Top

The Egyptian Journal of Neurology, Psychiatry and Neurosurgery

Published in:

Open Access 01-12-2021 | Carotid Stenosis | Research

Non-protected carotid artery stenting for symptomatic carotid stenosis in low resource settings

Authors: Ayman H. El-Sudany, Shady S. Georgy, Amr S. Zaki, Rady Y. Bedros, Ahmed El-Bassiouny

Published in: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Issue 1/2021

Abstract

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.

Werner N, Zeymer U, Mark B, Hochadel M, Hauptmann KE, Jung J, et al. Carotid artery stenting in clinical practice: does sex matter? Results from the carotid artery stenting registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK). Clin Cardiol. 2012;35(2):111–8. https://doi.org/10.1002/clc.21015.CrossRefPubMedPubMedCentral

Müller-Hüllsbeck S, Jahnke T, Liees C, Glass C, Paulsen F, Grimmet J, et al. In vitro comparison of four cerebral protection filters for preventing human plaque embolization during carotid interventions. J Endovasc Ther. 2002;9(6):793–802. https://doi.org/10.1177/152660280200900612.CrossRef

Kastrup A, Groschel K, Krapf H, Brehm BR, Dichgans J, Schulz JB. Early outcome of carotid angioplasty and stenting with and without cerebral protection devices: a systematic review of the literature. Stroke. 2003;34(3):813–9. https://doi.org/10.1161/01.STR.0000058160.53040.5F.CrossRefPubMed

Garg N, Kargoirgos N, Pismiss GT, Sohal DP, Longo GM, Johanning JM, et al. Cerebral protection devices reduce periprocedural strokes during carotid angioplasty and stenting: a systematic review of the current literature. J Endovasc Ther. 2009;16(4):412–27. https://doi.org/10.1583/09-2713.1.CrossRefPubMed

Maynard M, Baldi S, Rostagno R, Zander T, Rabellino M, Llorens R, et al. Carotid stenting without the use of balloon angioplasty and distal protection devices: preliminary experience in 100 cases. AJNR Am J Neuroradiol. 2007;28(7):1378–83. https://doi.org/10.3174/ajnr.A0543.CrossRef

Tietke MW, Kerby T, Alfke K, Riedel C, Rohr A, Jensenet U, et al. Complication rate in unprotected carotid artery stenting with closed cell stents. Neuroradiology. 2010;52(7):611–8. https://doi.org/10.1007/s00234-010-0672-y.CrossRefPubMed

Mohammadian R, Sohrabi B, Mansourizadeh R, Mohammadian F, Nasiri B, Haririan S. Unprotected carotid artery stenting: complications in 6 month follow up. Neuroradiology. 2012;54(3):225–30. https://doi.org/10.1007/s00234-011-0867-x.CrossRefPubMed

Baldi S, Zander T, Rabellinio M, González G, Maynar M. Carotid artery stenting without angioplasty and cerebral protection: a single center experience with up to 7 years follow-up. AJNR Am J Neuroradiol. 2011;32(4):759–63. https://doi.org/10.3174/ajnr.A2375.CrossRefPubMedPubMedCentral

Mansour OY, Weber J, Niesen W, Schumacher M, Berlis A. Carotid angioplasty and stenting without protection devices: safety and efficacy concern-single center experience. Clin Neuroradiol. 2011;21(2):65–73. https://doi.org/10.1007/s00062-011-0057-6.CrossRefPubMed

10.

Cho YD, Kim SE, Lim JW, Choi HJ, Cho YJ, Jeon JP. Protected versus unprotected carotid artery stenting: meta-analysis of the current literature. J Korean Neurosurg Soc. 2018;61(4):458–66. https://doi.org/10.3340/jkns.2017.0202.001.CrossRefPubMedPubMedCentral

11.

Jean LM, Ludovic T, Didier L, Jean FA, Herve R, Alain V, et al. Endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis (EVA-3S) trial: results up to 4 years from a randomized multicenter trial. Lancet Neurol. 2008;7(10):885–92.CrossRef

12.

