The impact of post-dilatation on periprocedural outcomes during carotid artery stenting: A single-center experience
Feyzullah Besli1, Fatih Gungoren1, Ozcan Kocaturk2
1Department of Cardiology, Harran University Faculty of Medicine, Sanliurfa, Turkey.
Insights
Balloon post-dilatation during carotid artery stenting (CAS) did not increase major adverse events but significantly raised silent ischemia rates. Consider post-dilatation only for severe residual stenosis after CAS.
Area of Science:
- Interventional Cardiology
- Neurology
- Vascular Surgery
Background:
- Carotid artery stenting (CAS) is a standard treatment for carotid artery disease.
- Periprocedural embolic events are a known risk of CAS.
- The impact of balloon post-dilatation on CAS outcomes requires further investigation.
Purpose of the Study:
- To evaluate the effect of balloon post-dilatation on periprocedural outcomes in patients undergoing CAS.
- To compare major adverse events and silent ischemia rates between CAS with and without post-dilatation.
Main Methods:
- A study of 128 patients undergoing CAS, divided into groups with (group 1) and without (group 2) post-dilatation.
- Major adverse events included death, stroke, and transient ischemic attack within 30 days.
- Silent ischemia was assessed using diffusion-weighted magnetic resonance imaging.
Main Results:
- No significant differences in major adverse events at 30 days between groups (5.1% vs. 4.3%).
- Silent ischemia rates were significantly higher in the post-dilatation group (45.8% vs. 26.1%, p=0.020).
- Multivariate analysis showed post-dilatation increased silent ischemia 2.4-fold (p=0.020).
Conclusions:
- Balloon post-dilatation after CAS did not increase major adverse events.
- Post-dilatation significantly increases the incidence of periprocedural silent ischemia.
- Post-dilation should be reserved for cases with severe residual stenosis post-CAS.
Background And Aims:
Carotid artery stenting (CAS) is an accepted treatment modality for carotid artery disease. However, CAS is associated with periprocedural embolic events, and the effect of balloon post-dilatation has not been sufficiently investigated in large studies. We assessed the effect of post-dilatation on periprocedural outcomes during CAS.
Methods:
The study included 128 patients who underwent CAS. The patients were divided into groups according to whether post-dilatation was (post-dilatation [+], group 1) or was not (post dilatation [-], group 2) performed after stent deployment. Major adverse events were defined as death, minor or major stroke, and transient ischemic attack at 30 days. Silent ischemia was assessed using diffusion-weighted magnetic resonance imaging.
Results:
No significant between-group differences were found in baseline characteristics, comorbid diseases, or lesion characteristics. The degree of stenosis and procedure duration was greater in group 1 than in group 2. The rate of major adverse events at 30 days was similar between the two groups (5.1% vs. 4.3%, p = 0.844). The silent ischemia rate and number of high-intensity signals were higher in group 1 than in group 2 (45.8% vs. 26.1%, p = 0.020 and 1.01 [1.2] vs. 0.42 [0.79], p = 0.002). Multivariate analysis revealed that post-dilatation was associated with a 2.4-fold increase in silent ischemia (95% confidence interval: 1.15-5.20, p = 0.020).
Conclusions:
Although post-dilatation was not associated with an increase in major adverse events, it significantly increased the incidence of periprocedural silent ischemia. Therefore, post-dilation should be performed only in cases with severe residual stenosis after CAS.
