Feasibility of carotid artery stenting with double cerebral embolic protection in high-risk patients.
BACKGROUND
Previous trials comparing carotid artery stenting (CAS) with carotid endarterectomy have shown that the former can increase the stroke rate. However, in the last years, because of the improvements either of the technique or the improvement of the stents and embolic protection devices (EPD), CAS has become a very competitive procedure. In this study, we tried to assess the feasibility and the safety of using double EPD (proximal and distal) in high-risk patients.


METHODS
We collected data about all consecutive patients with carotid artery stenosis who underwent CAS and compared clinical and procedural characteristics as well as immediate and 30-day outcomes between the use of double vs. single EPD.


RESULTS
Between November 2007 and August 2014, 294 patients underwent CAS. In 35 of them (11.9%) double EPD was used. In comparison with the patients treated with single EPD, those with double EPD presented more with acute carotid syndrome (recurrent TIAs < 48 hr, minor stroke < 14 days) and with complex plaque (79.4 vs. 33.6%, P < 0.0001). There was no difference between the 2 groups in primary success (100 vs. 99.6%, P = 0.16) and in 30-days major complications: death (0 vs. 0.8%, P = 0.6), major stroke (0 vs. 0.8%, P = 0.42), and minor stroke (0 vs 1.1%, P = 0.66).


CONCLUSIONS
In our experience, in high-risk patients with high-risk lesions, the use of double EPD (proximal and distal) is safe and effective in minimizing the risk of cerebral embolization, but, to validate such a technique in wide range of patients, further studies are warranted.
Department of Cardiology, Infermi Hospital, Rivoli, Italy.
Ferdinando
F
Varbella
Department of Cardiology, Infermi Hospital, Rivoli, Italy.
Andrea
A
Gagnor
Department of Cardiology, Infermi Hospital, Rivoli, Italy.
Cristina
C
Rolfo
Department of Cardiology, Infermi Hospital, Rivoli, Italy.
Enrico
E
Cerrato
Department of Cardiology, S. Ambrogio Clinical Institute, Milan, Italy.
Mario
M
Bollati
Department of Cardiology, Infermi Hospital, Rivoli, Italy.
Paolo
P
Giay Pron
Department of Cardiology, Infermi Hospital, Rivoli, Italy.
Massimo
M
Hartwig
Department of Cardiology, Infermi Hospital, Rivoli, Italy.
Sara
S
Palacio Restrepo
Department of Neurology, Infermi Hospital, Rivoli, Italy.
Monica
M
Reggiani
Department of Neurology, Infermi Hospital, Rivoli, Italy.
Salvatore
S
Amarù
Department of Neurology, Infermi Hospital, Rivoli, Italy.
Emilio
E
Luda di Cortemiglia
Department of Cardiology, Infermi Hospital, Rivoli, Italy.
Francesco
F
Tomassini
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D057505:Embolic Protection Devices; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
carotid revascularization; cerebrovascular diseases; peripheral artery disease