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Published on: May 14, 2013
Safety Outcomes Using a Proximal Protection Device in Carotid Stenting of Long Carotid Stenoses
Kunakorn Atchaneeyasakul1, Priyank Khandelwal1, Sudheer Ambekar1
1Interventional Division, Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA.
Insights
Proximal embolic protection devices are safe for carotid stenting, even in high-risk patients with long lesions or string signs. These devices effectively reduce stroke risk during carotid artery stenting procedures.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurology
Background:
- Embolic protection devices (EPDs) mitigate risks during carotid stenting.
- Proximal EPDs reverse internal carotid artery (ICA) flow, reducing perioperative microemboli.
- Carotid stenting of ICA lesions >10 mm or with string sign carries a high stroke risk.
Purpose of the Study:
- Evaluate safety outcomes of proximal EPDs in high-risk carotid stenting patients.
- Assess EPD efficacy in patients with elongated ICA lesions (>10 mm) or string sign.
- Compare outcomes between long lesions and shorter lesions.
Main Methods:
- Retrospective analysis of carotid stenting with proximal EPDs at a tertiary center.
- Identification of high-risk features for adverse events.
- Comparison of outcomes for lesions >10 mm versus shorter lesions.
Main Results:
- 100% technical success for stent placement in 27 patients (96.3% symptomatic).
- No major stroke or coronary events; one minor stroke occurred.
- In the high-risk group (lesion length >10 mm or string sign), one minor stroke (4.8%) occurred, with no significant difference in complications compared to controls.
Conclusions:
- Proximal embolic protection devices demonstrate safety in carotid stenosis patients.
- EPDs are safe for high-risk carotid stenting, including those with lesions >10 mm or string sign.
- This approach offers a safe option for complex carotid artery interventions.
Background:
Embolic protection devices can prevent atherosclerotic emboli during carotid stenting. Newer proximal protection devices reverse flow in the internal carotid artery (ICA), leading to reduction in perioperative microemboli. The risk of stroke is high for carotid stenting of ICA lesions with a length >10 mm and/or angiographic string sign.
Objective:
We aimed to evaluate the safety outcomes of proximal embolic protection device usage in this high-risk group.
Methods:
This is a retrospective analysis of patients who underwent carotid stenting procedures with proximal embolic protection devices at a tertiary care center. High-risk features for adverse events with carotid stenting were identified. Peri- and postprocedural outcomes were recorded. We further compared outcomes in patients with a carotid stenosis length >10 mm to those with shorter stenosis.
Results:
From January 2011 to December 2014, we included 27 patients; 96.3% were symptomatic and 3.7% were asymptomatic. There was a stent placement technical success rate of 100%. No major stroke or coronary events were recorded. One minor stroke event developed in one patient. A carotid lesion length >10 mm and/or angiographic string sign was noted in 21/27 patients, with an average lesion length of 14.4 mm. One patient (4.8%) in this group developed a minor stroke event. Neither a coronary nor a major stroke event was recorded in this group. There was no significant difference in the complication rate between the long lesion and the control group.
Conclusion:
In our patient cohort, it was found that a proximal embolic protection device is safe for patients with carotid stenosis, including those with a carotid lesion length >10 mm and/or angiographic string sign.
