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Carotid Angioplasty and Stenting Without Protection Devices

Safety and Efficacy Concerns—Single Center Experience

Karotisangioplastie und Stenting ohne Protektionssysteme

Sicherheits- und Wirksamkeitsbedenken – Erfahrungen eines Einzelzentrums

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Abstract

Purpose

Against the background of the increasing dilemma in the scientific community regarding protected versus unprotected carotid artery stent (CAS) placement and the disputed points in interpreting the results of scientific studiesas well as the difficulty in conducting such randomized controlled studies, this article gives a review of experiences with carotid stent placement without the use of protection devices.

Methods

This series comprised 133 consecutive patients with 136 carotid stenoses of which 128 carotid arteries (94%) were either symptomatic (93 out of 136 = 68.4%) or had a greater than 70% stenosis (35 out of 136 = 25.7%) and 8 out of 136 were asymptomatic and had stenoses between 50% and 70%. Patients underwent neurologic and sonographic evaluation before the procedure and during follow-up (mean 18 months).

Results

Primary stent placement was carried out in 110 out of 136 lesions and predilatation was necessary before stent deployment in 26 lesions,. Neurologic periprocedural complications included 3 disabling and 1 non-disabling strokes. During the follow-up period there were 6 deaths all unrelated to the carotid disease and no major strokes. The degree of stenosis decreased from a mean of 81% to a mean of 12.3% immediately after the procedure, 22 patients were defined as restenosis of which 9 were symptomatic.

Conclusions

Carotid stent placement without the use of distal protection devices was found to be a safe and effective procedure with a relatively low incidence of periprocedural complications.

Zusammenfassung

Zielsetzung

Vor dem Hintergrund des wachsenden Dilemmas der „scientific community“ bezüglich der geschützten oder ungeschützten Platzierung eines Karotis-Stent sowie der umstrittenen Aspekte bei der Interpretationen der Ergebnisse wissenschaftlicher Studien und auch der Probleme bei der Ausführung solcher Studien werden Erfahrungen mit Platzierungen von Karotis-Stents ohne Protektionssysteme präsentiert.

Methoden

Die Untersuchungsserie umfasste 133 konsekutive Patienten mit 136 Karotisstenosen, darunter 128 Stenosen (94 %), die entweder symptomatisch (93 von 136 = 68,4 %) waren oder eine Größe über 70 % hatten (35 von 136 = 25,7 %). Acht der 136 Stenosen waren asymptomatisch und lagen zwischen 50 und 70 %. Die Patienten wurden vor der Stent-Platzierung und während der Nachuntersuchung (im Median 18 Monate) neurologisch und sonografisch betreut.

Ergebnisse

Eine primäre Stent-Platzierung wurde bei 110 der 136 Stenosen durchgeführt. Bei den restlichen 26 Läsionen war vor der Stent-Platzierung eine Prädilatation notwendig. Während der Prozedur traten neurologische Komplikationen in Form von 3 schweren und einem leichten Schlaganfall auf. Während der „Follow-up“-Periode verstarben 6 Patienten; die Todesursachen waren unabhängig von der Karotiskrankheit, und es traten keine schweren Schlaganfälle auf. Der Stenosegrad verringerte sich von einem Median von 81 % vor der Platzierung zu 12,3 % unmittelbar nach dem Verfahren. Es wurden 22 Fälle als Restenose klassifiziert, und 9 dieser Patienten waren symptomfrei.

Schlussfolgerungen

Die Platzierung eines Karotis-Stent ohne Einsatz eines distalen Protektionssystems ist ein sicheres und effektives Verfahren mit einer relativ niedrigen Rate an periprozeduralen Komplikationen.

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Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Neuroradiology, Freiburg University Hospital, Breisacher Str. 64, 79106, Freiburg, Germany

    O. Y. Mansour MD, J. Weber MD & M. Schumacher MD

  2. Neurology department, Interventional neurology division, Alexandria University, Alexandria, Egypt

    O. Y. Mansour MD

  3. Department of Neurology, Freiburg University Hospital, Breisacher Str. 64, 79106, Freiburg, Germany

    W. Niesen MD

  4. Klinik für Diagnostische Radiologie und Neuroradiologie, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany

    A. Berlis MD

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  1. O. Y. Mansour MD
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  2. J. Weber MD
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  4. M. Schumacher MD
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  5. A. Berlis MD
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Correspondence to O. Y. Mansour MD.

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Mansour, O., Weber, J., Niesen, W. et al. Carotid Angioplasty and Stenting Without Protection Devices. Clin Neuroradiol 21, 65–73 (2011). https://doi.org/10.1007/s00062-011-0057-6

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  • DOI: https://doi.org/10.1007/s00062-011-0057-6

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