Welcome to the WSC 2022 Interactive Program
The congress will officially run on Singapore Standard Time (SGT/UTC+8)
To convert the congress times to your local time Click here
*Please note that all sessions in halls Summit 1, Summit 2 & Hall 406 will be live streamed in addition to the onsite presentation
ASK THE SPEAKER
Sessions in Halls 406, Summit 1 and Summit 2 have a Q&A component, through the congress App called “Ask the Speaker”
COMBINED ACUTE REVASCULARIZATION IN EARLY BILATERAL CAROTID STENT OCCLUSION
Abstract
Background and Aims
Insertion of a carotid stent in the treatment of significant stenosis is a standard procedure. It involves the subsequent use of antiplatelet therapy to maintain stent patency. We present a case report of combined acute revascularization in a patient with occlusion in recently introduced stents of both carotid arteries.
Methods
The patient (male, 73 years) was admitted for stroke recurrence upon discontinuation of antiplatelet therapy. According to the CTA, the closure of implanted stents of both carotid arteries was confirmed. Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) were performed with complete recanalization of the left carotid stent. With an interval of 3 days, there was a significant deterioration in right-hand lateralization. Progressive stent thrombosis was detected. Percutaneous transluminal stent angioplasty and prolonged low-dose IVT were used. Reocclusion occurred after 4 hours. Thus, MT of the left carotid stent was performed again. Subsequently, the stent thrombosis occurs again.
Results
With the impossibility of maintaining the patency of carotid stents even on the maximum drug therapy and despite endovascular procedures, bilateral neurosurgical revascularization of the middle cerebral arteries using ECIC bypasses (arteria temporalis superficialis into the middle cerebral artery basin on both sides) was successfully performed. Prolonged low-dose IVT (20 mg rTPA/10 hours) administered for a total of 17 hours has proven to be an acute bridging therapy until surgery.
Conclusions
Early occlusion of the carotid stent is a significant complication of endovascular treatment of stenotic arteries. ECIC bypass revascularization of the middle cerebral artery can be a highly effective therapeutic procedure.
EARLY CAROTID STENT COMPLICATIONS AFTER SUCCESSFUL CAROTID ANGIOPLASTY AND STENTING
Abstract
Background and Aims
Carotid Artery Stenting (CAS) is nowadays an established treatment option for carotid artery disease. There are many known complications of CAS, including: intra-procedural (dissection), and post-procedural (fluid collection, pseudoaneurysm, thrombosis, thromboembolism, restenosis, stent deformation or fracture and arteriovenous fistula). We aim to highlight the procedural complications of incomplete stent apposition post-CAS.
Methods
We describe 3 cases of patients who underwent successful CAS but with early complications. Two patients had stent malappositions and one patient had stent shortening. We performed a non-systematic literature review to identify the relevance of these stent complications in CAS patients.
Results
The majority of available studies on incomplete stent apposition comes from coronary artery stenting studies. Laminar flow is disrupted by malapposed stent struts, leading to areas of high shear rate. This can increase the risk of stent thrombosis.
Conclusions
There are few descriptions of carotid artery stent malapposition. We hope to highlight a less well-described complication. More studies are required to determine the long-term outcomes of patients with incomplete stent apposition.
CLINICAL OUTCOMES OF ENDOVASCULAR TREATMENT FOR ISCHEMIC STROKE WITH INTERNAL CAROTID ARTERY DISSECTION
Abstract
Background and Aims
The clinical outcomes and safety of endovascular treatment for acute carotid artery dissection is not well described. The purpose of this study was to describe the clinical characteristics and outcome of ischemic stroke related with carotid dissection which has performed the endovascular treatment.
Methods
A retrospective review of patients endovascular treated for acute spontaneous or posttraumatic carotid artery dissection with ischemic stroke, over a 13-year period from September 2005 to November 2017 was performed. The patients (6 women and 16 men; mean age, 46 years) had a total of 22 patients. Twelve patients were free of any trauma history. In the Borgess classification, type I dissections have intact intima (IA: with persistent anterograde flow, IB: completely occluded) and type II dissections have an intimal tear (IIA: with side wall aneurysm, IIB: clear intimal flap and aneurysmal dilatation). All endovascular treatment was performed when the diffusion image and patient symptoms were mismatched.
Results
22 dissected carotid arteries were found which were performed balloon angioplasty and stent placement. 8 (36.4%) were type IA, 7 (31.8%) were type IB, 5 (22.7%) were type IIA and 2 (9.1%) were type IIB. Initial mean NIHSS was 1 (confidence interval: 0-6) and occurred in 10 patients in association with trauma. 19 (86.4%) patients were able to live independently on 90 days, and hemorrhagic complication occurred in 4 (22.7%) patients after the endovascular treatment.
Conclusions
Endovascular treatment for selective patients with carotid artery dissection associated with ischemic stroke is a safe and acceptable treatment strategy with good clinical outcomes.
