Multicenter evaluation of carotid artery stenting with a filter protection system.
OBJECTIVE
The aim of this study was to evaluate the feasibility and safety of carotid artery stenting (CAS) with a filter protection system.


BACKGROUND
Neurologic events linked to the embolization of particulate matter to the cerebral circulation may complicate CAS. Strategies designed to capture embolic particles during carotid intervention are being evaluated for their efficacy in reducing the risk of these events.


METHODS
Between September 1999 and July 2001, a total of 162 patients (164 hemispheres) underwent CAS with filter protection (NeuroShield, MedNova Ltd., Galway, Ireland) according to prospective protocols evaluating the filter system at three institutions.


RESULTS
Angiographic success was achieved in 162 of the procedures (99%) and filter placement was successful in 154 (94%) procedures. Carotid access was unsuccessful in two cases (1%) and filter placement in eight cases (5%). Of the latter, five procedures were completed with no protection and three were completed using alternative protection devices. On an intention-to-treat basis, the overall combined 30-day rate of all-stroke and death was 2% (four events: two minor strokes and two deaths). This includes one minor stroke in a patient with failed filter placement and CAS completed without protection. There was one cardiac arrhythmic death and one death from hyperperfusion-related intracerebral hemorrhage. There were no major embolic strokes.


CONCLUSIONS
Carotid artery stenting with filter protection is technically feasible and safe. Early clinical outcomes appear to be favorable and need to be confirmed in a larger comparative study.
Al-Mubarak
Nadim
N
Lenox Hill Heart and Vascular Institute, New York, New York, USA.
Colombo
Antonio
A
Gaines
Peter A
PA
Iyer
Sriram S
SS
Corvaja
Nicola
N
Cleveland
Trevor J
TJ
Macdonald
Sumaira
S
Brennan
Cristina
C
Vitek
Jiri J
JJ
D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005374:Filtration / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome