free from TIA. Residual stenosis was
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Objective This study reports the early and late results of percutaneous transluminal angioplasty (PTA) and intravascular stenting for atherosclerotic stenosis of the iliac artery. Methods From December 1994 to February 2000, we performed iliac artery angioplasty and primary intravascular stent placement in 42 vessel of 31 patients (23 men and 8 women; mean age, 70.5 years). A total of 44 self expanding Wallstents ( Boston Schneider, Inc. ) were deployed. All patients underwent angioplasty and stent placement successfully. Results Clinical follow up was available for all patients at a mean of (36?13) months. All patients with clinical ischemic category (claudication or rest pain) were improved. Angiographic follow up with completed data are available for 20 of 31 patients at a mean follow up of (10?5) months. The iliac artery restenosis rate was 2%(1/42). The patients again underwent balloon angioplasty successfully. Conclusions PTA and primary stenting of the iliac arteries are effective and safety for treating iliac arterial stenosis,and should be the method of first shoice.