Skip to main content

Advertisement

Log in

Complication rate in unprotected carotid artery stenting with closed-cell stents

  • Topic Article
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

The discussion on the use of protection devices (PDs) in carotid artery stenting (CAS) is gaining an increasing role in lowering the periprocedural complication rates. While many reviews and reports with retrospective data analysis do promote the use of PDs the most recent multi-centre trials are showing advantages for unprotected CAS combined with closed-cell stent designs.

Methods

We retrospectively analysed 358 unprotected CAS procedures performed from January 2003 to June 2009 in our clinic. Male/female ratio was 2.68/1. The average age was 69.3 years. Seventy-three percent (261/358) showed initial neurological symptoms. All patients were treated on a standardised interventional protocol. A closed and small-sized cell designed stent was implanted in most cases (85.2%). One hundred seventy-one (47.8%) were controlled by Doppler ultrasonography usually at first in a 3-month and later in 6-month intervals.

Results

The peri-interventional and 30-day mortality/stroke rate was 4.19% (15/358). These events included three deaths, five hyperperfusion syndromes (comprising one death by a secondary fatal intracranial haemorrhage), one subarachnoid haemorrhage and seven ischaemic strokes. Only 20% (3/15) of all complications occurred directly peri-interventional. The overall peri-interventional complication rate was 0.8% (3/358). Most complications occurred in initial symptomatic patients (5.36%). The in-stent restenosis rate for more than 70% was 7% (12/171) detected at an average of 9.8 month.

Conclusion

Our clinical outcome demonstrates that unprotected CAS with small cell designed stents results in a very low procedural complication rate, which makes the use of a protection device dispensable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Kerber CW, Hornwell LD, Loehnden OL (1980) Catheter dilatation of proximal carotid stenosis during distal bifurcation endarterectomy. AJNR 1:348–349

    CAS  PubMed  Google Scholar 

  2. Bockenheimer SAM, Mathias K (1983) Percutaneous transluminal angioplasty of atherosclerotic internal carotid artery stenosis. AJNR 4:791–792

    CAS  PubMed  Google Scholar 

  3. Wiggli U, Grazl O (1983) Transluminal angioplasty of stenotic carotid arteries. Case reports and protocol. AJNR 4:793–795

    CAS  PubMed  Google Scholar 

  4. Tievsky AL, Dury EM, Mardiat JG (1983) Transluminal angioplasty in postsurgical stenosis of the extracranial carotid artery. AJNR 4:800–802

    CAS  PubMed  Google Scholar 

  5. Hasso AN, Bird CR (1983) Percutaneous transluminal angioplasty of carotid and vertebral arteries. In: Jang GD (ed) Angioplasty. New York, McGraw-Hill Book Company, pp 104–115

    Google Scholar 

  6. Diethrich EB, Gordon MH, Lopez-Galarza LA et al (1995) Intraluminal Palmaz stent implantation for treatment of recurrent carotid artery occlusive diseasa: a plan for the future. J Intervent Cardiol 8:213–218

    Article  CAS  PubMed  Google Scholar 

  7. Ringleb PA, Allenberg J, Bruckmann H, Eckstein HH, Fraedrich G, Hartmann M, Hennerici M, Jansen O, Klein G, Kunze A, Marx P, Niederkorn K, Schmiedt W, Solymosi L, Stingele R, Zeumer H, Hacke W (2006) 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 368:1239–1247

    Article  CAS  PubMed  Google Scholar 

  8. Mas J-L, Chattellier G, Beyssen B et al (2006) Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med 355:1660–1671

    Article  CAS  PubMed  Google Scholar 

  9. Coward LJ, McCabe DJ, Ederle J, Featherstone RL, Clifton A, Brown MM, CAVATAS Investigators (2007) Long-term outcome after angioplasty and stenting for symptomatic vertebral artery stenosis compared with medical treatment in the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized trial. Stroke 38(5):1526–1530

