Protected stent-assisted carotid angioplasty in symptomatic high-risk NASCET-ineligible patients.
OBJECTIVE
The North American Symptomatic Carotid Endarterectomy Trial (NASCET) excluded patients with severe medical, angiographic and neurological risk factors. The aim of this study is to determine the safety and efficacy of protected stent angioplasty in these high-risk patients.


METHODS
Sixty-eight consecutive symptomatic NASCET-ineligible patients underwent protected stent-assisted carotid angioplasty. Patients were classified according to surgical risk based on Sundt criteria, and stratified for medical therapy according to stroke risk. Twenty-one patients were classified as Sundt grade 3 (30.8%) and 36 patients as grade 4 (52.9%).


RESULTS
The procedure was technically successful in all patients, with stenosis averaging 82.1% (range 70-99%) before the procedure and 6.3% (range 0-30%) after treatment. There were no periprocedural deaths or major strokes, but two patients had minor, non-embolic stokes (2.9%). During a mean clinical follow-up of 14.4 months (range 1-30 months), no new neurological events occurred in relation to the treated vascular territory.


CONCLUSIONS
Carotid angioplasty with cerebral protection can be performed safely in high-risk patients. During the follow-up period, angioplasty was highly effective in terms of stroke prevention and arterial patency.
Cohen
José E
JE
Department of Neurosurgery, Hadassah-Hebrew University Hospital, Jerusalem, Israel. jcohenns@yahoo.com
Umansky
Felix
F
Rajz
Gustavo
G
Ben-Hur
Tamir
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D015906:Angioplasty, Balloon, Coronary; D016893:Carotid Stenosis / Q000145:classification / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015607:Stents; D016896:Treatment Outcome