Carotid Artery Stenting without Angioplasty and Cerebral Protection: A Single-Center Experience with up to 7 Years' Follow-Up

• Published in: American journal of neuroradiology : AJNR Vol. 32; no. 4; pp. 759 - 763
• Main Authors: BALDI, S, ZANDER, T, RABELLINO, M, GONZALEZ, G, MAYNAR, M
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL American Society of Neuroradiology 01-04-2011
• Series: Fellows' Journal Club
• Subjects: Adult; Adult and adolescent clinical studies; Aged; Aged, 80 and over; Biological and medical sciences; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - mortality; Carotid Stenosis - therapy; Cerebral Angiography; Cerebral Revascularization - adverse effects; Cerebral Revascularization - methods; Cerebral Revascularization - mortality; Female; Follow-Up Studies; Humans; Incidence; Interventional; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Miscellaneous; Mood disorders; Nervous system; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Recurrence; Risk Factors; Stents - adverse effects; Stroke - mortality; Time Factors; Treatment Outcome; Experience; Nervous system diseases; Radiodiagnosis; Blood vessel; Carotid; Central nervous system; Instrumental dilatation; Circulatory system; Protection; Artery; Encephalon
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A2375

The use of cerebral protection during CAS in the treatment of carotid artery disease is matter of controversy. The purpose of this study was to evaluate the outcome of CASWBAP in a large cohort of patients, with ≤7 years' follow-up.
Two hundred thirty-six patients with 255 symptomatic carotid stenoses and/or with high-risk-morphology plaques of >50% and asymptomatic plaques of >70% were prospectively identified. Patients underwent neurologic and carotid US examination before the procedure and during follow-up at 1, 3, 6, and 12 months and annually thereafter. Plain films of the neck were obtained immediately after the procedure and then at 1 and 3 months.
Technical success was achieved in 253/255 (99%) patients. Primary stent placement was successful in 248/253 (98%) patients. Neurologic periprocedural complications within 30 days included 1 (0.4%) nondisabling stroke, 1 (0.4%) disabling stroke, 11 (4.3%) TIAs, and 1 (0.4%) death. The mean duration of follow-up was 23 ± 1.4 months (range, 3-84 months). During the follow-up period, there were 9 additional deaths (7 unrelated to the carotid disease and 2 stroke-related) and 2 strokes (in other vascular territories). The degree of stenosis decreased from a mean of 82% before the procedure to a mean of 30% immediately after. During follow-up, 38 (14.8%) angioplasties were performed due to restenosis in 19 (7.4%) patients, lack of stent expansion in 14 (5.4%), or both in 5 (1.9%).
CASWBAP is effective and safe with a low incidence of periprocedural complications, providing satisfactory long-term clinical results.