Improved carotid artery stenting (CAS) results are credited to the development of embolic protection devices (EPDs). Reported are outcomes and technical failures of two classes of EPDs: distal balloon occlusion and distal filtration. We present a retrospective review of 206 CAS procedures from April 2001-September 2005. Filters (AccuNet, Angioguard, Filterwire, or Emboshield) were used in 98 cases (48%), distal balloon occlusion (PercuSurge) in 94 (46%), and no protection in 14. Data include demographics and procedural records. Mean age was 70 years (76% men, 24% women). At 30 days, there were no deaths, no myocardial infarctions, two major ipsilateral strokes (1%), two minor posterior strokes (1%), four transient ischemic attacks (2%), and one major access site complication (0.5%). Major neurologic events were equally divided between balloon occlusion and filters. Mean balloon occlusion time was 12 min, with only two patients (2%) manifesting reversible neurologic intolerance during flow arrest. In the last 100 cases, filter devices were preferentially used due to preserved antegrade flow. However, 11 cases (11%) necessitated intraoperative switching to balloon occlusion because of either extreme tortuosity or severe stenosis of the target lesion precluding passage of the filter element. CAS-specific equipment has improved procedural results. Despite theoretic advantages of filter EPDs, up to 10% of lesions are either too narrow or tortuous to allow safe passage of the filter element. Switching to a distal balloon occlusion system, which is well tolerated, may be preferred to unprotected predilation. Practitioners of CAS should be versed in both.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine