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Carotid artery stenting without post-stenting balloon dilatation
Atsushi Ogata1, Makoto Sonobe2, Noriyuki Kato2
1Department of Neurosurgery, National Hospital Organization, Mito Medical Center, Ibaraki, Japan Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan.
Insights
Carotid artery stenting (CAS) without post-dilatation is a safe and effective procedure, demonstrating low rates of stroke and restenosis. This method offers a feasible approach for patients requiring CAS, with comparable outcomes across different embolic protection devices.
Area of Science:
- Vascular Surgery
- Interventional Neuroradiology
- Cardiovascular Imaging
Background:
- Carotid artery stenting (CAS) is a common procedure to prevent stroke.
- Post-dilatation is often used after CAS, but its necessity is debated.
- Evaluating CAS outcomes without post-dilatation is crucial for optimizing patient care.
Purpose of the Study:
- To assess the clinical outcomes and MRI findings following CAS performed without post-dilatation.
- To determine the safety and feasibility of this CAS technique.
Main Methods:
- 176 CAS procedures were performed on 169 patients (61.4% symptomatic) using embolic protection devices.
- Stents were deployed without post-dilatation.
- Periprocedural complications and mid-term outcomes were analyzed, including diffusion-weighted imaging (DWI) on MRI.
Main Results:
- The 30-day stroke rate was 2.3% (1.5% asymptomatic, 2.8% symptomatic).
- 14.8% of patients showed new cerebral infarcts on post-CAS DWI.
- Mid-term outcomes included 1.1% ipsilateral stroke and 3.4% restenosis.
Conclusions:
- CAS without post-dilatation is a feasible and safe procedure.
- This technique is associated with a low incidence of stroke and restenosis.
- Outcomes were consistent regardless of the embolic protection device used.
Purpose:
To evaluate the clinical outcome and MRI findings after carotid artery stenting (CAS) without post-dilatation.
Methods:
Between May 2005 and April 2012, a total of 169 consecutive patients (61.4% symptomatic) underwent 176 CAS procedures performed with an embolic protection device (GuardWire, n=116; FilterWire EZ, n=60). All stents were deployed without post-dilatation. Periprocedural complications and mid-term outcomes were analyzed.
Results:
The stroke rate was 2.3% within 30 days post-CAS (asymptomatic patients 1.5%; symptomatic patients 2.8%). Cerebral infarction occurred in one asymptomatic patient (1.5%) and one symptomatic patient (0.9%). Intracranial hemorrhage occurred in two symptomatic patients (1.9%). Post-CAS diffusion-weighted imaging (DWI) revealed a high-intensity area in 26 of 176 procedures (14.8%). Ipsilateral stroke after 31 days occurred in two patients (1.1%) and restenosis occurred in six (3.4%). A post-CAS comparison of the embolic protection devices revealed no difference in stroke incidence within 30 days and in DWI high-intensity area.
Conclusions:
Our CAS procedure without post-dilatation is feasible, safe and associated with a low incidence of stroke and restenosis.