Protected carotid stenting: clinical advantages and complications of embolic protection devices in 442 consecutive patients.
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.
Cremonesi
Alberto
A
Interventional Cardio-Angiology Unit, Department of Medical and Surgical Cardiology, Villa Maria Cecilia Hospital, Via Corriera 1, 48010 Cotignola, Italy.
Manetti
Raffaella
R
Setacci
Francesco
F
Setacci
Carlo
C
Castriota
Fausto
F
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