Superficial temporal artery access for transfemoral or transbrachial carotid artery stenting in selected patients considered unfit for carotid surgery.

BACKGROUND: Transfemoral (TFCAS) or transbrachial carotid artery stenting (TBCAS) is an alternative to carotid endarterectomy (CEA) for treatment of high-grade internal carotid artery (ICA) stenosis. A difficult aortic arch (i.e., type III or bovine arch) and/or a tortuous/stenosed common carotid artery (CCA) are potential reasons for technical failure. This study explores the benefits of superficial temporal artery access (STAA) in aiding TFCAS or TBCAS for patients with challenging anatomical conditions. METHODS: Clinical data of patients who underwent TFCAS or TBCAS using STAA between January and November 2023 were prospectively collected. Demographics, comorbidities, clinical presentation, and imaging studies were reviewed. Primary outcomes included 30-day stroke/death and technical success. Secondary outcomes and causes of failures were assessed. RESULTS: Ten patients (mean age: 74 [range: 66-84] years) with difficult aortic arch (N.=2), CCA tortuosity (N.=2), proximal CCA stenosis (N.=2), previous technical TFCAS failure (N.=2) and aortoiliac occlusive disease (AIOD) (N.=2) underwent TFCAS or TBCAS supported by STAA. Successful STAA was possible in eight patients (six facilitated TFCAS and two TBCAS. after TBCAS occurred TIA). In two cases STAA was not successful. There were no deaths or strokes within 30 days, transient ischemic attack (TIA) occurred in one patient. Follow-up Duplex ultrasound confirmed occlusion of the STA in all patients, without clinical consequences. CONCLUSIONS: This prospective study suggests that TFCAS/TBCAS supported by STAA is a viable and safe approach when traditional access methods are ineffective and transcarotid artery stenting in not available or not possible. Despite a 20% technical failure in the current series, this technique may be useful for challenging anatomy of the aortic arch, CCA stenosis and tortuosity, and AIOD. When feasible, STAA may be a promising adjunct to TFCAS/TBCAS.

Clinical Characteristics and Predictors of Long-Term Prognosis of Acute Peripheral Arterial Ischemia Patients Treated Surgically.

BACKGROUND: Acute peripheral arterial ischemia is a rapidly developing loss of perfusion, resulting in ischemic clinical manifestations. This study aimed to assess the incidence of cardiovascular mortality in patients with acute peripheral arterial ischemia and either atrial fibrillation (AF) or sinus rhythm (SR). METHODS: This observational study involved patients with acute peripheral ischemia treated surgically. Patients were followed-up to assess cardiovascular mortality and its predictors. RESULTS: The study group included 200 patients with acute peripheral arterial ischemia and either AF (n = 67) or SR (n = 133). No cardiovascular mortality differences between the AF and SR groups were observed. AF patients who died of cardiovascular causes had a higher prevalence of peripheral arterial disease (58.3% vs. 31.6%, p = 0.048) and hypercholesterolemia (31.2% vs. 5.3%, p = 0.028) than those who did not die of such causes. Patients with SR who died of cardiovascular causes more frequently had a GFR <60 mL/min/1.73 m2 (47.8% vs. 25.0%, p = 0.03) and were older than those with SR who did not die of such causes. The multivariable analysis shows that hyperlipidemia reduced the risk of cardiovascular mortality in patients with AF, whereas in patients with SR, an age of ≥75 years was the predisposing factor for such mortality. CONCLUSIONS: Cardiovascular mortality of patients with acute ischemia did not differ between patients with AF and SR. Hyperlipidemia reduced the risk of cardiovascular mortality in patients with AF, whereas in patients with SR, an age of ≥75 years was a predisposing factor for such mortality.

Elasticity of the carotid artery walls as a prognostic factor for the occurrence of restenosis after a surgery for internal carotid artery stenosis.

BACKGROUND: Restoration of carotid artery patency is one of the most frequently performed operations in vascular surgery. One of the most important problems that occur both short- and long-term after carotid endarterectomy is recurrent stenosis. Despite advances in imaging studies and better knowledge of the mechanisms of atherogenesis, the mechanism of restenosis remains unclear. Patients with internal carotid artery atherosclerosis experience decreased elasticity of the intima-media complex, resulting in increased vessel wall stiffness. In the future, measurement of carotid artery elasticity may become a marker for the development of post-surgical stenosis occurring after endarterectomy of both the carotid artery and other peripheral vessels. AIM: To assess the elasticity of carotid artery walls as a prognostic factor for the occurrence of restenosis after a surgery for common carotid artery stenosis. METHODS: Classic carotid artery endarterectomy was performed in 180 patients selected on the basis of standard, ultrasound- based recommendations. The phenomenon of restenosis was examined using ultrasound techniques at 3, 6, 9 and 12 months after the surgery. Measurements of carotid artery elasticity were performed using a Vascular Echo Doppler device, and patients were divided into two groups depending on the occurrence (or non-occurrence) of restenosis. RESULTS: Group I (without restenosis) included 156 (86.6%) patients, and Group II (with restenosis) included 24 (13.4%) patients. At 3 and 6 months after the surgery, an increase of the elasticity of vessel walls (coefficient a) was observed in both groups, but the differences in the elasticity of the carotid arteries were not significant. At 12 months after the surgery, all patients in Group II (with restenosis) had significantly increased coefficient a values as compared to Group I patients (p < 0.05). CONCLUSIONS: A decrease in carotid artery wall elasticity as measured using coefficient a may be associated with the process leading to the occurrence of restenosis after the surgery. Further research is required in order to confirm the conclusions presented in this paper and to explain potential mechanisms of this phenomenon.