Use of endovascular clamping as neuroprotection during carotid stenting in the presence of a critical ipsilateral stenosis of the external carotid artery.
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.
Stabile
Eugenio
E
Laboratory of Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy.
Sorropago
Giovanni
G
Tesorio
Tullio
T
Salemme
Luigi
L
Ambrosini
Vittorio
V
Cioppa
Angelo
A
Popusoi
Gregory
G
Nammas
Wail
W
Biamino
Giancarlo
G
Rubino
Paolo
P