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<meta name="DC.Title" content="The Influence of Carotid Artery Catheterization Technique on the Incidence of Thromboembolism during Carotid Artery Stenting" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2141" />
<meta name="DC.Date" content="2010-10-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Thromboembolic events related to CAS continue to be the main limitation to the widespread use of this technique as a first-line treatment for carotid occlusive disease. Our aim was to evaluate thromboembolism during CAS using DWI for catheterization techniques of the carotid artery.

MATERIALS AND METHODS: Thirty-two consecutive patients with symptomatic carotid stenosis underwent CAS involving 1 of 2 carotid artery catheterization techniques: One used a 7F or 8F catheter (group 1, n = 16) and the other used a coaxial system in which a 7F or 8F catheter was used in conjunction with a 4F or 5F catheter (group 2, n = 16). DWI was performed before and after CAS. Clinical variables, the number and location of NES on DWI after CAS, were compared between the 2 groups.

RESULTS: NES on DWI occurred in 53% of all patients. The incidence of NES was significantly higher in patients 65 years of age and older versus those younger than 65 years of age ( P = .013). All NESs were asymptomatic, and their rate of occurrence did not differ significantly between groups 1 and 2. The incidence of NES in the other territories that were outside that of the treated carotid artery ( P = .004) and the incidence of multiple NESs ( P = .04) were significantly higher in group 1.

CONCLUSIONS: NES in the other territories mainly arises from the atherosclerotic aortic arch and arch vessels during the manipulation of endoluminal devices. The carotid artery catheterization technique using the coaxial system with a 7F or 8F catheter in conjunction with a 4F or 5F catheter reduced the incidence of NES in the other territories.

ACA
:   anterior cerebral artery
ACT
:   activated clotting time
CAS
:   carotid artery stenting
CCA
:   common carotid artery
CEA
:   carotid endarterectomy
DWI
:   diffusion-weighted imaging
ICA
:   internal carotid artery
NES
:   new embolic signal" />
<meta name="DC.Contributor" content="H.J. Kim" />
<meta name="DC.Contributor" content="H.J. Lee" />
<meta name="DC.Contributor" content="J.H. Yang" />
<meta name="DC.Contributor" content="I.S. Yeo" />
<meta name="DC.Contributor" content="J.S. Yi" />
<meta name="DC.Contributor" content="I.W. Lee" />
<meta name="DC.Contributor" content="S.B. Lee" />
<meta name="DC.Contributor" content="S.Y. Ryu" />
<meta name="DC.Contributor" content="J.K. Kim" />
<meta name="DC.Contributor" content="P.S. Yang" />
<meta name="article:published_time" content="2010-10-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="The Influence of Carotid Artery Catheterization Technique on the Incidence of Thromboembolism during Carotid Artery Stenting" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Thromboembolic events related to CAS continue to be the main limitation to the widespread use of this technique as a first-line treatment for carotid occlusive disease. Our aim was to evaluate thromboembolism during CAS using DWI for catheterization techniques of the carotid artery.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Thirty-two consecutive patients with symptomatic carotid stenosis underwent CAS involving 1 of 2 carotid artery catheterization techniques: One used a 7F or 8F catheter (group 1, &lt;i&gt;n&lt;/i&gt; = 16) and the other used a coaxial system in which a 7F or 8F catheter was used in conjunction with a 4F or 5F catheter (group 2, &lt;i&gt;n&lt;/i&gt; = 16). DWI was performed before and after CAS. Clinical variables, the number and location of NES on DWI after CAS, were compared between the 2 groups.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;NES on DWI occurred in 53% of all patients. The incidence of NES was significantly higher in patients 65 years of age and older versus those younger than 65 years of age (&lt;i&gt;P&lt;/i&gt; = .013). All NESs were asymptomatic, and their rate of occurrence did not differ significantly between groups 1 and 2. The incidence of NES in the other territories that were outside that of the treated carotid artery (&lt;i&gt;P&lt;/i&gt; = .004) and the incidence of multiple NESs (&lt;i&gt;P&lt;/i&gt; = .04) were significantly higher in group 1.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;NES in the other territories mainly arises from the atherosclerotic aortic arch and arch vessels during the manipulation of endoluminal devices. The carotid artery catheterization technique using the coaxial system with a 7F or 8F catheter in conjunction with a 4F or 5F catheter reduced the incidence of NES in the other territories.&lt;/p&gt;" />
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<meta name="twitter:title" content="The Influence of Carotid Artery Catheterization Technique on the Incidence of Thromboembolism during Carotid Artery Stenting" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Thromboembolic events related to CAS continue to be the main limitation to the widespread use of this technique as a first-line treatment for carotid occlusive disease. Our aim was to evaluate thromboembolism during CAS using DWI for catheterization techniques of the carotid artery.

