Abstract No. 596 Safety and efficacy of dual-layered carotid stent (C guard, Inspire MD) without distal embolic protection device

Purpose: To evaluate the safety and efficacy of carotid artery stenting (CAS) performed without an embolic protection device (EPD) in a selected group of asymptomatic patients with primary internal carotid artery (ICA) stenosis or restenosis after carotid endarterectomy (CEA). Materials and Methods: Between May 2015 and May 2018, 77 patients (mean age 77 years; 60 men) underwent CAS without any embolic protection device. Forty-seven (61%) patients had primary ICA stenosis and were excluded from CEA because of high surgical risk; the other 30 (39%) patients had post-CEA restenosis (n=26) or a distal ICA flap after eversion CEA (n=4). The mean ICA stenosis was 82%. All procedures were performed from a femoral artery access. Pre- and/or postdilation were used in 64 patients. The primary outcome was the incidence of major complications (death, stroke, or myocardial infarction) during the procedure and within 30 days; the secondary outcome was the incidence of restenosis in follow-up. Results: No relevant bradycardia was encountered during CAS. The combined rate of stroke, death, or myocardial infarction at 30 days was 1.3%. The single stroke patient recovered fully after 2 months. Over a follow-up that ranged to 3 years (mean 24±18 months), no further neurological events were recorded. One (1.3%) patient had a >70% restenosis after 6 months; the lesion was dilated, successfully restoring the lumen contour. Conclusion: In our series, endovascular treatment of carotid stenosis without the use of protection devices in patients with primary stenosis or postsurgical restenosis can achieve satisfactory safety and efficacy outcomes. The choice of performing CAS without using EPDs should follow a tailored approach based on the appropriate patient anatomy and specific clinical parameters to minimize neurological complications.

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Captured Macro-embolus of Fractured Atheromatous Plaque by the Embolic Protection Device during Carotid Stent Assisted Angioplasty

Neurointervention ◽

10.5469/neuroint.2013.8.1.52 ◽

2013 ◽

Vol 8 (1) ◽

pp. 52

Author(s):

Mun Chul Kim ◽

Shelby Bennett ◽

Richard Farb ◽

Sydney Croul ◽

Seon-Kyu Lee

Keyword(s):

Atheromatous Plaque ◽

Protection Device ◽

Carotid Stent ◽

Embolic Protection Device ◽

Embolic Protection

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TRENDS AND SHORT-TERM OUTCOMES WITH THE USE OF CEREBRAL EMBOLIC PROTECTION DEVICE IN PATIENTS UNDERGOING TAVR

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02525-0 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1166

Author(s):

Aaqib Malik ◽

Syed Zaid ◽

Alexandros Briasoulis ◽

Tomo Ando ◽

Steven Lansman ◽

...

Keyword(s):

Protection Device ◽

Short Term ◽

Embolic Protection Device ◽

Embolic Protection

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Ostial common carotid artery occlusion and balloon-mounted stenting: Implication of embolic protection device in tandem lesion

Radiology Case Reports ◽

10.1016/j.radcr.2021.06.071 ◽

2021 ◽

Vol 16 (9) ◽

pp. 2783-2786

Author(s):

Takashi Mizowaki ◽

Atsushi Fujita ◽

Jun Imura ◽

Masahiro Nakahara ◽

Hirotomo Tanaka ◽

...

Keyword(s):

Carotid Artery ◽

Common Carotid Artery ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Protection Device ◽

Embolic Protection Device ◽

Embolic Protection ◽

Common Carotid Artery Occlusion

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Abstract P540: Safety of Carotid Artery Stenting Without Embolic Protection: A Single Centre Experience

Stroke ◽

10.1161/str.52.suppl_1.p540 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Christine Hawkes ◽

Aviraj Deshmukh ◽

Brian van Adel

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Atheromatous Plaque ◽

Stroke Rate ◽

Protection Device ◽

Single Centre ◽

Stent Occlusion ◽

Embolic Protection Device ◽

Embolic Protection

Introduction: One of the most feared complications of carotid revascularization, including carotid artery stenting (CAS), is peri-procedural ischemic stroke. Several studies suggest that the use of a distal embolic protection device (EPD), as well as over-sized pre- and post-stenting balloon angioplasty, may increase the risk of dislodgement of atheromatous plaque in patients undergoing CAS. The CREST trial, that mandated the use of an EPD, had a peri-procedural ischemic stroke rate of 4.1%. We hypothesize that our technique of stenting without the use of an EPD and sub-maximal angioplasty will have a low risk of peri-procedural complications. Methods: A retrospective review was conducted of consecutive cases of ICA stenting without use of an embolic protection device between January 2012 and June 2020 at a Canadian stroke centre. Data was extracted from the patient electronic medical record and Picture Archives and Communications Systems (PACS). Both symptomatic and asymptomatic CAS cases were included. Results: A total of 220 patients were included in the study, with a median age of 70 years (range 39-93 years), and 83 patients (38%) were female. The vast majority of patients were symptomatic (216 patients [98%]). A large portion of patients had a contralateral ICA occlusion or near occlusion (56 patients [25%]). In the majority of cases, a Precise Cordis RX carotid stent (Cordis) was placed. There were four patients with peri-procedural ischemic strokes (1.8%), with two occurring 8-30 days after stenting. There was one case of acute stent occlusion associated with an ischemic stroke. Two patients (less than 1%) had hyperperfusion syndrome after CAS. Median length of stay following the procedure was one day. Conclusions: In this single centre series, the peri-procedural risks of CAS without using an EPD are low. The ischemic stroke rate is less than 2%, lower than what has been reported in large randomized controlled trials using embolic protection.

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