Carotid artery stenting with pre-stenting dilatation alone: Safety and efficacy

Area of Science:

• Vascular Surgery
• Interventional Neurology
• Cardiovascular Research

Background:

• Carotid artery stenting (CAS) is a key treatment for atherosclerotic carotid stenosis, offering an alternative to carotid endarterectomy.
• Periprocedural ischemic stroke remains a significant concern in CAS, influenced by device choice and procedural techniques.
• The optimal balloon dilatation strategy, specifically the use of pre- and post-stenting dilatation, is a subject of ongoing debate.

Purpose of the Study:

• To compare the safety and efficacy of CAS using pre-stenting dilatation alone versus combined pre- and post-stenting dilatation.
• To evaluate the impact of different dilatation strategies on periprocedural stroke rates and long-term outcomes.

Main Methods:

• Retrospective analysis of 1248 CAS procedures in 1158 patients from May 2009 to December 2020.
• Comparison of baseline characteristics, procedural details, and outcomes between pre-dilatation-alone and combined dilatation groups.
• Primary endpoint: 30-day composite stroke rate. Secondary endpoints: periprocedural adverse events, long-term in-stent restenosis (ISRS > 50%).

Main Results:

• The 30-day composite stroke rate was significantly lower in the pre-dilatation-alone group (2.1%) compared to the combined group (7.2%; p=0.003).
• Overall 30-day stroke rate was 2.6% across all procedures.
• At a median 66-month follow-up, ISRS > 50% occurred in 5.9% of stents, with no significant difference between the two dilatation groups (5.9% vs. 5.7%).

Conclusions:

• CAS utilizing pre-stenting dilatation alone is associated with a reduced periprocedural stroke rate compared to combined dilatation.
• The simplified approach of pre-stenting dilatation alone demonstrates comparable long-term in-stent restenosis rates.
• These findings suggest that a simplified procedural strategy may reduce embolic risk without compromising the efficacy of CAS.