MATERIALS AND METHODS: Thirty-two consecutive patients with symptomatic carotid stenosis underwent CAS involving 1 of 2 carotid artery catheterization techniques: One used a 7F or 8F catheter (group 1, n = 16) and the other used a coaxial system in which a 7F or 8F catheter was used in conjunction with a 4F or 5F catheter (group 2, n = 16). DWI was performed before and after CAS. Clinical variables, the number and location of NES on DWI after CAS, were compared between the 2 groups.

RESULTS: NES on DWI occurred in 53% of all patients. The incidence of NES was significantly higher in patients 65 years of age and older versus those younger than 65 years of age ( P = .013). All NESs were asymptomatic, and their rate of occurrence did not differ significantly between groups 1 and 2. The incidence of NES in the other territories that were outside that of the treated carotid artery ( P = .004) and the incidence of multiple NESs ( P = .04) were significantly higher in group 1.

CONCLUSIONS: NES in the other territories mainly arises from the atherosclerotic aortic arch and arch vessels during the manipulation of endoluminal devices. The carotid artery catheterization technique using the coaxial system with a 7F or 8F catheter in conjunction with a 4F or 5F catheter reduced the incidence of NES in the other territories.

ACA
:   anterior cerebral artery
ACT
:   activated clotting time
CAS
:   carotid artery stenting
CCA
:   common carotid artery
CEA
:   carotid endarterectomy
DWI
:   diffusion-weighted imaging
ICA
:   internal carotid artery
NES
:   new embolic signal" />
<meta name="og-title" property="og:title" content="The Influence of Carotid Artery Catheterization Technique on the Incidence of Thromboembolism during Carotid Artery Stenting" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/9/1732" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Thromboembolic events related to CAS continue to be the main limitation to the widespread use of this technique as a first-line treatment for carotid occlusive disease. Our aim was to evaluate thromboembolism during CAS using DWI for catheterization techniques of the carotid artery.

MATERIALS AND METHODS: Thirty-two consecutive patients with symptomatic carotid stenosis underwent CAS involving 1 of 2 carotid artery catheterization techniques: One used a 7F or 8F catheter (group 1, n = 16) and the other used a coaxial system in which a 7F or 8F catheter was used in conjunction with a 4F or 5F catheter (group 2, n = 16). DWI was performed before and after CAS. Clinical variables, the number and location of NES on DWI after CAS, were compared between the 2 groups.

RESULTS: NES on DWI occurred in 53% of all patients. The incidence of NES was significantly higher in patients 65 years of age and older versus those younger than 65 years of age ( P = .013). All NESs were asymptomatic, and their rate of occurrence did not differ significantly between groups 1 and 2. The incidence of NES in the other territories that were outside that of the treated carotid artery ( P = .004) and the incidence of multiple NESs ( P = .04) were significantly higher in group 1.

CONCLUSIONS: NES in the other territories mainly arises from the atherosclerotic aortic arch and arch vessels during the manipulation of endoluminal devices. The carotid artery catheterization technique using the coaxial system with a 7F or 8F catheter in conjunction with a 4F or 5F catheter reduced the incidence of NES in the other territories.

