Key result
Unprotected carotid artery stenting in 36 patients resulted in one in-hospital fatal stroke and one intracranial hemorrhage, with no long-term MI, stroke, or death among the 22 patients followed for 6 months.
Why the study?
The safety of carotid artery stenting without protection devices is uncertain due to potential side effects of protective devices and embolic risks during angioplasty.
Does unprotected carotid artery angioplasty prevent MACCE in patients with carotid artery stenosis?
Case Series (n=36)
No
Does unprotected carotid artery angioplasty prevent MACCE in patients with carotid artery stenosis?
Unprotected carotid artery stenting showed some severe in-hospital complications but no major adverse events in the limited long-term follow-up cohort, suggesting it may be a feasible alternative but requires further prospective study.
Unprotected CAS showed low events in this small series; leaves open comparative safety versus protection in larger prospective trials.
Background: Carotid artery stenosis is one of the main causes of ischemic stroke in Iranian population. Carotid artery stenting (CAS) is a method with for treating carotid artery disease, in order to prevent stroke. Dispersion of the embolus is a significant risk for carotid angioplasty which can be prevented by using protective devices. But studies have shown that the use of these protective devices is not safe and can have side effects such as vascular spasm and dissection. Method: 36 patients who underwent unprotected carotid artery angioplasty from April 2018 to August 2019 in Shahid Madani hospital retrospectively entered this study. Hospital records were studied for data collection. Patients were followed by phone interviews. Major adverse cardiovascular and cerebral events (MACCE) was defined as a composite of the occurrence of stroke, MI, bleeding, and all-cause mortality in the long term. Mean duration of our follow-up was 6 months. Results: During in-hospital course, an 82 years old woman with a history of CVA, hypertension, diabetes and a significant stenosis in her contralateral ICA, had an episode of stroke which was fatal. Also, there was a 46 years old woman without any risk factors, who had developed intracranial hemorrhage (ICH). 22 patients were followed. No MI, stroke, or death occurred in any of the patients. There were only 2 cases of bleeding. Conclusion: Carotid artery stenting without protection may be is a safe method of carotid revascularization. Further prospective studies and clinical trials are needed.
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Ghaffari et al. (2020) conducted a case series in Carotid artery stenosis (n=36). Unprotected carotid artery stenting was evaluated on Major adverse cardiovascular and cerebral events (MACCE) defined as a composite of MI, stroke, bleeding, and all-cause mortality. Unprotected carotid artery stenting in 36 patients resulted in one in-hospital fatal stroke and one intracranial hemorrhage, with no long-term MI, stroke, or death among the 22 patients followed for 6 months.
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