Carotid Revascularization with and without the Use of an Embolic Protection Device: A Single-Center Experience from Pakistan

Abstract

Background: To assess the safety and clinical efficacy of carotid artery stenting with and without an embolic protection device (EPD) in both symptomatic and asymptomatic carotid disease cases. Methods: Retrospective data of 55 symptomatic (≥50% occlusion by digital subtraction angiography [DSA], ≥70% by ultrasound, computed tomography angiography [CTA], and magnetic resonance angiography [MRA]) and asymptomatic (≥60% by DSA, ≥70% by ultrasound, ≥80% by CTA and MRA) carotid disease cases undergoing carotid stenting/angioplasty revascularization from February 2014 to October 2017 was reviewed. All symptomatic patients either experienced recurrent transient ischemic attacks or one or more stroke attacks. An EPD protocol was designed for its selective use based on plaque morphologies and working diameters. The primary end points at 30 days of follow-up were a periprocedural incidence of any stroke, myocardial infarction or death, and ipsilateral stroke during the follow-up period. Results: Of the 55 cases, 39 were males and 16 females; mean age was 64.8 years. Fifty-one patients (92.7%) were symptomatic, with a mean stenosis of 80.1%. EPD was used in only 11 cases (20%). Minor stroke rate during the first 30 postoperative days was 1.8% (1 case) with EPD; no myocardial infarction or mortality. No stroke occurred during the median 1.5 years’ follow-up. Conclusion: Based on our single-center experience and findings of a relatively small sample size, carotid revascularization with stenting and angioplasty without EPD in experienced hands was found to be safe and efficacious. In addition, it proves cost-effective for patients by limiting the use of unnecessary disposables. These results are comparable to those reported in major trials and are well within the complication thresholds suggested in current guidelines. These results also show promise and illustrate the need for a larger, randomized controlled trial in order to thoroughly address this aspect of carotid revascularization.

Carotid Artery Stenting Using the Walrus Balloon Guide Catheter With Flow Reversal for Proximal Embolic Protection: Technical Description and Single-Center Case Series

“…Furthermore, current evidence suggests that particles smaller than the micropores of the distal filters cannot be prevented from passing through. 2,3,[12][13][14][15] Therefore, proximal flow control (arrest or reversal) is crucial to ensure safe crossing of the plaque. 3,15 A combination of proximal flow control and distal filters, a technique that has been described as "seat belt and airbag," can also be used depending on the operator's preference, institution's standard of care, and the lesion's characteristics.…”

“…KEY WORDS: Carotid artery, Stenting, Carotid stenosis, Balloon guide catheter, Embolic protection Operative Neurosurgery 24: [11][12][13][14][15][16]2023 https://doi.org/10.1227/ons.0000000000000442 C arotid artery stenting (CAS) is an established modality of treatment for extracranial carotid artery disease in patients with high surgical risk or lesions posing difficult anatomic access for carotid endarterectomy (CEA). 1 The risk of periprocedural stroke in CAS has decreased over the years with the advent of different embolic protection methods.…”