E-105 Carotid stenting without embolic protection devices is safe: a single-center experience

Abstract

Background and purpose One of the main procedural complications with carotid artery stenting (CAS) is intra-procedural dislodgement of atheromatous plaque. Performing the procedure using a distal embolic protection device is believed to minimize the risk of cerebral embolisms and subsequent ischemic stroke. The purpose of this study to share our experience with CAS without using distal embolic protection devices. Method We performed a retrospective chart review of 102 percutaneous stenting and/or angioplasty procedures involving the extracranial carotid artery performed at our institution between January 2012 and April 2018. Ninety-Five patients underwent the procedure without the use of a distal embolic protection device. Baseline, procedural and follow-up data were prospectively collected. Technical success rate, stroke/death/myocardial infarction rate at 30 days, access-site complications, and long term follow up outcome were collected. Results All procedures were performed on patients with symptomatic carotid stenosis except one procedure which was performed on a patient with recurrent severe stenosis post carotid endarterectomy (CEA). Carotid artery percutaneous stenting and/or angioplasty was successful in 94 procedures (94%). There were no minor strokes or TIAs. Major adverse events in the peri-procedural period (0–30 days) occurred in two patients (2%), and there was one death (1%) secondary to a large intracerebral hemorrhage in a patient with hyperperfusion syndrome. One patient (1%) suffered a myocardial infarction (NSTEMI) as well as a major stroke due to acute in-stent thrombosis with complete occlusion of the stent 3 days after CAS. Three patients (3%) sustained access related complications: one patient required a blood transfusion. During the follow-up period, (range: 0 to 60 months) there were 6 deaths: 1 patient due to a massive ipsilateral stroke 8 days after a failed attempt at CAS; 2 patients died secondary to myocardial infarction, 3 patients died of non-neurological causes. Conclusion Our results of carotid artery stenting and/or angioplasty without using a distal embolic protection device demonstrates high feasibility and safety without an increased risk of intraprocedural/periprocedrual ipsilateral ischemic stroke. Disclosures N. Alharbi: None. M. Alwadai: None. A. Martyniuk: None. A. Aljuzair: None. A. Algird: None. B. Van Adel: None.