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.
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.
Authors: P A Ringleb; J Allenberg; H Brückmann; H-H Eckstein; G Fraedrich; M Hartmann; M Hennerici; O Jansen; G Klein; A Kunze; P Marx; K Niederkorn; W Schmiedt; L Solymosi; R Stingele; H Zeumer; W Hacke Journal: Lancet Date: 2006-10-07 Impact factor: 79.321
Authors: Alan S Go; Dariush Mozaffarian; Véronique L Roger; Emelia J Benjamin; Jarett D Berry; Michael J Blaha; Shifan Dai; Earl S Ford; Caroline S Fox; Sheila Franco; Heather J Fullerton; Cathleen Gillespie; Susan M Hailpern; John A Heit; Virginia J Howard; Mark D Huffman; Suzanne E Judd; Brett M Kissela; Steven J Kittner; Daniel T Lackland; Judith H Lichtman; Lynda D Lisabeth; Rachel H Mackey; David J Magid; Gregory M Marcus; Ariane Marelli; David B Matchar; Darren K McGuire; Emile R Mohler; Claudia S Moy; Michael E Mussolino; Robert W Neumar; Graham Nichol; Dilip K Pandey; Nina P Paynter; Matthew J Reeves; Paul D Sorlie; Joel Stein; Amytis Towfighi; Tanya N Turan; Salim S Virani; Nathan D Wong; Daniel Woo; Melanie B Turner Journal: Circulation Date: 2013-12-18 Impact factor: 29.690
Authors: Hans-Henning Eckstein; Peter Ringleb; Jens-Rainer Allenberg; Jürgen Berger; Gustav Fraedrich; Werner Hacke; Michael Hennerici; Robert Stingele; Jens Fiehler; Hermann Zeumer; Olav Jansen Journal: Lancet Neurol Date: 2008-09-05 Impact factor: 44.182
Authors: A Mathur; G S Roubin; S S Iyer; C Piamsonboon; M W Liu; C R Gomez; J S Yadav; H D Chastain; L M Fox; L S Dean; J J Vitek Journal: Circulation Date: 1998-04-07 Impact factor: 29.690
Authors: Gary M Ansel; L Nelson Hopkins; Michael R Jaff; Paolo Rubino; J Michael Bacharach; Dierk Scheinert; Subbarao Myla; Tony Das; Alberto Cremonesi Journal: Catheter Cardiovasc Interv Date: 2010-07-01 Impact factor: 2.692
Authors: H J Barnett; D W Taylor; M Eliasziw; A J Fox; G G Ferguson; R B Haynes; R N Rankin; G P Clagett; V C Hachinski; D L Sackett; K E Thorpe; H E Meldrum; J D Spence Journal: N Engl J Med Date: 1998-11-12 Impact factor: 91.245