Safety of Unprotected Carotid Artery Stent Placement in Symptomatic and Asymptomatic Patients: A Retrospective Analysis of 30-day Combined Adverse Outcomes

Abstract

Stent placement without EPD was performed with a high technical success rate. For asymptomatic patients, the combined 30-day adverse-outcomes rate was within the limits recommended by the American Heart Association for carotid endarterectomy and compared favorably with results reported for CAS with EPD. When a transient ischemic attack is excluded, the 30-day combined death and stroke rate among patients with prior symptoms also compared favorably with published results.

Evaluation of Fibrous Cap Rupture of Atherosclerotic Carotid Plaque with Thin-Slice Source Images of Time-of-Flight MR Angiography

“…7) Therefore, information concerning the condition of fi brous cap as well as the plaque composition should be included in the determination of treatment plan; carotid endarterectomy, carotid artery stenting, and medical treatment with lipid-lowering therapy. 5,7,12,[27][28][29][30]…”

Carotid Artery Stenting Without Embolic Protection Device: A Single-Center Experience

“…At the same time, studies on CAS without protection are few in the modern stent era or are a subanalysis of larger studies. [13][14][15][16][17][18][19] Our CAS experience began with the routine use of different types of distal filters in all procedures. After more than 200 filters were found empty on visual examination, we began doubting the role of the filter in our practice: was it fundamental to the success and the safety of our patients?…”

“…After more than 200 filters were found empty on visual examination, we began doubting the role of the filter in our practice: was it fundamental to the success and the safety of our patients? Supported by good results from other centers, [13][14][15][16][17][18][19] we decided to treat some selected patients without protection devices, initially selecting low risk plaques (restenosis) and progressing to different types of lesions.…”

“…Protection devices have been reported to protect against only 25% of embolisms related to the procedure. 19 Moreover, the evidence base for using EPDs is weaker in elderly patients as they have a higher risk of embolism and other complications due to vascular tortuosity and other risk factors. In this population, the use of any protection device has an added risk of embolism, which does not justify their routine use.…”

Unprotected carotid artery stenting in modern practice

“…A multinational registry analysis and a pooled meta‐analysis from nearly a decade ago seemed to validate this . However, more recent cohorts have shown low stroke rates with unprotected stenting, though these studies have been limited in size and scope . Hence, although EPD were recommended by expert opinion in consensus guidelines and used in 96% of patients in the most recent domestic randomized trial comparing CAS with carotid endarterectomy (CEA), outcomes data remain mixed .…”