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Published on: May 9, 2013
Carotid artery stenting with routine cerebral protection in high-risk patients
Peter H Lin1, Ruth L Bush, Dieter F Lubbe
1Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Methodist Hospital, HVAMC (112), 2002 Holcombe Blvd., Houston, TX 70030, USA. plin@bcm.tmc.edu
Insights
Carotid artery stenting with cerebral protection is a safe and effective treatment for high-risk patients with carotid occlusive disease. This minimally invasive procedure demonstrated high success rates and low complication rates in a recent study.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid artery stenting (CAS) is an alternative treatment for carotid occlusive disease.
- High-risk patients often require specialized treatment approaches.
- Routine cerebral embolization protection is crucial during CAS.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of CAS with routine cerebral protection.
- To analyze clinical outcomes in high-risk patients undergoing CAS.
- To assess procedural success and complication rates.
Main Methods:
- Retrospective analysis of 68 high-risk patients undergoing CAS over 26 months.
- Utilized Monorail Wallstents for all procedures.
- Employed neuroprotection devices: PercuSurge (28%) and Filterwire (72%).
Main Results:
- Procedural success in 97% of cases (70/72 stenoses).
- Low 30-day stroke and death rate (2.7%) and overall complication rate (6.9%).
- No periprocedural mortality or device-related complications; all stented vessels remained patent.
Conclusions:
- Percutaneous carotid stenting with routine cerebral protection is feasible and effective.
- This approach offers a safe treatment option for high-risk patients.
- The study supports CAS with neuroprotection for carotid occlusive disease management.
Background:
Carotid artery stenting has emerged as an alternative treatment modality in carotid occlusive disease. This study examined our experience of carotid stenting with routine cerebral embolization protection in high-risk patients.
Methods:
Clinical variables and treatment outcome of high-risk patients who underwent carotid stenting with neuroprotection were analyzed during a 26-month period.
Results:
Sixty-eight high-risk patients with 72 carotid artery stenoses were treated. Procedural success was achieved in 70 cases (97%), and symptomatic lesions existed in 17 (24%) patients. Monorail Wallstents stents were used in all cases. Neuroprotective devices used were PercuSurge (28%) and Filterwire (72%). There was no periprocedural mortality or neuroprotective device-related complications. The 30-day stroke and death rate was 2.7%, and the overall complication rate was 6.9%. All stented vessels remained patent during the follow-up period (mean 15.3 +/- 4.2, range 1 to 23 months). Two asymptomatic in-stent restenosis (3%) occurred at 6 and 8 months, which were both successfully treated with balloon angioplasty.
Conclusions:
Our study showed that percutaneous carotid stenting with routine use of a cerebral protection device is a feasible and effective treatment in high-risk patients with carotid occlusive disease.
