title: Carotid artery stenting: clinical and procedural implications for near-occlusion stenosis.
abstract: OBJECTIVE
  The advisability of implanting a stent in carotid near-occlusion stenosis is a controversial topic. We have assessed procedural and clinical implications of stent implantation for carotid artery disease with near occlusion.
  
  
  METHODS
  We included 205 patients who underwent carotid artery revascularisation with a stent. The group of patients with near-occlusion stenosis (n=54)was compared to the rest of the population (n=151).
  
  
  RESULTS
  No differences were found between groups for age, sex, and the percentage of symptomatic patients (three-quarters of the population). Carotid stent revascularisation for near-occlusion stenosis presented a high procedural success rate (96%) similar to that of revascularisation processes for other lesions (98%). Stenting in cases of near-occlusion stenosis required increased use of proximal protection (54% vs. 20.5%, P<.001) and predilation (33% vs. 17%, P=.01). The process to repair near-occlusion stenosis cause increased detachment of plaque, as shown by higher percentages of macroscopic plaque captured by protection devices (18.5% vs. 7%, P=.01) and of perioperative ischaemic brain lesions (47% vs 31%, P = .07). At 30 days of follow-up, the tendency toward adverse neurological events (death, major and minor stroke) was higher in the near-occlusion group (9.2% vs. 3.2%, P=.08).
  
  
  CONCLUSIONS
  Stent revascularisation for near-occlusion carotid stenosis has a high procedural success rate; however, its higher plaque load was responsible for the increased rate of ischaemic brain lesions and adverse neurovascular events at 30 days post-procedure.
authors: Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena y Área, Sevilla, España. Electronic address: rjruizsalmeron@yahoo.es.
authors: R J
authors: RJ
authors: Ruiz-Salmerón
authors: M A
authors: MA
authors: Gamero
authors: C
authors: C
authors: Carrascosa
authors: S
authors: S
authors: Pérez
authors: D
authors: D
authors: de Araujo
authors: F
authors: F
authors: Marcos
authors: S
authors: S
authors: Rodríguez de Leiras
authors: M
authors: M
authors: Vizcaíno
authors: C
authors: C
authors: Caparrós
authors: G
authors: G
authors: Izquierdo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000473:pathology; D002339:Carotid Arteries / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D002548:Cerebral Revascularization; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015607:Stents
keywords: Cerebral infarction; Cerebrovascular circulation; Circulación cerebrovascular; Infarto cerebral; Revascularisation; Revascularización; Stent