Thirty-day outcomes of direct carotid artery stenting with cerebral protection in high-risk patients
Abstract
Background Implantation of a carotid artery stent after predilation is a standard approach in the endovascular treatment of carotid artery stenoses. Stenting without predilation may be an alternative approach in a certain subset of patients.
The present prospective, single-center registry was designed to evaluate the feasibility and safety of direct carotid artery stenting (DCAS) in high-risk patients. Methods and Results Symptomatic patients with stenosis > 50% and asymptomatic patients with stenosis > 70% were eligible for enrolment.
Criteria for high-risk patients included: need or history of open heart surgery, history of myocardial infarction, multivessel coronary artery disease, left ventricular dysfunction (ejection fraction <= 40%), severe pulmonary or renal disease, significant contralateral carotid disease, previous endarterectomy, and age :80 years. All procedures were performed using a filter protection device.
Patients underwent complete clinical examination before and after DCAS and at 30-day follow-up. A total of 83 consecutive patients (45 males, 68 9 years, 33% symptomatic) underwent 100 procedures and 103 stents were deployed successfully.
The technical success rate of stenting was 100%. Predilation of carotid stenosis was necessary in 1 (1%) procedure.
Carotid-artery stenoses before and after DCAS were 80 +/- 9% and 7 +/- 9%, respectively. The median fluoroscopic time for DCAS was 7 min., The overall rate of in-hospital major adverse cerebrovascular events (death, stroke, myocardial infarction) was 5% (2 minor strokes, 3 transient attacks).
There was 1 (1%) minor stroke within the 30-day follow-up. Conclusion DCAS is feasible and can be per-formed with an acceptable risk in high-risk patients.