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. Conclusion: 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.

Hybrid surgery versus endovascular intervention for patients with chronic internal carotid artery occlusion: A single-center retrospective study

“…We accessed electronic medical records to evaluate eligibility and collected perioperative data from eligible subjects. An increase in NIHSS score of more than 3 points were classified as major stroke (11,12). Patients with severe system disease who could not tolerate surgery and anesthesia were excluded.…”

Transcervical access, reversal of flow and mesh-covered stents: New options in the armamentarium of carotid artery stenting

“…Furthermore, due to the rigidity of many filter devices and a required minimal distal landing zone depending on the length of the basket of the filter device, the vessel wall apposition may not be optimal (especially in tortuous vessel segments) and could therefore allow cerebral embolization[12]. These studies have supported that, compared with distal EPDs, proximal EPDs reduce the perioperative microembolic signals detected by transcranial Doppler and the number of new ischemic lesions[6-9]. …”

“…Up to 90% of CAS procedures can be complicated by embolic events and EPDs may capture these embolized particles[ 2 ]. Although some studies report good outcomes for various distal EPDs (also known as filtering devices)[ 3 - 5 ], others studies argue that distal filters may not be able to prevent all perioperative emboli[ 6 - 9 ]. The pore size of most available filter devices is > 80 μm[ 3 ], but many emboli are < 80 μm in size[ 10 , 11 ].…”

Imaging Identification and Prognosis of the Distal Internal Carotid Artery With Near and Complete Occlusion After Recanalization

“…Drug therapy is still the preferred treatment in treating carotid ICANO and ICACO, but ischemic symptoms refractory to medical therapy are an indication for revascularization (5)(6)(7). Both carotid endarterectomy (CEA) and endovascular intervention (EI) with a proximal embolic protection device have achieved satisfactory results for ICANO (8). As for ICACO, hybrid surgery is a feasible and effective surgical method, which combined CEA, immediate intraoperative angiography, and EI in a hybrid operating suite (7,9).…”