    Article  CAS  PubMed  Google Scholar 

  10. Hobson RW 2nd (2000) CREST (carotid revascularization endarterectomy versus stent trial): background, design, and current status. Semin Vasc Surg 13(2):139–143

    PubMed  Google Scholar 

  11. Hobson RW 2nd, Howard VJ, Roubin GS, Brott TG, Ferguson RD, Popma JJ, Graham DL, Howard G, CREST Investigators (2004) Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase. J Vasc Surg 40(6):1106–1111

    Article  PubMed  Google Scholar 

  12. Reimers B, Corvaja N, Moshiri S, Saccà S et al (2001) Cerebral protection with filter devices during carotid artery stenting. Circulation 104:12–15

    Article  CAS  PubMed  Google Scholar 

  13. Castriota F, Cremonesi A, Manetti R, Liso A, Oshoala K, Ricci E, Balestra G (2002) Impact of cerebral protection devices on early outcome of carotid stenting. J Endovasc Ther 9:786–792

    Article  PubMed  Google Scholar 

  14. Cremonesi A, Manetti R, Castriota F, Setacci F, Setacci C (2003) Protected carotid stenting: clinical advantages and complications of embolic protection devices in 442 consecutive patients. Stroke 34:1936–1943

    Article  PubMed  Google Scholar 

  15. Kastrup A, Groschel K, Krapf H, Brehm BR, Dichgans J, Schulz JB (2003) Early outcome of carotid angioplasty and stenting with and without cerebral protection devices: a systematic review of the literature. Stroke 34:813–819

    Article  PubMed  Google Scholar 

  16. Theiss W, Hermanek P, Mathias K et al (2008) Predictors of death and stroke after carotid angioplasty and stenting a subgroup analysis of the pro-CAS data. Stroke 39(8):2325–2330, Epub 2008 Jun 26

    Article  PubMed  Google Scholar 

  17. Garg N, Karagiorgos N, Pisimisis GT, Sohal DP, Longo GM, Johanning JM, Lynch TG, Pipinos II (2009) Cerebral protection devices reduce periprocedural strokes during carotid angioplasty and stenting: a systematic review of the current literature. J Endovasc Ther 16(4):412–427

    Article  PubMed  Google Scholar 

  18. Al-Mubarak N, Roubin GS, Vitek JJ, Iyer SS, New G, Leon MB (2001) Effect of the distal-balloon protection system on microembolization duringcarotid stenting. Circulation 104:1999–2002

    Article  CAS  PubMed  Google Scholar 

  19. Jaeger H, Mathias K, Drescher R, Hauth E, Bockisch G, Demirel E, Gissler HM (2001) Clinical results of cerebral protection with a filter device during stent implantation of the carotid artery. Cardiovasc Intervent Radiol 24:249–256

    Article  CAS  PubMed  Google Scholar 

  20. Al-Mubarak N, Colombo A, Gaines PA, Iyer SS, Corvaja N, Cleveland TJ, Macdonald S, Brennan C, Vitek JJ (2002) Multicenter evaluation of carotid artery stenting with a filter protection system. J Am Coll Cardiol 39:841–846

    Article  PubMed  Google Scholar 

  21. Guimaraens L, Sola MT, Matali A, Arbelaez A, Delgado M, Soler L, Balaguer E, Castellanos C, Ibanez J, Miquel L, Theron J (2002) Carotid angioplasty with cerebral protection and stenting: report of 164 patients (194 carotid percutaneous transluminal angioplasties). Cerebrovasc Dis 13:114–119

    Article  PubMed  Google Scholar 

  22. Jansen O, Fiehler J, Hartmann M, Brückmann H, for the SPACE investigators (2009) Protection or non-protection in carotid stent angioplasty—the influence of interventional techniques on outcome data from the SPACE Trial. Stroke 40:841–846

    Article  PubMed  Google Scholar 

  23. Duda Sh, Wiskirchen J, Tepe G, Bitzen M, Kaulich TW, Stoeckel D et al (2000) Physical properties of endovascular stents: an experimental comparison. J Vasc Interv Radiol 11:645–e654

