Complications of carotid artery stenting are largely preventable: a retrospective error analysis.
Procedure-related complications with carotid artery stenting must be minimized for it to be a valid treatment for carotid stenosis. Failure analysis was done for 207 carotid stent procedures. All complications were reviewed and technical errors were identified. The procedure-related stroke rate was 2.9%, technical failure rate was 1.9%, and no patients died. Two strokes resulted from protocol deviations. A third stroke occurred while crossing a long, irregular lesion with a protection device instead of establishing flow reversal. Excessive instrumentation of the aortic arch resulted in 2 strokes. Distal embolization occurred after open-cell stenting a friable lesion in 1 patient. The majority of neurologic events and technical complications that occur during carotid stenting are preventable. By adhering to technical protocols, avoiding excessive instrumentation in the aortic arch, using flow reversal in selected lesions, and matching the appropriate anatomy and stent, results of carotid artery stenting can be exceptional.
Veeraswamy
Ravi K
RK
Division of Vascular Surgery, Department of Surgery at Emory University School of Medicine, Atlanta, GA 30322, USA. veeraswamy@emoryhealthcare.org
Rubin
Brian G
BG
Sanchez
Luis A
LA
Curi
Michael A
MA
Geraghty
Patrick J
PJ
Parodi
Juan C
JC
Sicard
Gregorio A
GA
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011859:Radiography; D012042:Registries; D015607:Stents; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*