Carotid interventions

Foreword......Page 8
Preface......Page 10
Contents......Page 14
Contributors......Page 18
1 Neurovascular Anatomy for Carotid Angiography and Interventions......Page 22
Aortic Arch Anatomy and Its Variants......Page 23
Intracranial Angiography......Page 25
Anterior Cerebral Artery......Page 26
Middle Cerebral Artery......Page 28
Pathologic Findings......Page 29
References......Page 34
2 Aortic Arch Classification into Segments Facilitates Carotid Stenting......Page 36
Arch Branch Access Is Determined by Segment of Origin (\"Surf and Turf\" Classification)......Page 38
Optimal Arch Aortogram......Page 39
Other Access Options......Page 40
Technical Tips......Page 42
References......Page 43
3 Equipment, Inventory, and Facilities for Carotid Angioplasty and Stenting......Page 44
Equipment......Page 45
Inventory......Page 47
References......Page 52
Role of Carotid Arteriography in Clinical Vascular Practice......Page 54
Clinical Evaluation of the Patient Before Carotid Arteriography......Page 55
Arterial Access for Carotid Arteriography......Page 58
Access Sheath for Carotid Arteriography......Page 59
Guidewires and Catheters for Carotid Arteriography......Page 60
Handling of Guidewires and Catheters During Carotid Arteriography......Page 62
Arch Aortography......Page 63
Selective Cerebral Catheters......Page 65
Selective Catheterization of Aortic Arch Branches with Simple Curve Catheters......Page 69
Selective Catheterization of Aortic Arch Branches with Complex Curve Catheters......Page 76
Performing Selective Carotid Arteriography......Page 79
Carotid Arteriography Sequences......Page 80
Protocol for Carotid and Cerebral Arteriography......Page 82
Technical Tips for Carotid Arteriography......Page 83
Complications of Carotid Arteriography......Page 84
Completion Arteriography After Carotid Endarterectomy......Page 86
Qualifications to Perform Carotid Arteriography......Page 87
References......Page 88
More About Cerebral Catheters......Page 90
Intracranial Angiography......Page 93
What To Do When Intracranial Pathology is Present......Page 101
Cerebral Aneurysm......Page 104
Intracranial Occlusive Disease......Page 108
Angiographic Considerations for Planning Carotid Stent Placement......Page 109
References......Page 111
Assess the Anatomy......Page 114
Supplies for Arch Access......Page 115
Placement of Access for Carotid Intervention......Page 118
Alternate Methods of Sheath Placement......Page 123
Approach to the Arch......Page 125
Troubleshooting the Access......Page 127
Tips for Carotid Artery Access for Intervention......Page 129
References......Page 130
7 Patient Selection for Carotid Interventions: Anatomical and Comorbid Factors......Page 132
Patient Comorbidities......Page 133
Local Arterial Access......Page 134
Aortic Arch Anatomy and Pathology......Page 135
Carotid Artery Anatomy and Pathology......Page 137
References......Page 139
8 Periprocedural Management of Patients Undergoing Carotid Interventions......Page 140
Strategy for Anticoagulation and Antiplatelet Agents......Page 141
Strategy for Procedure-Related Hemodynamic Changes......Page 143
Strategy for Management of Arterial Access Sites......Page 145
After the Case......Page 146
Technical Tips......Page 147
References......Page 148
Sheath Access and Guidewire Positioning......Page 152
Carotid Angioplasty and Stent Placement......Page 156
Completion......Page 158
References......Page 159
10 Technique of Carotid Bifurcation Angioplasty and Stent Placement: How I Do It......Page 162
Preprocedure Preparation......Page 164
Procedural Details......Page 165
Conclusion......Page 169
11 Technique of Carotid Bifurcation Angioplasty and Stent Placement: How I Do ItUntitled......Page 170
Preprocedural Evaluation......Page 171
Access......Page 172
Selective Common Carotid Cannulation......Page 173
Common Carotid Sheath Access......Page 176
