Carotid Stenting without Use of Balloon Angioplasty and Distal Protection Devices: Preliminary Experience in 100 Cases

Abstract

BACKGROUND AND PURPOSE:A major concern during carotid artery stent placement is the potential for cerebral embolism. Diminishing the number of device manipulations across the lesion might reduce procedural stroke risk. For this purpose, we report our initial experience with carotid stent placement without the use of either balloon angioplasty or distal protection devices.

Predictors and Timing of Hypotension and Bradycardia after Carotid Artery Stenting

“…Because balloon dilation has also been incriminated for embolisms occurring during CAS, some authors have suggested the performance of carotid stent placement without deliberate use of angioplasty. 22,23 In our series, the stenosis severity was marginally associated with hypotension and bradycardia requiring drug intervention. This association was independent of the aggressiveness of the dilation performed during the procedure.…”

Unprotected Carotid Artery Stenting in Symptomatic Patients with High-Grade Stenosis: Results and Long-Term Follow-Up in a Single-Center Experience

“…10 On the other hand, several uncontrolled reports have shown excellent results in patients treated by unprotected stent placement techniques. [11][12][13][14][15] We performed a study to assess the safety and efficacy of unprotected CAS. The aim of this study was to establish the cumulative incidence of stroke, death, or myocardial infarction within 30 days after the procedure and at 1-year follow-up.…”

Decreased Cerebral Perfusion in Carotid Artery Stenosis, Carotid Angioplasty and Its Effects on Cerebral Circulation

“…They demonstrated an average r e d u c t i o n o f s t e n o s i s f r o m 7 9 % t o 2 1 % immediately after stent release, and in some cases, there was an almost complete opening of the stent. In most cases, however, the stent opening occurred gradually over time with an average final stenosis of 15% at the 6-month radiographic evaluation (Maynar et al, 2007).…”

“…Maynar et al (2007) published a series of 100 cases where neither the protection system nor balloon angioplasty was used. They demonstrated an average r e d u c t i o n o f s t e n o s i s f r o m 7 9 % t o 2 1 % immediately after stent release, and in some cases, there was an almost complete opening of the stent.…”

“…In this group, intra-stent angioplasty (post-dilatation balloon) was used only when the residual stenosis post-stenting did not change compared with the degree of stenosis before the stent placement; intra-stent angioplasty was also used when the residual stenosis was greater than 30%. The force of an self-expanding stent alone can dilate severely stenosed carotid (Lownie et al, 2005), and as the dilation is gradual, it may function protectively against hemorrhagic reperfusion (Maynar et al, 2007). Fig.…”