EFFECT OF PLGA- BASED ENCAPSULATED TPA NANOPARTICLES- MEDIATED ULTRASOUND- GUIDED COMBINED SONOTHROMBOLYSIS AND SONOPORATION THERAPY ON ATHEROTHROMBOTIC STENOSIS
Abstract
Background and Aims
Thrombus formation on a disrupted atherosclerotic plaque is a key event that leads to atherothrombosis. The aim of this study was to generate a rabbit carotid artery model of atherothrombotic stenosis with morphological similarities to the human disease and the subsequent assessment of the reliability of B- mode ultrasound- guided combined sonothrombolysis and sonoporation therapy accompanied by PLGA- based encapsulated tPA nanoparticles administration in this model.
Methods
Briefly, New Zealand white rabbits were submitted to carotid artery atherothrombotic stenosis by primary balloon injury followed 1.5% cholesterol- rich diet injury for 12 weeks and finally perivascularly severe cold injury. Then treatment group underwent pulsed- low level focused ultrasound ( F= 1.2 MHz, P= 5 W, PD= 300 ms) combined sonothrombolysis and sonoporation therapy accompanied by simultaneously PLGA - based encapsulated tPA nanoparticles (0.8 mg/kg) administration, wherein diagnostic B- mode ultrasound is combined with therapy system, with a goal of increased safety.
Results
Results from color Doppler and B-mode ultrasonography and histopathology, showed a significant reduction in the mean value for blood mean velocity, percentage of luminal cross-sectional area of stenosis and thrombus content and a significant increase in the mean value for blood volume flow at the stenotic region in the treatment group compared with the other groups (p<0.05).
Conclusions
Enhanced sonoporation effect of focused ultrasound, induced by inertial cavitation effect of collapsed capsules, accompanied by thrombolysis effect of ultrasound, can cause to enhance the anti-thrombotic effect of tPA and significantly reduce the thrombus content and dilate the luminal cross sectional area of stenosis.
RISK OF CAROTID ARTERY RESTENOSIS AFTER CAROTID ARTERY STENTING: LONG-TERM FOLLOW-UP RESULTS
Abstract
Background and Aims
The risk factors associated with long-term outcome including in-stent restenosis after carotid artery angioplasty with stenting (CAS) is unclear. We aimed to investigate the incidence and risk factors of in-stent restenosis after CAS and to compare those between symptomatic and asymptomatic carotid artery stenosis.
Methods
From January 2013 to December 2018, patients with symptomatic stenosis (more than 50%) and asymptomatic stenosis (more than 70%) of carotid artery were included and treated with CAS. Imaging outcomes using carotid duplex ultrasound were followed up. To define the in-stent restenosis (at least 50%), we used a cutoff for peak systolic velocity (PSV) in the internal carotid artery (ICA) greater than 125 cm/s or ratios of PSV of the ICA to common carotid artery greater than 2.0. These parameters were compared among patients with asymptomatic and symptomatic carotid artery stenosis. Risk factors associated with in-stent restenosis were evaluated.
Results
Of 190 patients, 123 patients with symptomatic carotid artery stenosis and 67 patients with asymptomatic carotid artery stenosis were included. Patients were followed up by ultrasound for a median of 37 months (IQR 19.75 to 70.00). Kaplan-Meier analysis showed a significant difference in the rate of in-stent restenosis after CAS between symptomatic and asymptomatic carotid artery stenosis. Increased pre-procedural PSV of ICA was significantly associated factor for in-stent restenosis after CAS in patients with symptomatic carotid artery stenosis (OR: 1.004, 95% CI 1.000 to 1.007; p=0.045).
Conclusions
In-stent restenosis after CAS frequently showed in patients with symptomatic carotid artery stenosis and associated with increased pre-procedural ICA PSV.
CAROTID STENTING WITH CONTRALATERAL TOTAL OCCLUSION
Abstract
Background and Aims
Contralateral carotid stenosis has impact on outcome of carotid stenting. Objective of this study to observe the outcome of carotid stenting without protection device in patients with symptomatic carotid stenosis with contralateral carotid occlusion
Methods
ThisProspective longitudinal Study was conducted with 14ischemic stroke patients with carotid artery stenosis with contralateral carotid artery complete occlusionin a university hospital of Bangladesh from November 2020 toMarch 2022.The incidence of strokeand otherscomplications during periprocedural period following carotid artery stenting and subsequent 30 days follow up period were recorded.Functional outcome was measured by mRS at day 30.
Results
In this study, among 14 patients, severe stenosis was 64.2% and carotid artery near total occlusion was 14.2%.Technical success rate was 100%. There was no recurrence of periprocedural stroke.Hemodynamic instability (HI) was 35.7% and no other periprocedural complication were developed.Functional outcome measured by modified Rankin scale Scores (mRS) at day 30 was good (100%).
Conclusions
There is a controversy that contralateral carotid occlusion has impact on outcome of carotid stenting procedure. This study observes there was no recurrence of stroke following stenting in patients with contralateral carotid occlusion
ANGIOPLASTIC STENOSIS IN SPONTANEOUS BILATERAL CAROTIC ARTERY DISSECTION
Abstract
Background and Aims
Internal carotid artery dissection is one of ischemic stroke causes at young age, especially less than 45 years old. Invasive angiography method with cerebral Digital Subtraction Angiography (DSA) has become the gold standard for diagnosis.
