Carotid artery stenting with routine cerebral protection in high-risk patients.
BACKGROUND
Carotid artery stenting has emerged as an alternative treatment modality in carotid occlusive disease. This study examined our experience of carotid stenting with routine cerebral embolization protection in high-risk patients.


METHODS
Clinical variables and treatment outcome of high-risk patients who underwent carotid stenting with neuroprotection were analyzed during a 26-month period.


RESULTS
Sixty-eight high-risk patients with 72 carotid artery stenoses were treated. Procedural success was achieved in 70 cases (97%), and symptomatic lesions existed in 17 (24%) patients. Monorail Wallstents stents were used in all cases. Neuroprotective devices used were PercuSurge (28%) and Filterwire (72%). There was no periprocedural mortality or neuroprotective device-related complications. The 30-day stroke and death rate was 2.7%, and the overall complication rate was 6.9%. All stented vessels remained patent during the follow-up period (mean 15.3 +/- 4.2, range 1 to 23 months). Two asymptomatic in-stent restenosis (3%) occurred at 6 and 8 months, which were both successfully treated with balloon angioplasty.


CONCLUSIONS
Our study showed that percutaneous carotid stenting with routine use of a cerebral protection device is a feasible and effective treatment in high-risk patients with carotid occlusive disease.
Lin
Peter H
PH
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Methodist Hospital, HVAMC (112), 2002 Holcombe Blvd., Houston, TX 70030, USA. plin@bcm.tmc.edu
Bush
Ruth L
RL
Lubbe
Dieter F
DF
Cox
Mitchell M
MM
Zhou
Wei
W
McCoy
Sally A
SA
Felkai
Deborah
D
Paladugu
Ramesh
R
Lumsden
Alan B
AB
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D002545:Brain Ischemia / Q000517:prevention & control*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008851:Micropore Filters; D008875:Middle Aged; D011482:Protective Devices; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler