Carotid artery stenting without post-stenting balloon dilatation

Abstract

PurposeTo evaluate the clinical outcome and MRI findings after carotid artery stenting (CAS) without post-dilatation.MethodsBetween May 2005 and April 2012, a total of 169 consecutive patients (61.4% symptomatic) underwent 176 CAS procedures performed with an embolic protection device (GuardWire, n=116; FilterWire EZ, n=60). All stents were deployed without post-dilatation. Periprocedural complications and mid-term outcomes were analyzed.ResultsThe stroke rate was 2.3% within 30 days post-CAS (asymptomatic patients 1.5%; symptomatic patients 2.8%). Cerebral infarction occurred in one asymptomatic patient (1.5%) and one symptomatic patient (0.9%). Intracranial hemorrhage occurred in two symptomatic patients (1.9%). Post-CAS diffusion-weighted imaging (DWI) revealed a high-intensity area in 26 of 176 procedures (14.8%). Ipsilateral stroke after 31 days occurred in two patients (1.1%) and restenosis occurred in six (3.4%). A post-CAS comparison of the embolic protection devices revealed no difference in stroke incidence within 30 days and in DWI high-intensity area.ConclusionsOur CAS procedure without post-dilatation is feasible, safe and associated with a low incidence of stroke and restenosis.

Optical coherence tomography guided carotid artery stent procedure: technique and potential applications

“…In 3 of 40 patients (7.5%) undergoing OCT imaging, no postdilatation was performed because adequate stent‐expansion was visualized. The risk of embolization and hemodynamic perturbation associated with high‐pressure balloon postdilatation was avoided . The remainder of the 37 patients (92.5%) had postdilatation performed with balloon sizing based upon OCT guidance (5.0 × 20 mm n = 30, 5.5 × 20 mm n = 7).…”

Carotid Artery Stenting in a Patient With Sinus Bradycardia: Clinical Case

“…Определенные опасения вызывала воз-можность повышения частоты такого отдаленного осложнения КАС, как рестеноз в стенте. Анализ опыта центров не дает однозначных данных, однако значи-мые рестенозы после КАС наблюдались с небольшой частотой (3,4-4,3%), чаще оставались неврологиче-ски бессимптомными и легко выявлялись при выпол-нении неинвазивного УЗ-исследования, что позволяло рассматривать их как относительно «доброкачествен-ное» осложнение [7,9,10]. Исключением стали на-блюдения Hung и соавт., согласно которым наличие рестеноза было ассоциировано с повышением часто-Ишемические микроочаги в головном мозге при стентировании сонных артерий той инсульта, однако их исследование отличалось вы-сокой частотой послеоперационных осложнений и включало тяжелых пациентов с анамнезом лучевой те-рапии [11].…”

Selective-versus-Standard Poststent Dilation for Carotid Artery Disease: A Systematic Review and Meta-Analysis

“…However, to the best of our knowledge, there is no evidence in the recently published literature supporting the superiority of either of these techniques. Standard poststent balloon angioplasty has become the standard of care in many vascular centers, [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] and only some interventionalists 19, [36][37][38][39][40][41] prefer performing poststent angioplasty on a selective base. On the basis of the latter studies, standard poststent balloon angioplasty may be associated with additional risks in patients with acceptable angiographic results, without additional post-carotid artery stent placement (CAS) angioplasty.…”