title: Safety Outcomes Using a Proximal Protection Device in Carotid Stenting of Long Carotid Stenoses.
abstract: BACKGROUND
  Embolic protection devices can prevent atherosclerotic emboli during carotid stenting. Newer proximal protection devices reverse flow in the internal carotid artery (ICA), leading to reduction in perioperative microemboli. The risk of stroke is high for carotid stenting of ICA lesions with a length >10 mm and/or angiographic string sign.
  
  
  OBJECTIVE
  We aimed to evaluate the safety outcomes of proximal embolic protection device usage in this high-risk group.
  
  
  METHODS
  This is a retrospective analysis of patients who underwent carotid stenting procedures with proximal embolic protection devices at a tertiary care center. High-risk features for adverse events with carotid stenting were identified. Peri- and postprocedural outcomes were recorded. We further compared outcomes in patients with a carotid stenosis length >10 mm to those with shorter stenosis.
  
  
  RESULTS
  From January 2011 to December 2014, we included 27 patients; 96.3% were symptomatic and 3.7% were asymptomatic. There was a stent placement technical success rate of 100%. No major stroke or coronary events were recorded. One minor stroke event developed in one patient. A carotid lesion length >10 mm and/or angiographic string sign was noted in 21/27 patients, with an average lesion length of 14.4 mm. One patient (4.8%) in this group developed a minor stroke event. Neither a coronary nor a major stroke event was recorded in this group. There was no significant difference in the complication rate between the long lesion and the control group.
  
  
  CONCLUSIONS
  In our patient cohort, it was found that a proximal embolic protection device is safe for patients with carotid stenosis, including those with a carotid lesion length >10 mm and/or angiographic string sign.
authors: Interventional Division, Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA.
authors: Kunakorn
authors: K
authors: Atchaneeyasakul
authors: Interventional Division, Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA.
authors: Priyank
authors: P
authors: Khandelwal
authors: Interventional Division, Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA.
authors: Sudheer
authors: S
authors: Ambekar
authors: Interventional Division, Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA.
authors: Kevin
authors: K
authors: Ramdas
authors: Interventional Division, Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA.
authors: Luis
authors: L
authors: Guada
authors: Interventional Division, Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA.
authors: Dileep
authors: D
authors: Yavagal
keywords: Carotid stenosis; Carotid stent; Microemboli; Proximal protection; Stroke