Carotid angioplasty and stenting without protection devices: safety and efficacy concerns--single center experience

Against the background of the increasing dilemma in the scientific community regarding protected versus unprotected carotid artery stent (CAS) placement and the disputed points in interpreting the results of scientific studies as well as the difficulty in conducting such randomized controlled studies, this article gives a review of experiences with carotid stent placement without the use of protection devices.

This series comprised 133 consecutive patients with 136 carotid stenoses of which 128 carotid arteries (94%) were either symptomatic (93 out of 136 = 68.4%) or had a greater than 70% stenosis (35 out of 136 = 25.7%) and 8 out of 136 were asymptomatic and had stenoses between 50% and 70%. Patients underwent neurologic and sonographic evaluation before the procedure and during follow-up (mean 18 months).

Primary stent placement was carried out in 110 out of 136 lesions and predilatation was necessary before stent deployment in 26 lesions,. Neurologic periprocedural complications included 3 disabling and 1 non-disabling strokes. During the follow-up period there were 6 deaths all unrelated to the carotid disease and no major strokes. The degree of stenosis decreased from a mean of 81% to a mean of 12.3% immediately after the procedure, 22 patients were defined as restenosis of which 9 were symptomatic.

Carotid stent placement without the use of distal protection devices was found to be a safe and effective procedure with a relatively low incidence of periprocedural complications.