title: Thirty-day outcomes of direct carotid artery stenting with cerebral protection in high-risk patients.
abstract: BACKGROUND
  Implantation of a carotid artery stent after predilation is a standard approach in the endovascular treatment of carotid artery stenoses. Stenting without predilation may be an alternative approach in a certain subset of patients. The present prospective, single-center registry was designed to evaluate the feasibility and safety of direct carotid artery stenting (DCAS) in high-risk patients.
  
  
  RESULTS
  Symptomatic patients with stenosis >50% and asymptomatic patients with stenosis >70% were eligible for enrolment. Criteria for high-risk patients included: need or history of open heart surgery, history of myocardial infarction, multivessel coronary artery disease, left ventricular dysfunction (ejection fraction < or =40%), severe pulmonary or renal disease, significant contralateral carotid disease, previous endarterectomy, and age > or =80 years. All procedures were performed using a filter protection device. Patients underwent complete clinical examination before and after DCAS and at 30-day follow-up. A total of 83 consecutive patients (45 males, 68+/-9 years, 33% symptomatic) underwent 100 procedures and 103 stents were deployed successfully. The technical success rate of stenting was 100%. Predilation of carotid stenosis was necessary in 1 (1%) procedure. Carotid-artery stenoses before and after DCAS were 80+/-9% and 7+/-9%, respectively. The median fluoroscopic time for DCAS was 7 min. The overall rate of in-hospital major adverse cerebrovascular events (death, stroke, myocardial infarction) was 5% (2 minor strokes, 3 transient attacks). There was 1 (1%) minor stroke within the 30-day follow-up.
  
  
  CONCLUSIONS
  DCAS is feasible and can be performed with an acceptable risk in high-risk patients.
authors.affiliation: CardioVascular Center, Department of Cardiology, University Hospital Motol, Prague, Czech Republic. veselka.josef@seznam.cz
authors.forename: Josef
authors.initials: J
authors.lastname: Veselka
authors.forename: Daniela
authors.initials: D
authors.lastname: Cerná
authors.forename: Petra
authors.initials: P
authors.lastname: Zimolová
authors.forename: Peter
authors.initials: P
authors.lastname: Blasko
authors.forename: Jirí
authors.initials: J
authors.lastname: Fiedler
authors.forename: Petr
authors.initials: P
authors.lastname: Hájek
authors.forename: Martin
authors.initials: M
authors.lastname: Maly
authors.forename: David
authors.initials: D
authors.lastname: Zemánek
authors.forename: Radka
authors.initials: R
authors.lastname: Duchonová
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000628:therapy*; D002531:Cerebellum; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008171:Lung Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications