Safety and clinical outcomes of neuroprotected, patient-tailored Carotid Artery Stenting: A prospective single-center cohort

Background/Introduction Carotid artery stenosis (CS) accounts for a substantial proportion of ischemic strokes (around 20%). Revascularization is recommended in symptomatic patients and in selected asymptomatic individuals with severe stenosis after multidisciplinary evaluation. However, prospective real-world data on carotid artery stenting (CAS), particularly in contemporary high-volume practice, remain limited. Purpose To evaluate the safety and short-term clinical outcomes of neuroprotected, patient-tailored CAS performed in a high-volume catheterization laboratory over a 4-year period. Methods This prospective cohort study included 76 consecutive patients undergoing elective CAS with systematic use of cerebral protection devices over a 4-year period. All patients underwent invasive angiographic assessment of both carotid and coronary arteries. The decision to perform CAS was based on symptomatic status, comorbidities, estimated surgical risk, anatomical considerations, and patient preference following multidisciplinary discussion. Procedural planning incorporated aortic arch anatomy, carotid tortuosity, calcification burden, prior carotid endarterectomy, and history of neck irradiation. Results The study population consisted predominantly of men (85%), and 70% had a history of prior ischemic stroke; 30% were asymptomatic. Procedural success was achieved in all cases (100%). The left internal carotid artery was treated in 51.7% and the right in 48.3% of patients. Periprocedural complications were infrequent. Vagal reactions occurred in 15.8% of cases and were managed with intravenous atropine; one patient (1.3%) required temporary trans-venous pacing. Periprocedural cerebrovascular events occurred in 3 patients (3.9%), including 2 symptomatic and 1 asymptomatic patient; all events were transient ischemic attacks without permanent neurological deficit. At 60-day follow-up, no major adverse cardiovascular events were recorded. Duplex ultrasound identified in-stent restenosis (≥50%) in 3 patients (3.9%), all asymptomatic. Conclusions In this prospective real-world cohort, neuroprotected, patient-tailored CAS was associated with high procedural success and low rates of periprocedural neurological events and short-term adverse outcomes. These findings, which are in accordance with the latest published data, provide contemporary observational insight on CAS performance in experienced centers and may alter clinical decision-making in selected patients with carotid artery stenosis, eventually contributing to stroke burden reduction.