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Carotid artery stenting with distal filter protection: single-center experience in high-surgical-risk patients
1Department of Cardiology and Angiology, Ev. Bethesda-Johanniter-Klinikum Duisburg GmbH, Standort Johanniter, Kreuzacker 1-7, 47228, Duisburg, Germany. knur@johanniter-rheinhausen.de
Insights
Protected carotid artery stenting (CAS) using a filter device is safe and effective for high-risk patients with severe carotid stenosis. This approach demonstrated a low rate of major adverse events, reducing stroke and death risks.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid artery stenting (CAS) offers an alternative treatment for high-surgical-risk patients with carotid stenosis.
- Cerebral protection systems may reduce the risk of stroke and death during CAS procedures.
Purpose of the Study:
- To evaluate the initial experience and safety of protected CAS using a distal filter device in high-risk patients.
- To assess the periprocedural complication rates and clinical outcomes in this patient cohort.
Main Methods:
- Retrospective analysis of 65 consecutive high-surgical-risk patients undergoing CAS with a distal filter protection device between January 2006 and July 2008.
- Inclusion criteria: symptomatic or asymptomatic severe carotid artery disease.
- Data collection included technical success, periprocedural neurologic complications, filter-related complications, and major adverse cardiovascular and cerebrovascular events (MACE).
Main Results:
- Technical success rate was 97.2%.
- Periprocedural neurologic complications included two transient ischemic attacks and one major stroke.
- The overall in-hospital and 30-day MACE rate was 1.5% (3.6% in symptomatic, 0% in asymptomatic patients).
- Three filter-related complications occurred but were managed without adverse patient outcomes.
Conclusions:
- Protected CAS with a distal filter system is a safe and effective treatment option for high-risk patients with severe carotid artery disease.
- The procedure is associated with a low incidence of periprocedural complications, including stroke and death.
Abstract:
Carotid artery stenting (CAS) is an efficient alternative procedure for the treatment of high-surgical-risk patients with symptomatic and asymptomatic carotid stenosis. The use of cerebral protection systems might decrease procedural risk of stroke and death. We report our initial experience with protected carotid stenting in high-risk patients with severe carotid artery disease. From January 2006 until July 2008 we routinely performed CAS using a distal filter protection device in 65 consecutive high-surgical-risk patients with 72 high-grade carotid stenoses. Technical success rate was 97.2%. Neurologic periprocedural complications included two transient ischemic attacks and one major stroke. Three filter-related complications were managed without negative results to the patients. The overall in-hospital and 30-days MACE rate was 1.5%, 3.6% in symptomatic patients and 0% in asymptomatic patients. In our series of high-risk patients, CAS with the use of a distal filter protection system was safe and effective with a low incidence of periprocedural complications.