Crossing the Internal Carotid Artery Stenosis, Angioplasty, and Stenting......Page 177
Completion Angiogram......Page 181
Postoperative Care and Follow-up......Page 184
References......Page 185
12 Cerebral Protection Devices for Carotid Stenting: Technique and Results......Page 186
Types of Cerebral Protection Devices and Techniques for Use......Page 189
Conclusions......Page 192
References......Page 193
Distal Occlusion Devices......Page 194
Distal Filter Devices......Page 197
Proximal Occlusion Devices......Page 204
Conclusion......Page 206
References......Page 207
What Are the Mechanisms of Perioperative Stroke?......Page 208
How Is a Perioperative Neurological Event Managed?......Page 211
How Is Intracranial Hemorrhage Recognized?......Page 216
What Is the Rationale for Catheter-Based Neurorescue Therapy?......Page 217
What Are the Results of Neurorescue Therapy for Stroke During Carotid Stent Placement?......Page 219
Angiographic Assessment of the Patient with Acute Neurological Deficit During Carotid Stenting......Page 220
How Can You Tell the Clinical Importance of an Intracranial Occlusion?......Page 221
What Are the Indications for Rescue Therapy During Carotid Stenting?......Page 223
Technique of Catheter-Based Neurorescue in the Cerebral Arteries......Page 224
References......Page 226
Patient Selection......Page 230
Carotid Arteriography......Page 232
Carotid Artery Sheath Access......Page 233
Perioperative Management......Page 236
Carotid Bifurcation Angioplasty and Stenting......Page 237
Cerebral Protection Devices......Page 240
16 Summary of Results of Carotid Bifurcation Angioplasty and Stenting......Page 244
Carotid Endarterectomy......Page 245
Carotid Angioplasty and Stenting......Page 250
Conclusion......Page 258
References......Page 259
Approach to Lesions of the Common Carotid and Innominate Arteries......Page 266
Supplies......Page 268
Technique......Page 270
Simultaneous Combined Carotid Endarterectomy and Retrograde Balloon Angioplasty and Stent of Proximal Stenosis of the Innominate or Common Carotid Artery......Page 275
Open Surgery vs. Endovascular Approach to Stenoses of the Innominate and Common Carotid Arteries......Page 277
References......Page 278
18 Balloon Angioplasty and Stent Placement in the Subclavian Arteries: Technique and Results......Page 280
Philosophy of Intervention......Page 282
Preoperative Evaluation......Page 283
Technique......Page 284
Results......Page 291
References......Page 293
Systemic Complications......Page 296
Complications Involving the Stent Site and the Surrounding Vasculature......Page 297
Neurological and End Organ Complications......Page 300
What Is the Learning Curve for Carotid Stenting?......Page 301
Complications of Cerebral Protection Devices......Page 302
References......Page 303
What Is the Rationale for a Carotid Stent Program?......Page 306
Who Is Responsible for Patient Care?......Page 307
What Might Be Included in a Carotid Stent Program?......Page 308
Training......Page 309
Hospital Privileges to Perform Carotid Interventions......Page 310
Proctoring......Page 312
Dealing with Endovascular Realities......Page 313
References......Page 315
How Did We Get Here?......Page 316
So Why Is Carotid Stent Placement Here to Stay?......Page 318
Technical Aspects of the Carotid Stent Procedure: Developments in Progress......Page 320
What Will Happen to the Trials?......Page 323
What Will the Management of Carotid Stenosis Look Like in 5-10 Years?......Page 324
References......Page 325
Appendix A. Inventory for Carotid Access and Interventions from Vascular Therapy at Kaiser Hawaii......Page 328
Appendix B. Comparison of Monorail and Coaxial Systems......Page 330
Appendix C. National Institute of Health Stroke Scale......Page 331
Appendix D. Conversion Table for French Sizes......Page 336
Index......Page 338
Back cover......Page 348