S. Sacca - Academia.edu (original) (raw)
Papers by S. Sacca
JACC: Cardiovascular Interventions, 2015
A 62-year-old man was admitted for acute transient ischemic attack due to spontaneous dissection ... more A 62-year-old man was admitted for acute transient ischemic attack due to spontaneous dissection of proximal left internal carotid artery (ICA) (Figure 1A). Initially managed conservatively, 72 h later, the patient had a massive left hemispheric stroke (National Institutes of Health Stroke Scale (NIHSS) score of 22). After a discussion by the brain team (neurologist, vascular surgeon, FI GURE 1 Pre-Operative Imaging (A) Computed tomography scan at admission and (B, C) urgent carotid artery angiography at 2 h after in-hospital stroke, showing artery dissection with slow antegrade flow (arrows).
Stroke, 2002
Background and Purpose — Histopathologic analysis was performed to better understand quantity, pa... more Background and Purpose — Histopathologic analysis was performed to better understand quantity, particle size, and composition of embolized debris collected in protection filters during carotid artery stent implantation. Methods — Elective carotid stent implantation with the use of a distal filter protection was attempted in 38 consecutive lesions (36 patients) of the internal carotid artery presenting >70% diameter stenosis (mean, 82.1±11.1%). Mean age of the patients was 70.7±7.7 years; 75% were men, and 50% of patients had previous neurological symptoms. Results — In 37 lesions (97.4%) it was possible to position the filter device, and in all lesions a stent was successfully implanted. The only complication occurring in the hospital and during the 30-day follow-up was 1 death due to acute myocardial infarction. Neurological sequelae did not occur. Histomorphometric analysis was performed on the filters. Presence of debris was detected in 83.7% of filters. The mean surface area ...
JACC: Cardiovascular Interventions, 2010
Objectives The aim of this study was to assess the safety and effectiveness of carotid artery ste... more Objectives The aim of this study was to assess the safety and effectiveness of carotid artery stenting (CAS) with proximal cerebral protection in patients showing string sign at carotid angiography. Background Presence of string sign is a well-known factor for adverse events in patients with severe carotid artery disease undergoing CAS. Methods We used retrospective analysis of a cohort of patients who underwent carotid angiography with the intention to undergo carotid stenting and had angiographically documented string sign in the target lesion. Results From October 2006 to August 2007, 25 patients (21 men and 4 women, mean age 70.9 Ϯ 8.7 years) presented with string sign during carotid angiography. This was 6.0% of a total of 416 patients studied during the time of the study. Twenty patients (80.0%) were symptomatic, and 5 (20.0%) were asymptomatic. Carotid artery stenting was performed successively in all patients. Proximal cerebral protection was applied in all but 1 patient. The 30-day death/stroke rate was 0%. At 12-month follow-up neurological events did not occur; 1 patient developed a nonfatal myocardial infarction, and another patient died from noncardiac cause. The 12-month death/ stroke rate was 4.0%. Conclusions Carotid stenting under proximal cerebral protection seems to be a feasible and safe procedure to manage patients with severe carotid stenosis in presence of angiographic string sign. Further prospective trials are required to prove efficacy of CAS in larger study populations.
Circulation, 2001
Background —Distal embolization of debris during percutaneous carotid artery stenting may result ... more Background —Distal embolization of debris during percutaneous carotid artery stenting may result in neurological deficit. Filter devices for cerebral protection potentially reduce the risk of embolization. Methods and Results —Elective carotid stent implantation using 3 different types of distal filter protection devices was attempted in 88 consecutive lesions (84 patients) in the internal carotid artery that had >70% diameter stenosis (mean, 78.7±10.7%). Procedures were performed in 3 different centers. The mean age of the patients was 69±8 years, 75% were men, and 35.7% had neurological symptoms. In 86 lesions, a stent was successfully implanted (97.7%). In 83 of these 86 procedures (96.5%), it was possible to position a filter device. In 53% of filters, there was macroscopic evidence of debris. Collected material consisted of lipid-rich macrophages, fibrin material, and cholesterol clefts. Neurological complications during the procedure, in the hospital, and at 30 days of clin...