ACA
:   anterior cerebral artery
ACT
:   activated clotting time
CAS
:   carotid artery stenting
CCA
:   common carotid artery
CEA
:   carotid endarterectomy
DWI
:   diffusion-weighted imaging
ICA
:   internal carotid artery
NES
:   new embolic signal" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node9840--5" data-node-nid="9840" id="top-node-9840--61495563003" data-pisa="ajnr;31/9/1732" data-pisa-master="ajnr;ajnr.A2141" data-apath="/ajnr/31/9/1732.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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      <h1 class="highwire-cite-title" id="page-title">The Influence of Carotid Artery Catheterization Technique on the Incidence of Thromboembolism during Carotid Artery Stenting</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">H.J. Kim</span>, <span class="highwire-citation-author" data-delta="1">H.J. Lee</span>, <span class="highwire-citation-author" data-delta="2">J.H. Yang</span>, <span class="highwire-citation-author" data-delta="3">I.S. Yeo</span>, <span class="highwire-citation-author" data-delta="4">J.S. Yi</span>, <span class="highwire-citation-author" data-delta="5">I.W. Lee</span>, <span class="highwire-citation-author" data-delta="6">S.B. Lee</span>, <span class="highwire-citation-author" data-delta="7">S.Y. Ryu</span>, <span class="highwire-citation-author" data-delta="8">J.K. Kim</span> and <span class="highwire-citation-author" data-delta="9">P.S. Yang</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">October 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1732-1736; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2141 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9840--61495563003" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">H.J. Kim </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.J.%2BKim%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kim%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AH.J.%2BKim%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">H.J. Lee </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.J.%2BLee%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lee%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AH.J.%2BLee%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">J.H. 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<p id="p-4"><strong>BACKGROUND AND PURPOSE:</strong> Thromboembolic events related to CAS continue to be the main limitation to the widespread use of this technique as a first-line treatment for carotid occlusive disease. Our aim was to evaluate thromboembolism during CAS using DWI for catheterization techniques of the carotid artery.</p>
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<p id="p-5"><strong>MATERIALS AND METHODS:</strong> Thirty-two consecutive patients with symptomatic carotid stenosis underwent CAS involving 1 of 2 carotid artery catheterization techniques: One used a 7F or 8F catheter (group 1, <em>n</em> = 16) and the other used a coaxial system in which a 7F or 8F catheter was used in conjunction with a 4F or 5F catheter (group 2, <em>n</em> = 16). DWI was performed before and after CAS. Clinical variables, the number and location of NES on DWI after CAS, were compared between the 2 groups.</p>
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<p id="p-6"><strong>RESULTS:</strong> NES on DWI occurred in 53% of all patients. The incidence of NES was significantly higher in patients 65 years of age and older versus those younger than 65 years of age (<em>P</em> = .013). All NESs were asymptomatic, and their rate of occurrence did not differ significantly between groups 1 and 2. The incidence of NES in the other territories that were outside that of the treated carotid artery (<em>P</em> = .004) and the incidence of multiple NESs (<em>P</em> = .04) were significantly higher in group 1.</p>
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<p id="p-7"><strong>CONCLUSIONS:</strong> NES in the other territories mainly arises from the atherosclerotic aortic arch and arch vessels during the manipulation of endoluminal devices. The carotid artery catheterization technique using the coaxial system with a 7F or 8F catheter in conjunction with a 4F or 5F catheter reduced the incidence of NES in the other territories.</p>
</div></div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">ACA<span class="def-item-dt-sep"></span></dt><dd>anterior cerebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">ACT<span class="def-item-dt-sep"></span></dt><dd>activated clotting time<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">CAS<span class="def-item-dt-sep"></span></dt><dd>carotid artery stenting<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">CCA<span class="def-item-dt-sep"></span></dt><dd>common carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">CEA<span class="def-item-dt-sep"></span></dt><dd>carotid endarterectomy<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">DWI<span class="def-item-dt-sep"></span></dt><dd>diffusion-weighted imaging<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">ICA<span class="def-item-dt-sep"></span></dt><dd>internal carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">NES<span class="def-item-dt-sep"></span></dt><dd>new embolic signal</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><div class="license" id="license-1"><p id="p-3">Indicates open access to non-subscribers at <a href="http://www.ajnr.org">www.ajnr.org</a></p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/9/1732.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 31</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 9 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Oct 2010 </div></div>
      
      
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      <div class="highwire-cite-title">The Influence of Carotid Artery Catheterization Technique on the Incidence of Thromboembolism during Carotid Artery Stenting</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">H.J.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">H.J.</span> <span class="nlm-surname">Lee</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">J.H.</span> <span class="nlm-surname">Yang</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">I.S.</span> <span class="nlm-surname">Yeo</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">J.S.</span> <span class="nlm-surname">Yi</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">I.W.</span> <span class="nlm-surname">Lee</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">S.B.</span> <span class="nlm-surname">Lee</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">S.Y.</span> <span class="nlm-surname">Ryu</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">J.K.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">P.S.</span> <span class="nlm-surname">Yang</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1732-1736; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2141 </span></div>
  
  
  
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      <div class="highwire-cite-title">The Influence of Carotid Artery Catheterization Technique on the Incidence of Thromboembolism during Carotid Artery Stenting</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">H.J.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">H.J.</span> <span class="nlm-surname">Lee</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">J.H.</span> <span class="nlm-surname">Yang</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">I.S.</span> <span class="nlm-surname">Yeo</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">J.S.</span> <span class="nlm-surname">Yi</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">I.W.</span> <span class="nlm-surname">Lee</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">S.B.</span> <span class="nlm-surname">Lee</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">S.Y.</span> <span class="nlm-surname">Ryu</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">J.K.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">P.S.</span> <span class="nlm-surname">Yang</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1732-1736; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2141 </span></div>
  
  
  
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