[Carotid artery stenting with proximal or distal brain protection: early outcome].
BACKGROUND
Stroke is the third cause of death and a leading cause of disability. Significant atherosclerotic carotid artery stenosis is associated with as many as one in five strokes. Recent randomized trials have shown that percutaneous carotid artery stenting (CAS) is at least as effective and safe as surgery.


OBJECTIVE
To evaluate the early outcome of CAS performed with brain protection systems in a large series of consecutive patients.


METHODS
From January 2001 to April 2004, 132 patients (age 63 +/- 8 years, 99 symptomatic and 90 with co-existing coronary artery disease, 36 women) with carotid artery stenosis were treated in our Institution. All patients underwent independent neurological assessment and non-invasive imaging (extra- and intracranial duplex Doppler and CT angiography, brain CT) before the procedure to tailor the brain protection system to the patient and lesion. Proximal (Parodi Anti-Emboli System, Mo.Ma) or distal (Percusurge/Guardwire, filters i.e. Angioguard, EPI FilterWire, Accunet, Spider, NeuroShield) neuroprotection was applied respectively in 42 (31%) and 93 (69%) cases. Clinical evaluation was performed on discharge and at 30 days.


RESULTS
Procedural success rate was 130/132 (98.6%). The degree of stenosis (expressed as % diameter reduction, QCA) decreased from 76.3 +/- 10.6 to 16.9 +/- 9.1 (p < 0.001) while the minimal lumen diameter increased from 1.48 +/- 0.67 to 3.72 +/- 0.71 mm (p < 0.001). In the peri-procedural period, 5 (3.7%) patients had TIA and 1 (0.7%) had hyperperfusion syndrome with a small haemorrhagic stroke, but with a complete clinical recovery. There were no deaths, myocardial infarctions nor any major strokes. On discharge no patients had neurological deterioration as compared to the admission status. At 30 days there were no new cardiac or neurological events.


CONCLUSIONS
Our results show that percu-taneous CAS--when performed with brain protection--has a high success rate and a very low complication rate. It is conceivable that the patient/lesion-tailored application of a particular neuroprotection system importantly contributes to the favourable early outcome of CAS.
Pieniazek
Piotr
P
Klinika Chorób Serca i Naczyń, Instytut Kardiologii Collegium Medicum UJ, Kraków. kardio@kki.krakow.pl
Kabłak-Ziembicka
Anna
A
Przewłocki
Tadeusz
T
Musiałek
Piotr
P
Moczulski
Zbigniew
Z
Motyl
Rafał
R
Frasik
Wiesław
W
Leśniak-Sobelga
Agata
A
Zmudka
Krzysztof
K
Tracz
Wiesława
W
D002339:Carotid Arteries / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D018696:Neuroprotective Agents