Cardiovascular Revascularization Medicine, 2008
CardioVascular and Interventional Radiology, 2013
Purpose To evaluate the perioperative safety and midterm prognosis (B12 months) of HydroSoft coil... more Purpose To evaluate the perioperative safety and midterm prognosis (B12 months) of HydroSoft coils in treating ruptured aneurysms at the anterior circulation compared with bare platinum coils. Materials and Methods Patients with aneurysmal subarachnoid hemorrhages admitted to our hospital between January 2009 and March 2012 were retrospectively analyzed. According to strict inclusion and exclusion criteria, cases were selected and classified into two groups: In group A, HydroSoft coils were used as the primary filling coils (C40 % of total coil length); in group B, only bare platinum coils were used. Cases in both groups were all treated with stent-assistance. A comparison between the two groups was performed for periprocedural complications as well as immediate and mid-term outcomes. The stents used included Enterprise, Neuroform, and Solitaire. Results Fifty-six aneurysms were in group A patients, and 68 aneurysms were in group B patients. Compared with group B, group A did not have increased incidence of complications but had greater packing attenuation (44.5 ± 8.8-29.8 ± 9.1 %, t = 2.577, P = 0.014) and increased initial complete occlusion rates (63-44 %, v 2 = 4.161, P = 0.041). Radiologic follow-up were performed in 46 patients from group A and 51 patients from group B. Complete occlusion rates at follow-up were significantly greater in group A than in group B (89.1-70.6 %, v 2 = 5.08, P = 0.043); the difference in recanalization rates were statistically insignificant between the groups (6.5-5.9 %, P = 1.000). Conclusion HydroSoft coils proved safe during the periprocedural period and provided greater initial complete occlusion rates, greater packing density, and better followup results compared with bare platinum coils.
The Annals of Thoracic Surgery, 2006
Objectives In an attempt to reduce post-operative events we investigated a new therapeutic strate... more Objectives In an attempt to reduce post-operative events we investigated a new therapeutic strategy consisting of a simultaneous hybrid revascularization by carotid artery stenting (CAS), immediately followed by an on-pump coronary artery bypass graft (CABG).
JACC: Cardiovascular Interventions, 2010
Objectives The aim of this study was to assess the safety and effectiveness of carotid artery ste... more Objectives The aim of this study was to assess the safety and effectiveness of carotid artery stenting (CAS) with proximal cerebral protection in patients showing string sign at carotid angiography.
JACC: Cardiovascular Interventions, 2015
A 62-year-old man was admitted for acute transient ischemic attack due to spontaneous dissection ... more A 62-year-old man was admitted for acute transient ischemic attack due to spontaneous dissection of proximal left internal carotid artery (ICA) (Figure 1A). Initially managed conservatively, 72 h later, the patient had a massive left hemispheric stroke (National Institutes of Health Stroke Scale (NIHSS) score of 22). After a discussion by the brain team (neurologist, vascular surgeon, FI GURE 1 Pre-Operative Imaging (A) Computed tomography scan at admission and (B, C) urgent carotid artery angiography at 2 h after in-hospital stroke, showing artery dissection with slow antegrade flow (arrows).
Stroke, 2002
Background and Purpose — Histopathologic analysis was performed to better understand quantity, pa... more Background and Purpose — Histopathologic analysis was performed to better understand quantity, particle size, and composition of embolized debris collected in protection filters during carotid artery stent implantation. Methods — Elective carotid stent implantation with the use of a distal filter protection was attempted in 38 consecutive lesions (36 patients) of the internal carotid artery presenting >70% diameter stenosis (mean, 82.1±11.1%). Mean age of the patients was 70.7±7.7 years; 75% were men, and 50% of patients had previous neurological symptoms. Results — In 37 lesions (97.4%) it was possible to position the filter device, and in all lesions a stent was successfully implanted. The only complication occurring in the hospital and during the 30-day follow-up was 1 death due to acute myocardial infarction. Neurological sequelae did not occur. Histomorphometric analysis was performed on the filters. Presence of debris was detected in 83.7% of filters. The mean surface area ...
