Protective carotid stenting: Clinical advantages and complications of embolic protection devices in 424 consecutive patients: Cremonesi A, Manetti R, Setacci F, et al. Stroke 2003;34:1936-43

Abstract

ConclusionIn a series of 442 patients undergoing carotid angioplasty or stenting the overall neurologic complication rate was 2.5%, and complications related to the cerebral protection device occurred in 4 of 442 patients (0.9%). SummaryThe authors studied complications related to cerebral protection devices during angioplasty or stenting of the extracranial carotid artery in 442 patients who underwent percutaneous angioplasty or stenting of the extracranial carotid artery. Fifty-seven percent of the patients had no symptoms. Six different cerebral protection devices were used during this study. The three most commonly used devices were the Johnson & Johnson-Cordis Angioguard Filter (37.8%), the Boston Scientific FilterWire EX (25.1%), and the EV3 Microvena Trap Filter (18.9%).The procedure was successfully performed in 440 of 442 patients, with no periprocedural deaths. In 342 patients stents were placed. Three hundred thirty-nine of the stents were self-expanding. Predilation was performed with coronary balloons in 167 patients. The in-hospital stroke and death rate and 30-day ipsilateral stroke and death rate was 1.1%. Neurologic complications included four intracranial hemorrhages, one major stroke, four minor strokes, four transient ischemic attacks, and six instances of transient neurologic symptoms resulting from intolerance of occlusive protection devices, for a total neurologic complication rate of 2.5%. The overall procedure-related complication rate was 3.4%. There were four cerebral protection device–related complications, including one carotid dissection resulting in occlusion, one trapped guide wire requiring operative removal, and two instances of limited dissection. In the retrieved protection devices, 69% demonstrated visible plaque debris captured by the device. CommentThe data add to the growing trend of routine use of protection devices for carotid artery stenting. In an editorial accompanying this article, Drs Eckert and Zeumer, from Hamburg, Germany, note that the use of cerebral protection devices has occurred in conjunction with increased operator experience and improvements in guide wires, stents, and periprocedural anticoagulation regimens. While cerebral protection devices may contribute to improved results with carotid artery angioplasty or stenting, other facets of the procedure are also evolving and being improved.