Carotid stenting with distal balloon protection: technical considerations (preliminary experience)

Abstract

Background and purpose: Most peri-procedural neurological events associated with carotid angioplasty and stenting are due to cerebral embolization. This study was undertaken to determine the safety and efficacy of the distal balloon protection using Guard Wire® temporary occlusion and aspiration system (PercuSurge) in patients with obstructive carotid stenosis during carotid stenting. Methods: A total of 90 patients underwent carotid artery stenting with distal balloon protection. Stenting was performed using coaxial system with 6F-90 cm sheath through femoral approach, pre-dilatation, placement of the stent and stent dilatation. Patients were pre-treated with anti-platelet medication. Results: In our more recent experience with 465 stented carotid arteries without distal protection, the complication rate was 4.5% (including two retinal emboli and two hyperperfusion syndromes). In symptomatic patients <80 years of age the complication rate was 3.5%, while in asymptomatic patients >80 years of age the complication rate was 3%. In symptomatic and asymptomatic patients >80, the complication rate was unacceptable, at 21% and 12%, respectively. With distal balloon protection, the complication rate in patients >80 decreased to 3.7%. Balloon protection placement was successful in all patients. Conclusion: The application of distal balloon protection system in carotid stenting was associated with favorable immediate and short-term outcome especially among patients >80 years of age.