JACC: Cardiovascular Interventions, 2010
Objectives The aim of this study was to assess the safety and effectiveness of carotid artery ste... more Objectives The aim of this study was to assess the safety and effectiveness of carotid artery stenting (CAS) with proximal cerebral protection in patients showing string sign at carotid angiography. Background Presence of string sign is a well-known factor for adverse events in patients with severe carotid artery disease undergoing CAS. Methods We used retrospective analysis of a cohort of patients who underwent carotid angiography with the intention to undergo carotid stenting and had angiographically documented string sign in the target lesion. Results From October 2006 to August 2007, 25 patients (21 men and 4 women, mean age 70.9 Ϯ 8.7 years) presented with string sign during carotid angiography. This was 6.0% of a total of 416 patients studied during the time of the study. Twenty patients (80.0%) were symptomatic, and 5 (20.0%) were asymptomatic. Carotid artery stenting was performed successively in all patients. Proximal cerebral protection was applied in all but 1 patient. The 30-day death/stroke rate was 0%. At 12-month follow-up neurological events did not occur; 1 patient developed a nonfatal myocardial infarction, and another patient died from noncardiac cause. The 12-month death/ stroke rate was 4.0%. Conclusions Carotid stenting under proximal cerebral protection seems to be a feasible and safe procedure to manage patients with severe carotid stenosis in presence of angiographic string sign. Further prospective trials are required to prove efficacy of CAS in larger study populations.
Circulation, 2001
Background —Distal embolization of debris during percutaneous carotid artery stenting may result ... more Background —Distal embolization of debris during percutaneous carotid artery stenting may result in neurological deficit. Filter devices for cerebral protection potentially reduce the risk of embolization. Methods and Results —Elective carotid stent implantation using 3 different types of distal filter protection devices was attempted in 88 consecutive lesions (84 patients) in the internal carotid artery that had >70% diameter stenosis (mean, 78.7±10.7%). Procedures were performed in 3 different centers. The mean age of the patients was 69±8 years, 75% were men, and 35.7% had neurological symptoms. In 86 lesions, a stent was successfully implanted (97.7%). In 83 of these 86 procedures (96.5%), it was possible to position a filter device. In 53% of filters, there was macroscopic evidence of debris. Collected material consisted of lipid-rich macrophages, fibrin material, and cholesterol clefts. Neurological complications during the procedure, in the hospital, and at 30 days of clin...
Cardiovascular Revascularization Medicine, 2008
CardioVascular and Interventional Radiology, 2013
Purpose To evaluate the perioperative safety and midterm prognosis (B12 months) of HydroSoft coil... more Purpose To evaluate the perioperative safety and midterm prognosis (B12 months) of HydroSoft coils in treating ruptured aneurysms at the anterior circulation compared with bare platinum coils. Materials and Methods Patients with aneurysmal subarachnoid hemorrhages admitted to our hospital between January 2009 and March 2012 were retrospectively analyzed. According to strict inclusion and exclusion criteria, cases were selected and classified into two groups: In group A, HydroSoft coils were used as the primary filling coils (C40 % of total coil length); in group B, only bare platinum coils were used. Cases in both groups were all treated with stent-assistance. A comparison between the two groups was performed for periprocedural complications as well as immediate and mid-term outcomes. The stents used included Enterprise, Neuroform, and Solitaire. Results Fifty-six aneurysms were in group A patients, and 68 aneurysms were in group B patients. Compared with group B, group A did not have increased incidence of complications but had greater packing attenuation (44.5 ± 8.8-29.8 ± 9.1 %, t = 2.577, P = 0.014) and increased initial complete occlusion rates (63-44 %, v 2 = 4.161, P = 0.041). Radiologic follow-up were performed in 46 patients from group A and 51 patients from group B. Complete occlusion rates at follow-up were significantly greater in group A than in group B (89.1-70.6 %, v 2 = 5.08, P = 0.043); the difference in recanalization rates were statistically insignificant between the groups (6.5-5.9 %, P = 1.000). Conclusion HydroSoft coils proved safe during the periprocedural period and provided greater initial complete occlusion rates, greater packing density, and better followup results compared with bare platinum coils.
The Annals of Thoracic Surgery, 2006
Objectives In an attempt to reduce post-operative events we investigated a new therapeutic strate... more Objectives In an attempt to reduce post-operative events we investigated a new therapeutic strategy consisting of a simultaneous hybrid revascularization by carotid artery stenting (CAS), immediately followed by an on-pump coronary artery bypass graft (CABG).
JACC: Cardiovascular Interventions, 2010
Objectives The aim of this study was to assess the safety and effectiveness of carotid artery ste... more Objectives The aim of this study was to assess the safety and effectiveness of carotid artery stenting (CAS) with proximal cerebral protection in patients showing string sign at carotid angiography.