Key result
Carotid stenting without cerebral protection is linked to a 1% rate of acute cerebral emboli.
Why the study?
The safety of performing carotid artery stenting without the use of a distal cerebral protection device in symptomatic carotid stenosis patients remains debated.
Does carotid artery stenting without a cerebral protection device maintain safety in patients with symptomatic carotid stenosis?
Cohort (n=91)
Single-blind
No
Does carotid artery stenting without a cerebral protection device maintain safety in patients with symptomatic carotid stenosis?
Carotid artery stenting without a distal cerebral protection device may be performed safely with a low periprocedural complication rate, which is relevant for low-resource settings.
May support unprotected CAS evaluation in low-resource settings; leaves open need for randomized confirmation of safety.
Background 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. 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. Results A 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. Conclusion Carotid artery stenting can be performed safely without the use of cerebral protection device.
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El-Sudany et al. (2021) conducted a cohort in Symptomatic carotid artery stenosis (n=91). Carotid artery stenting without cerebral protection device was evaluated on Periprocedural cerebral embolization (clinical deterioration on NIHSS and new acute cerebral emboli on DW-MRI within 24 hours). Carotid artery stenting performed without a cerebral protection device was associated with a low periprocedural complication rate, with only 1% of patients showing new acute cerebral emboli and mild clinical deterioration.
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