    Article  CAS  PubMed  Google Scholar 

  24. Bosiers M, Deloose K, Verbist J, Peeters P (2005) Carotid artery stenting: which stent for which lesion? Vascular 13:205–e210

    Article  PubMed  Google Scholar 

  25. Orlandi G, Fanucchi S, Fioretti C, Acerbi G, Puglioli M, Padolecchia R, Sartucci F, Murri L (2001) Characteristics of cerebral microembolism during carotid stenting and angioplasty alone. Arch Neurol 58:1410–1413

    Article  CAS  PubMed  Google Scholar 

  26. Eckert B, Zeumer H (2003) Carotid artery stenting with or without protection devices? Strong opinions, poor evidence! Stroke 34:1941–1943

    Article  PubMed  Google Scholar 

  27. Fiehler J, Jansen O, Berger J, Eckstein HH, Ringleb PA, Stingele R (2008) Differences in complication rates among the centres in the SPACE study. Neuroradiology 50(12):1049–1053, Epub 2008 Sep 23

    Article  PubMed  Google Scholar 

  28. Wholey MH, Jarmolowski CR, Wholey M, Eles GR (2003) Carotid artery stent placement-ready for prime time? J Vasc Interv Radiol 14(1):1–10

    PubMed  Google Scholar 

  29. Wholey MH, Wholey M, Mathias K et al (2000) Global experience in cervical carotid artery stent placement. Catheter Cardiovasc Interv 50(2):160–167

    Article  CAS  PubMed  Google Scholar 

  30. Schillinger M, Gschwendtner M, Reimers B, Trenkler J, Stockx L, Mair J, Macdonald S, Karnel F, Huber K, Minar E (2008) Does carotid stent cell design matter? Stroke 39(3):905–909

    Article  PubMed  Google Scholar 

  31. Brantley HP, Kiessling JL, Milteer HB Jr, Mendelsohn FO (2009) Hyperperfusion syndrome following carotid artery stenting: the largest single-operator series to date. J Invasive Cardiol 21(1):27–30

    PubMed  Google Scholar 

  32. Nederkoorn PJ, Brown MM (2009) Optimal cut-off criteria for duplex ultrasound for the diagnosis of restenosis in stented carotid arteries: review and protocol for a diagnostic study BMC. Neurology 9:36

    PubMed  Google Scholar 

  33. Lal BK, Hobson RW 2nd, Tofighi B, Kapadia I, Cuadra S, Jamil Z (2008) Duplex ultrasound velocity criteria for the stented carotid artery. J Vasc Surg 47:63–73

    Article  PubMed  Google Scholar 

  34. Spies Ch, Doshi R, Spoon J, Snell RJ (2007) Carotid artery stent type influences duplex ultrasonography derived peak systolic velocity: findings of an in-vitro model. Catheter Cardiovasc Interv 70(2):309–315

    Article  PubMed  Google Scholar 

  35. Chaktoura EY et al (2001) In-stent restenosis after carotid angioplasty-stenting: incidence and management. J Vasc Surg 33:220–225

    Article  Google Scholar 

  36. Willfort-Ehringer A et al (2002) Single-center experience with carotid stent restenosis. J Endovac Ther 9:299–307

    Article  Google Scholar 

  37. Setacci C et al (2005) In-stent restenosis after carotid artery angioplasty and stenting: a challenge for the vascular surgeon. Eur J Vasc Endovasc Surg 29:601–607

    Article  CAS  PubMed  Google Scholar 

  38. Levy EI et al (2005) Frequency and management of recurrent stenosis after carotid artery stent implantation. J Neurosurg 102:29–37

    PubMed  Google Scholar 

Download references

Conflict of interest statement

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marc W. K. Tietke.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tietke, M.W.K., Kerby, T., Alfke, K. et al. Complication rate in unprotected carotid artery stenting with closed-cell stents. Neuroradiology 52, 611–618 (2010). https://doi.org/10.1007/s00234-010-0672-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-010-0672-y

Keywords

Navigation