title: Protected carotid stenting: clinical advantages and complications of embolic protection devices in 442 consecutive patients.
abstract: OBJECTIVE
  Periprocedural embolization of debris during carotid stenting interventions may result in neurological deficit. This study was designed to evaluate in-hospital and 30-day adverse events in patients percutaneously treated for carotid artery disease with embolic protection devices.
  
  
  METHODS
  From 1999 to June 2002, a total of 442 consecutive patients underwent percutaneous angioplasty and/or stenting of the extracranial carotid artery. The endovascular procedure was conducted under embolic protection devices.
  
  
  RESULTS
  The percutaneous procedure was successful in 440 of 442 patients (99.5%). No periprocedural death occurred with any embolic protection device. All in-hospital stroke/death and 30-day ipsilateral stroke/death rate was 1.1%. The overall complication rate was 3.4%. Major adverse events included 1 major stroke (0.2%), 4 intracranial hemorrhages (0.9%), 1 carotid artery wall fissuration (0.2%), and 1 diffuse cardioembolism (0.2%). Minor adverse events included 4 minor strokes (0.9%) and 4 transient ischemic attacks (0.9%). The cerebral protection device-related complications were 4 (0.9%): 1 case of abrupt closure of the internal carotid artery because of spiral dissection (0.2%), 1 case of trapped guide wire (0.2%), and 2 cases of intimal dissection (0.5%). Transient loss of consciousness, tremors, and fasciculations were present in 6 of 40 patients (15%) in whom occlusive protection devices were used.
  
  
  CONCLUSIONS
  Our data suggest that percutaneous stenting of the carotid artery when a cerebral protection device is used is feasible and effective but not without potential complications. However, a long learning curve may exist for the proper use of some embolic protection devices.
authors.affiliation: Interventional Cardio-Angiology Unit, Department of Medical and Surgical Cardiology, Villa Maria Cecilia Hospital, Via Corriera 1, 48010 Cotignola, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cremonesi
authors.forename: Raffaella
authors.initials: R
authors.lastname: Manetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Setacci
authors.forename: Carlo
authors.initials: C
authors.lastname: Setacci
authors.forename: Fausto
authors.initials: F
authors.lastname: Castriota
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D002340:Carotid Artery Diseases / Q000601:surgery*; D020215:Carotid Artery, Internal, Dissection / Q000209:etiology; D004617:Embolism / Q000209:etiology / Q000517:prevention & control*; D005240:Feasibility Studies; D005260:Female; D005374:Filtration / Q000295:instrumentation / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D019736:Prostheses and Implants / Q000009:adverse effects; D012449:Safety; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D014463:Ultrasonography