Protected carotid stenting in high-risk patients with severe carotid artery stenosis
Robert D Safian1, John F Bresnahan, Michael R Jaff
1Cardiac and Vascular Intervention, William Beaumont Hospital, Royal Oak, Michigan 48073, USA. rsafian@beaumont.edu
Insights
Carotid artery stenting with distal embolic protection is a safe option for high-risk patients with severe carotid stenosis. This procedure demonstrated a 6.2% rate of major adverse cardiac and cerebrovascular events at 30 days.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurosurgery
Background:
- Patients with severe carotid stenosis and high-risk comorbidities face elevated risks with traditional carotid endarterectomy.
- Carotid artery stenting (CAS) emerges as a potentially safer alternative for this patient group.
Purpose of the Study:
- To evaluate the safety and efficacy of CAS using a specific distal embolic protection system.
- To assess the outcomes in high-risk patients undergoing CAS for severe carotid stenosis.
Main Methods:
- A prospective, non-randomized multicenter registry included 419 high-risk patients with severe carotid stenosis.
- Carotid artery stenting was performed using the Protégé stent and SPIDER Embolic Protection System.
- Dual antiplatelet therapy (aspirin and clopidogrel) was administered peri-procedurally and for three months post-intervention.
Main Results:
- Technical success was achieved in 97.4% of patients (408/419).
- The primary endpoint (death, stroke, myocardial infarction) occurred in 6.2% of patients (26/419) within 30 days.
- Independent predictors for adverse events included filter deployment duration, symptomatic stenosis, and baseline renal insufficiency.
Conclusions:
- Carotid artery stenting with distal embolic protection offers a viable revascularization alternative for select high-risk patients with severe carotid stenosis.
- The study supports CAS as a reasonable treatment option when carotid endarterectomy poses significant risks.
Objectives:
The purpose of this study was to determine the safety of carotid artery stenting with a unique distal embolic protection system in high-risk patients with severe carotid stenosis.
Background:
Previous studies suggest that some patients with carotid stenosis and serious comorbid conditions are at high risk for carotid endarterectomy, and may be safely treated by carotid artery stenting.
Methods:
A prospective non-randomized multicenter registry of 419 patients with severe carotid stenosis and high-risk features for carotid endarterectomy was conducted between April 2004 and October 2004. Carotid artery stenting was performed with the Protégé Self-Expanding Nitinol Stent and the SPIDER Embolic Protection System (ev3 Inc., Plymouth, Minnesota). Aspirin and clopidogrel were prescribed at least 24 h before and three months after revascularization. The primary outcome was the combined incidence of major adverse cardiac and cerebrovascular events at 30 days after intervention, including death, stroke, and myocardial infarction. A secondary outcome was the technical success, defined as successful deployment of all devices, filter retrieval, and final diameter stenosis <50%.
Results:
Technical success was achieved in 408 of 419 patients (97.4%). The primary end point was observed in 26 patients (6.2%), including death in 8 (1.9%), nonfatal stroke in 14 (3.3%), and nonfatal myocardial infarction in 4 (1%). Independent predictors of death or stroke at 30 days included duration of filter deployment, symptomatic carotid stenosis, and baseline renal insufficiency.
Conclusions:
For some patients with severe carotid stenosis and high-risk features for carotid endarterectomy, carotid artery stenting with distal embolic protection is a reasonable alternative for revascularization.
