title: Use of endovascular clamping as neuroprotection during carotid stenting in the presence of a critical ipsilateral stenosis of the external carotid artery.
abstract: OBJECTIVE
  Proximal endovascular clamping (PEC) appears to be a safe and effective cerebral protection technique for carotid artery stenting (CAS). So far the presence of severe stenosis of the ipsilateral external carotid artery (ECA) was considered a contraindication to PEC. This study presents the results of PEC for CAS in patients simultaneously presenting an ipsilateral ECA stenosis.
  
  
  RESULTS
  From September 2004 to December 2006, CAS was performed in 500 unselected cases using PEC. In sixty cases (12%) a severe ipsilateral ECA stenosis (>/=80%) was identified by angiography. In all these cases procedural success, defined as the ability to establish cerebral protection as well as stent deployment with a residual stenosis <30%, was achieved. Time of flow blockage was 188+/-37 sec. Clamping intolerance, a transient neurological deficit lasting < 20 min, occurred in five of 60 patients. In-hospital MACCE included only one minor stroke, but no major strokes, AMI or death.
  
  
  CONCLUSIONS
  This experience indicates that the use of PEC, also in the presence of a critical ECA stenosis, is safe and effective. Therefore critical ECA stenosis should no longer be considered a contraindication to PEC.
authors.affiliation: Laboratory of Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Stabile
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sorropago
authors.forename: Tullio
authors.initials: T
authors.lastname: Tesorio
authors.forename: Luigi
authors.initials: L
authors.lastname: Salemme
authors.forename: Vittorio
authors.initials: V
authors.lastname: Ambrosini
authors.forename: Angelo
authors.initials: A
authors.lastname: Cioppa
authors.forename: Gregory
authors.initials: G
authors.lastname: Popusoi
authors.forename: Wail
authors.initials: W
authors.lastname: Nammas
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Biamino
authors.forename: Paolo
authors.initials: P
authors.lastname: Rubino