Related Experiment Video
Updated: Jun 12, 2026
Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
[Carotid artery stenting with proximal or distal brain protection: early outcome]
Piotr Pieniazek1, Anna Kabłak-Ziembicka, Tadeusz Przewłocki
1Klinika Chorób Serca i Naczyń, Instytut Kardiologii Collegium Medicum UJ, Kraków. kardio@kki.krakow.pl
Insights
Percutaneous carotid artery stenting (CAS) with brain protection systems demonstrated a high success rate and low complication rates in a large patient series. Tailored neuroprotection strategies are key to favorable early outcomes in CAS procedures.
Area of Science:
- Interventional Cardiology
- Neurology
- Vascular Surgery
Context:
- Stroke is a leading cause of death and disability, with significant carotid artery stenosis a major risk factor.
- Percutaneous carotid artery stenting (CAS) has emerged as a viable alternative to surgery for treating carotid stenosis.
Purpose:
- To evaluate the early outcomes of CAS procedures utilizing brain protection systems.
- To assess the safety and efficacy of tailored neuroprotection strategies in CAS.
Summary:
- A study of 132 patients undergoing CAS with proximal or distal neuroprotection showed a 98.6% procedural success rate.
- Post-procedure, stenosis decreased significantly, with only minor complications (TIA, hyperperfusion syndrome) and complete recovery observed.
- No deaths, myocardial infarctions, or major strokes occurred, with no neurological deterioration at 30 days.
Impact:
- CAS with brain protection is a safe and effective treatment for carotid artery stenosis.
- Patient and lesion-specific neuroprotection systems contribute to favorable early outcomes, reducing stroke risk.
Background:
Stroke is the third cause of death and a leading cause of disability. Significant atherosclerotic carotid artery stenosis is associated with as many as one in five strokes. Recent randomized trials have shown that percutaneous carotid artery stenting (CAS) is at least as effective and safe as surgery.
Aim:
To evaluate the early outcome of CAS performed with brain protection systems in a large series of consecutive patients.
Methods:
From January 2001 to April 2004, 132 patients (age 63 +/- 8 years, 99 symptomatic and 90 with co-existing coronary artery disease, 36 women) with carotid artery stenosis were treated in our Institution. All patients underwent independent neurological assessment and non-invasive imaging (extra- and intracranial duplex Doppler and CT angiography, brain CT) before the procedure to tailor the brain protection system to the patient and lesion. Proximal (Parodi Anti-Emboli System, Mo.Ma) or distal (Percusurge/Guardwire, filters i.e. Angioguard, EPI FilterWire, Accunet, Spider, NeuroShield) neuroprotection was applied respectively in 42 (31%) and 93 (69%) cases. Clinical evaluation was performed on discharge and at 30 days.
Results:
Procedural success rate was 130/132 (98.6%). The degree of stenosis (expressed as % diameter reduction, QCA) decreased from 76.3 +/- 10.6 to 16.9 +/- 9.1 (p < 0.001) while the minimal lumen diameter increased from 1.48 +/- 0.67 to 3.72 +/- 0.71 mm (p < 0.001). In the peri-procedural period, 5 (3.7%) patients had TIA and 1 (0.7%) had hyperperfusion syndrome with a small haemorrhagic stroke, but with a complete clinical recovery. There were no deaths, myocardial infarctions nor any major strokes. On discharge no patients had neurological deterioration as compared to the admission status. At 30 days there were no new cardiac or neurological events.
Conclusions:
Our results show that percu-taneous CAS--when performed with brain protection--has a high success rate and a very low complication rate. It is conceivable that the patient/lesion-tailored application of a particular neuroprotection system importantly contributes to the favourable early outcome of CAS.