Methods
Case report A 28-years-old woman experienced sudden right limb weakness, drooped face to the left, and was unable to speak. Examination revealed normal blood pressure and motor aphasia. Blood examination revealed D-dimer of 1068 ng/dl. A plain head CT-scan revealed infarct in left cerebral hemisphere. TCD (transcranial Doppler) revealed partial stenosis of internal carotid artery (ICA). Head CT-angiography revealed bilateral carotid artery stenosis. Cerebral DSA showed flame-shaped appearance on the left ICA and pseudoaneurysm on the right ICA supporting the appearance of bilateral ICA dissection. The patient underwent stenting angioplasty on bilateral ICA and was given aspirin 1x80 mg and clopidogrel 1x75 mg.
Results
Arterial dissection occurs because of tear in the inner wall of endothelium and blood penetrates forming an intramural hematoma. Most arterial dissections occur spontaneously and are associated with connective tissue disorders, cystic medial necrosis (CMN), and intimal fibroplasia. Fibromuscular dysplasia has been reported more frequently in bilateral internal carotid artery dissections. DSA has become the gold standard in diagnosis and may reveal narrow and irregular vessel lumen, ICA occlusion, double lumen, pseudoaneurysm, intima flap, or string sign.
Conclusions
Spontaneous dissection of the carotid artery can occur at young age. Gold standard vascular examination is cerebral DSA. Stenting with angioplasty is performed for recanalization to inhibit the progression of severe stroke.
POOR NEUROLOGICAL DEFICIT WAS AN INDEPENDENT 30-DAY RISK FACTOR IN SYMPTOMATIC CAROTID STENOSIS AFTER CEA WITH SELECTIVE SHUNTING
Abstract
Background and Aims
The effificacy of carotid endarterectomy (CEA) depends on the detection and control of perioperative risk factors. We aimed to analyze the association between preoperative neurological defificit and the 30-day risk of major adverse cardiovascular events (MACEs) in CEA with selective shunting for symptomatic carotid stenosis.
Methods
We assessed 653 patients who underwent CEA with selective shunting for symptomatic carotid stenosis between August 2011 and August 2019. The primary outcomes of the study were the occurrence of MACEs, all-cause mortality, and myocardial infarction during the perioperative period after CEA. Multivariable logistic regression models were used to estimate the association between preoperative modifified Rankin Scale (mRS) and the 30-day risk of MACEs.
Results
In univariate logistic regression, histories of coronary artery disease (odds ratio (OR), 2.57 [95% confifidence interval (CI), 1.04-6.34]), a severe contralateral carotid stenosis or occlusion (OR, 4.52 [95% CI, 1.84-11.11]), and a poor neurological defificit (mRS 3 versus mRS < 3: OR, 3.78 [95% CI, 1.21-11.82]) were associated with higher primary outcome rates. In the multivariable regression analysis, poor neurological defificit was associated with a higher risk of the MACEs within 30 days (mRS 3 versus mRS < 3: 11.1% vs. 2.0%, adjusted OR 5.70 [95% CI, 1.50-21.60]). The interaction analysis revealed no interactive role in the association between neurological defificit and 30-day risk of MACEs.
Conclusions
Poor neurological defificit was an independent risk factor associated with the 30-day risk of MACEs in symptomatic patients who underwent CEA with selective shunting. The decision to perform surgery should be made after careful consideration.
SEVERE CONTRALATERAL CAROTID STENOSIS OR OCCLUSION DRIVE 30-DAY RISK AFTER CAROTID ENDARTERECTOMY
Abstract
Background and Aims
It is controversial whether patients with severe contralateral carotid stenosis or occlusion (SCSO) can benefit from carotid endarterectomy surgery. This study aimed to estimate the SCSO effects on early outcomes after carotid endarterectomy with selective shunting.
Methods
Between August 2011 and October 2019, a total of 617 patients who underwent carotid endarterectomy with selective shunting were analyzed. Of these patients, 116 were categorized into an SCSO group while the rest were assigned to the non-SCSO group. Primary study outcomes were the occurrence of major adverse events, defined as stroke, all cause mortality, and myocardial infarction during the perioperative period after carotid endarterectomy. Traditional multivariable logistic regression model and logistic regression model adjusted for propensity scores were used to estimate the SCSO effects on primary outcomes. Interaction and stratified analyses were conducted according to age, sex, comorbidities (hypertension, diabetes), preoperative neurological deficit, preoperative symptoms, and shunt use.
Results
Overall major adverse events rate within 30 days was 2.5%. Major adverse events rates in SCSO and non-SCSO groups were 9.5% and 1.6%, respectively. This difference was statistically significant (p < 0.001). In multivariable regression analysis, patients with SCSO had a higher risk of major adverse events (non-SCSO vs. SCSO: aOR 5.05 [95% CI, 1.78–14.55]). In 342 propensity score matched patients, results were consistent (propensity score: aOR, 3.78 [95% CI, 1.13–12.64]).
Conclusions
SCSO is an independent predictor of 30-day major adverse events. Whether these patients with SCSO are suitable for carotid endarterectomy should be carefully considered.