title: Cutting balloon angioplasty in percutaneous carotid interventions.
abstract: OBJECTIVE
  To report a prospective feasibility study of cutting balloon angioplasty (CBA) applied in the predilation phase of carotid artery stenting (CAS) in highly calcified lesions.
  
  
  METHODS
  From January 2003 to February 2007, 178 consecutive patients (109 men; mean age 73.1+/-7.3 years) with highly calcified carotid lesions underwent CAS with CBA applied as a pre-specified strategy in the predilation phase of the procedure. All steps in the procedure were performed under cerebral filter protection. The cutting balloon ranged in diameter from 3 to 4 mm and was inflated at nominal pressures in the target lesion. Pre-CBA dilation with a low-profile coronary balloon was performed only when the cutting balloon was not able to cross the lesion. Selection of the filters and stents was at the operator's discretion. Primary endpoints were the all stroke and death rates at 30 days and 6 months. Secondary endpoints included cutting balloon success (positioning and full balloon inflation), CAS technical success (residual angiographic stenosis <30%), CAS procedural success (technical success and no complications), and in-hospital major complications.
  
  
  RESULTS
  Cutting balloon success was achieved in all 178 patients. In 32 (18.0%), pre-CBA dilation was necessary due to inability to cross the lesion with the cutting balloon initially. CAS technical success was achieved in all patients. One (0.6%) patient suffered transient neurological intolerance due to flow cessation from massive debris in the distal filter; this event was completely resolved after the filter was removed (CAS procedural success 99.4%). One patient suffered a major stroke at day 15 (0.6% 30-day all stroke and death rate). At the 6-month follow-up, 174 (97.7%) patients were evaluated; 1 patient died from myocardial infarction at day 35, and 2 patients died from non-neurological or cardiac causes at days 103 and 158. The cumulative all stroke and death rate was 2.2%.
  
  
  CONCLUSIONS
  These data suggest that CBA performed during the predilation phase of CAS in highly calcified lesion is a safe and useful method to prepare this lesion subset for stenting.
authors.affiliation: Interventional Cardio-Angiology Unit, Villa Maria Cecilia Hospital, Cotignola, Italy. fcastriota@gvm-vmc.it
authors.forename: Fausto
authors.initials: F
authors.lastname: Castriota
authors.forename: Estêvão Carvalho
authors.initials: EC
authors.lastname: de Campos Martins
authors.forename: Carlo
authors.initials: C
authors.lastname: Setacci
authors.forename: Raffaella
authors.initials: R
authors.lastname: Manetti
authors.forename: Hazem
authors.initials: H
authors.lastname: Khamis
authors.forename: Barbara
authors.initials: B
authors.lastname: Spagnolo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Furgieri
authors.forename: Shane
authors.initials: S
authors.lastname: Gieowarsingh
authors.forename: Sepideh Torabi
authors.initials: ST
authors.lastname: Parizi
authors.forename: Paolo
authors.initials: P
authors.lastname: Bianchi
authors.forename: Francesco
authors.initials: F
authors.lastname: Setacci
authors.forename: Gianmarco
authors.initials: G
authors.lastname: de Donato
authors.forename: Alberto
authors.initials: A
authors.lastname: Cremonesi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D010865:Pilot Projects; D011446:Prospective Studies; D011474:Prosthesis Design; D011859:Radiography; D018570:Risk Assessment; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome