Internal carotid artery flow arrest/reversal cerebral protection techniques

We report on the progress of an ongoing prospective non-randomized trial evaluating carotid artery stenting (CAS) with adjuvant cerebral protection in patients who are considered high risk for surgery. The 62 patients (34M/28F) in this study underwent CAS with interruption or reversal of flow in the internal carotid artery to protect the brain from embolization of particulate debris that may otherwise egress to the brain resulting in a stroke. Twenty-seven patients (44%) had restenotic lesions after remote carotid endarterectomy and 11 (18%) had previous radical neck surgery with external beam radiation therapy for cancer. The average length of hospital stay was 1.3 +/- 0.7 days. There were no strokes or transient ischemic attacks during the procedure or follow-up. Intolerance to ICA flow arrest or reversal was noted in five patients, but the procedures were completed in stages without sequella. No significant change in NIH scale was reported based on independent neurology evaluation when baseline average scores (0.72 +/- 1.1) were compared to follow-up at 30 days (0.50 +/- .05) P > 0.05. The positive outcome in this small study suggests that CAS may be a safe alternative to CEA in high-risk patients.