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

Stroke ◽  
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.

FiberNet-A new embolic protection device for carotid artery stenting

2013 ◽  
Vol 83 (6) ◽  
pp. 1014-1020 ◽  
Author(s):  
C. Bauer ◽  
J. Franke ◽  
S.C. Bertog ◽  
V. Woerner ◽  
S. Ghasemzadeh-Asl ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Protection Device ◽  
Embolic Protection Device ◽  
Embolic Protection

scholarly journals Letter by de Castro-Afonso et al Regarding Article, “Operator’s Experience Is the Most Efficient Embolic Protection Device for Carotid Artery Stenting”

2014 ◽  
Vol 7 (1) ◽  
pp. 130-130
Author(s):  
Luis Henrique de Castro-Afonso ◽  
Lucas Giansante Abud ◽  
Jaicer Gonçalves Rolo ◽  
Antônio Carlos dos Santos ◽  
Lívia de Oliveira ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Protection Device ◽  
Embolic Protection Device ◽  
Embolic Protection

scholarly journals A case of tandem stenoses at the proximal common and internal carotid arteries treated with transbrachial stenting: a case report

2018 ◽  
Vol 25 (2) ◽  
pp. 225-229
Author(s):  
Hidemichi Ito ◽  
Masashi Uchida ◽  
Taigen Sase ◽  
Yuichiro Kushiro ◽  
Tetsuya Ikeda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Common Carotid Artery ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Protection Device ◽  
Embolic Protection Device ◽  
Embolic Protection ◽  
Carotid Stenoses ◽  
The Common

The transfemoral approach is a common technique for carotid artery stenting. However, it has the risk of distal embolism when stenting for a stenosis of the proximal common carotid artery because of poor stability of the guiding catheter resulting in difficulty in setting the embolic protection device prior to stenting. We present a novel therapeutic approach and technique for the treatment of tandem carotid stenoses including the proximal common carotid artery. A 63-year-old man presented with double stenoses at the common carotid artery and internal carotid artery. We used a transbrachial sheath guide that had a 6 Fr (2.24 mm, 0.088 inch) internal diameter and was 90 cm long, and was specifically designed for direct cannulation to the common carotid artery, like a modified Simmons catheter. Because the sheath guide positioned in the aortic arch made it possible to introduce safely the embolic protection device distal to the internal carotid artery stenosis without touching the plaque at the stenosis with no use of any coaxial catheters or guidewires, carotid artery stenting for tandem stenoses could be successfully carried out. The postoperative course was uneventful. In carotid artery stenting, especially for stenosis of the proximal common carotid artery, the sheath guide designed for transbrachial carotid cannulation was useful in stenting the tandem carotid stenoses.

First clinical experience with the GARDEX EPD: a novel embolic protection device for carotid artery stenting

2013 ◽  
Vol 8 (9) ◽  
pp. 1026-1032
Author(s):  
Martin Werner ◽  
Dierk Scheinert ◽  
Raffaello Borghesi ◽  
Alberto Cremonesi ◽  
Uri Rosenschein ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Clinical Experience ◽  
Carotid Artery Stenting ◽  
Protection Device ◽  
Embolic Protection Device ◽  
Embolic Protection

scholarly journals Carotid Artery Stenting Without Embolic Protection Device: A Single-Center Experience

2018 ◽  
Vol 26 (1) ◽  
pp. 121-127 ◽  
Author(s):  
Luca Garriboli ◽  
Gianguido Pruner ◽  
Tommaso Miccoli ◽  
Andrea Recchia ◽  
Paolo Tamellini ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Secondary Outcome ◽  
Protection Device ◽  
Safety And Efficacy ◽  
Embolic Protection Device ◽  
Embolic Protection ◽  
Ica Stenosis

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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