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Updated: Apr 11, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Poststent ballooning is associated with increased periprocedural stroke and death rate in carotid artery stenting
Tammam Obeid1, Dean J Arnaoutakis1, Isibor Arhuidese1
1Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md.
Insights
Post-stent ballooning during carotid artery stenting (CAS) significantly increases risks of hemodynamic depression and stroke or death. This technique should be reserved for severe residual stenosis cases to improve patient safety.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurosurgery
Background:
- Carotid endarterectomy (CEA) is the gold standard, but carotid artery stenting (CAS) is an alternative for high-risk patients.
- CAS application is debated due to higher perioperative risks compared to CEA.
- Evidence-based guidelines for CAS intraoperative techniques, particularly ballooning, are limited.
Purpose of the Study:
- To analyze the impact of pre-stent ballooning (pre-SB) and post-stent ballooning (post-SB) on hemodynamic depression (HD).
- To evaluate the effect of pre-SB and post-SB on the 30-day perioperative stroke and death rate.
- To provide evidence-based insights into optimizing CAS procedural techniques.
Main Methods:
- Retrospective analysis of 3772 patients undergoing CAS from 2005-2014 using the Vascular Quality Initiative database.
- Logistic regression models analyzed the association between pre-SB and post-SB combinations with HD and stroke/death.
- Controlled for patient demographics, comorbidities, symptom status, prior interventions, and stenosis degree.
Main Results:
- The combined pre-SB and post-SB technique showed a 2.1-fold increase in hemodynamic depression (OR, 2.13; P < .001).
- Combined pre-SB and post-SB also resulted in a 2.4-fold increase in perioperative stroke and death rate (OR, 2.37; P < .050).
- Overall perioperative stroke and death rate was 3.0% in the analyzed cohort.
Conclusions:
- Post-stent ballooning (post-SB) significantly elevates the risk of perioperative hemodynamic depression, stroke, and death compared to pre-stent ballooning (pre-SB) alone.
- The use of post-SB in CAS procedures should be carefully considered and limited to cases with severe residual stenosis.
- Findings suggest a need for refined protocols regarding ballooning techniques in CAS to enhance patient outcomes.
Background:
Whereas carotid endarterectomy (CEA) remains the "gold standard" treatment, given its low complication rate, carotid artery stenting (CAS) has emerged as a valid alternative in patients with prohibitive surgical risks. However, the application of CAS has been scrutinized, given its increased perioperative risk in comparison to CEA. Operators follow general guidelines in intraoperative techniques in CAS. However, few of those are evidence based. We believe that a specific outcome-driven examination of the effect of pre- and poststent deployment ballooning is warranted. The objective of this study was to analyze the effect of prestent ballooning (pre-SB) and poststent ballooning (post-SB) on hemodynamic depression (HD) and perioperative stroke or death.
Methods:
We performed a retrospective analysis of all patients who had CAS between 2005 and 2014 in the Vascular Quality Initiative database. Logistic regression analyses of the effect of different pre-SB and post-SB combinations on HD and the 30-day stroke and death rate were performed. We excluded patients who had no protection device, those with isolated common carotid artery lesions, and those who had no ballooning at all. The models controlled for patient age, gender, comorbidities, smoking status, symptomatic status, history of previous ipsilateral CEA, preoperative medications, and ipsilateral degree of stenosis.
Results:
A total of 3772 patients who underwent CAS were included for analysis. Average age of patients was 69.8 ± 9.6 years, with 63% being male. The overall perioperative stroke and death rate was 3.0%. Compared with pre-SB only technique, the combined pre-SB and post-SB technique had a 2.1-fold increase in HD (odds ratio, 2.13; 95% confidence interval, 1.51-3.01; P < .001) and 2.4-fold increase in perioperative stroke and death rate (odds ratio, 2.37; 95% confidence interval, 1.01-5.62; P < .050).
Conclusions:
Compared with pre-SB alone, the use of post-SB increases the chances of perioperative HD and stroke and death rate in patients undergoing CAS. Post-SB should be used only in those cases with severe residual stenosis.
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