Favorable early outcome of carotid artery stenting without protection devices.
OBJECTIVE
Protection devices are increasingly used in carotid artery stenting. However, no randomized trial has been conducted to evaluate the efficacy of such devices, and arguments have also been formulated against their routine use. We set out to investigate the complication rates associated with carotid artery stenting performed without protection devices. Applicability of covered stents in the carotid system was also evaluated.


METHODS
Between January 2001 and July 2003, 245 consecutive patients (260 hemispheres) underwent carotid artery stenting. No protection devices were applied. Covered stents were implanted in 31 (12.1%) cases. The incidence of complications during the intervention and the subsequent 30-day follow-up period was recorded.


RESULTS
The technical success rate was 98.8%. One postprocedural nonneurological death (0.4%) occurred. Neurological complications (inclusive of transient ischemic attacks) were observed in 14 cases (5.4%). The rate of major complications (death, major stroke, and myocardial infarction) was 1.6% among the symptomatic and 1.5% among the asymptomatic cases. The rate of minor strokes was 3.2% in the symptomatic and 1.5% in the asymptomatic group. Of the neurological complications, 64.3% occurred postprocedurally. No ipsilateral neurological complications were detected in the subgroup treated with covered stents.


CONCLUSIONS
Carotid artery stenting without protection devices appears to be safe. Most of the neurological complications could not have been prevented with protection devices, because they occurred after the intervention. The application of covered stents may reduce the rate of embolization-related complications in the periprocedural period.
Sztriha
László K
LK
Department of Neurology, Albert Szent-Györgyi Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary. sztriha@nepsy.szote.u-szeged.hu
Vörös
Erika
E
Sas
Katalin
K
Szentgyörgyi
Réka
R
Pócsik
Anna
A
Barzó
Pál
P
Szikra
Péter
P
Makai
Attila
A
Szólics
Alex
A
Elek
Péter
P
Rudas
László
L
Vécsei
László
L
D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000601:surgery*; D002404:Catheterization; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D011183:Postoperative Complications; D015607:Stents; D016896:Treatment Outcome