Proximal protection with hybrid stent, a safer combination for carotid artery stenting against carotid endarterectomy?
OBJECTIVE
Carotid revascularization is an established theurapeutic modality in preventing stroke and death among patients with severe carotid stenosis. Although carotid endarterectomy remains as the primary option, carotid stenting is accepted as an alternative for patients with high risk for carotid endarterectomy. Recently published reports have better results with proximal protection devices when compared with distal protection devices. These studies have revealed less microembolic signals and less periprocedural new ischemic lesions on diffusion weighted magnetic resonance imaging. Stent choice may be also important for these procedures as open cell stent design has advantage of better flexibility whereas closed cell systems have an advantage of better scaffolding. Hybrid stents which are composed of open cells in the proximal and distal part and closed cells in the middle may carry both advantages. The aim of this study is to demonstrate whether combination of proximal protection devices with hybrid stents can be a safe alternative for carotid stenting in terms of periprocedural and 30-day outcomes.


METHODS
Here we retrospectively evaluated 68 symptomatic carotid stenosis patients undergoing carotid stenting with hybrid stent (Cristallo Ideale®, Invatec s.r.l., Medtronic, Italy) and proximal protection device (MO.MA®, Invatec s.r.l., Medtronic, Italy).


RESULTS
Our results showed only 1 minor stroke in the periprocedural period and during the first 30-day after stenting, with no death or myocardial infarction.


CONCLUSIONS
Although our case number is not large, we propose that carotid stenting may be safer with utilization of proximal protection system and hybrid type carotid stents.
Neurology Clinics, Ankara Numune Education and Research Hospital, Ankara, Turkey - erdemgurkas@yahoo.com.
E
E
Gürkaş
F
F
Ak
G
G
Orhan
E
E
Bozkurt
E K
EK
Ulusoy
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000295:instrumentation*; D000925:Anticoagulants / Q000008:administration & dosage; D017536:Carotid Artery, Common / Q000601:surgery*; D016893:Carotid Stenosis / Q000628:therapy*; D038524:Diffusion Magnetic Resonance Imaging; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome; D014654:Vascular Patency
D000925:Anticoagulants