Non-protected carotid artery stenting for symptomatic carotid stenosis in low resource settings

Ayman H El-Sudany,Ahmed El-Bassiouny,Amr S Zaki,Rady Y Bedros,Shady S Georgy

doi:10.1186/s41983-021-00330-3

Abstract

BackgroundThe use of a distal cerebral protection device during extracranial carotid artery stenting is still a matter of debate. The aim of this work was to evaluate the safety of performing carotid artery stenting procedure without the use of cerebral protection device in patients with symptomatic carotid stenosis. A retrospective study was performed during the period from September 2015 till March 2020 including 91 patients with symptomatic carotid artery stenosis. All patients were treated with a single stent type (Wall stent® - Boston scientific) without the use of cerebral protection device. Pre- and post-procedural clinical assessment with the national institute of health stroke scale (NIHSS). Post procedure brain diffusion-weighted magnetic resonance imaging (DW-MRI) if clinically indicated within 24 h was used to determine periprocedural cerebral embolization.ResultsA low complication rate was found as only one case (1%) showed mild deterioration in NIHSS and new acute cerebral emboli were detected with brain DW-MRI.ConclusionCarotid artery stenting can be performed safely without the use of cerebral protection device.

Highlights

The use of a distal cerebral protection device during extracranial carotid artery stenting is still a matter of debate
The patients were chosen according to the carotid duplex findings if the stenosis is greater than 50% with confirmation of degree of stenosis during the diagnostic phase of the digital subtraction angiography as it should be greater than 50% to proceed for the stenting procedure
The study included ninety-one patients who underwent ninety-one Carotid artery stenting (CAS) procedures without the use of Cerebral protection device (CPD) .The baseline characteristics and risk factors of the patients are shown in Tables 1 and 2

Summary

Introduction

The use of a distal cerebral protection device during extracranial carotid artery stenting is still a matter of debate. The aim of this work was to evaluate the safety of performing carotid artery stenting procedure without the use of cerebral protection device in patients with symptomatic carotid stenosis. A retrospective study was performed during the period from September 2015 till March 2020 including 91 patients with symptomatic carotid artery stenosis. Many reviews and meta-analyses showed that the rate of ipsilateral stroke and death was less in patients treated with CAS and protection devices [3, 4]. In a recent meta-analysis, the usage of CPD reduced the rate of symptomatic stroke after CAS; in patients with symptomatic lesions, its efficacy was not much obvious and its routine usage during the procedure should be assessed well before mandatory usage [10]

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