Impact of cerebral protection devices on early outcome of carotid stenting.
OBJECTIVE
To evaluate the impact of cerebral protection devices on the procedural safety and outcome of carotid stent procedures.


METHODS
From June 1997 to July 2001, 275 consecutive patients (208 men; mean age 71 +/- 7.4 years) underwent percutaneous angioplasty and/or stenting of the extracranial carotid artery. In the first 125 (45.4%) patients, the procedures were performed without cerebral protection. After January 2000, protection devices were routinely used (150 [54.6%] patients), including the Angioguard filter, GuardWire occlusion system, TRAP Vascular Filtration System, EPI Filter Wire, NeuroShield, Parodi Anti-Embolism System, and Medicorp occlusive balloon.


RESULTS
The percutaneous procedures were effective in 273 (99.3%) patients. No death or major stroke occurred in either group. In the unprotected group, 5 (4.0%) complications occurred: 3 (2.4%) minor strokes, 1 (0.8%) transient ischemic attack (TIA), and 1 (0.8%) subarachnoid hemorrhage. In the patients treated under cerebral protection, there were 2 (1.3%) complications: 1 (0.7%) minor stroke and 1 (0.7%) subarachnoid hemorrhage. There were 4 (3.2%) periprocedural embolic complications in the unprotected group versus 1 (0.7%) in the protected patients.


CONCLUSIONS
Our data suggest that percutaneous dilation and stenting of the carotid arteries protected by cerebral protection devices is feasible and effective. In a consecutive series, the use of the cerebral protection systems reduced the acute neurological event rate related to embolic complications by 79%.
Castriota
Fausto
F
Interventional Cardio-Angiology Unit, Villa Maria Cecilia Hospital, Cotignola, Italy. vmc.emod@gruppovillamaria.it
Cremonesi
Alberto
A
Manetti
Raffaella
R
Liso
Armando
A
Oshola
Kareem
K
Ricci
Enrico
E
Balestra
Guido
G
D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D017536:Carotid Artery, Common / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D020878:Device Removal; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D007558:Italy; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D005996:Nitroglycerin / Q000627:therapeutic use; D011482:Protective Devices; D012086:Reoperation; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents; D005996:Nitroglycerin