Pinero P, Gonzalez A, Mayol A, Martinez E, Gonzalez Marcos JR, Boza F, et al. Silent ischemia after neuroprotected percutaneous carotid stenting: a diffusion weighted MRI study. AJNR Am J Neuroradiol. 2006;27(6):1338–45.PubMedPubMedCentral

13.

Vos JA, Van Den Berg JC, Ernst SM, Suttorp MJ, Overtoom TT, Mauser HW, et al. Carotid angioplasty and stent placement: comparison of transcranial Doppler US data and clinical outcome with and without filtering cerebral protection devices in 509 patients. Radiology. 2005;234(2):493–9. https://doi.org/10.1148/radiol.2342040119.CrossRefPubMed

14.

Schnaudigel S, Gröschel K, Pilgram SM, Kastrup A. New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke. 2008;39(6):1911–9. https://doi.org/10.1161/STROKEAHA.107.500603.CrossRefPubMed

15.

Ederle J, Bonati LH, Dobson J, Featherstone RL, Gaines PA, Beard JD, et al. Endovascular treatment with angioplasty or stenting versus carotid endarterectomy in patients with carotid artery stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long term follow up of a randomized trial. Lancet Neurol. 2009;8(10):898–907. https://doi.org/10.1016/S1474-4422(09)70228-5.CrossRefPubMedPubMedCentral

16.

Khedr H, Eweda A, Hamza M, Salem A, Elshemy W, Tawfik AM. Carotid endarterectomy versus carotid artery stenting without protection devices for the management of carotid artery stenosis. Egypt J Surg. 2016;35:225–30.CrossRef

17.

Hart JP, Peeters P, Verbist J, Deloose K, Bosiers M. Do device characteristics impact outcome of carotid artery stenting? J Vasc Surg. 2006;44(4):725–30. https://doi.org/10.1016/j.jvs.2006.06.029.CrossRefPubMed

18.

Jim J, Rubin BG, Landis GS, Kenwood CT, Siami FS, Sicard GA, et al. Society for Vascular Surgery Vascular Registry evaluation of stent cell design on carotid artery stenting outcomes. J Vasc Surg. 2011;54(1):71–9. https://doi.org/10.1016/j.jvs.2010.12.054.CrossRefPubMed

19.

Timaran CH, Rosero EB, Higuera A, Ilarraza A, Modrall JG, Clagett GP. Randomized clinical trial of open-cell vs closed-cell stents for carotid stenting and effects of stent design on cerebral embolization. J Vasc Surg. 2011;54(5):1310–6. https://doi.org/10.1016/j.jvs.2011.05.013.CrossRefPubMed

20.

Naggara O, Touzé E, Beyssen B, Trinquart L, Chatellier G, Meder JF, et al. Anatomical and technical factors associated with stroke or death during carotid angioplasty and stenting: results from the endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis (EVA-3S) trial and systematic review. Stroke. 2011;42(2):380–8. https://doi.org/10.1161/STROKEAHA.110.588772.CrossRefPubMed

Title: Non-protected carotid artery stenting for symptomatic carotid stenosis in low resource settings
Authors: Ayman H. El-Sudany
Shady S. Georgy
Amr S. Zaki
Rady Y. Bedros
Ahmed El-Bassiouny
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: Carotid Stenosis
Carotid Stenosis
Stroke
Published in: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery / Issue 1/2021
Electronic ISSN: 1687-8329
DOI: https://doi.org/10.1186/s41983-021-00330-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Non-protected carotid artery stenting for symptomatic carotid stenosis in low resource settings

Abstract

Background

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Reflex memory theory of acquired involuntary motor and sensory disorders

Relationship of Alberta Stroke Program Early CT Score (ASPECTS) with the outcome of ischemic stroke and the neurocognitive stroke biomarkers

Impact of COVID-19 pandemic in natural course of Moyamoya Angiopathy: an experience from tertiary-care-center in India

Pattern and prevalence of neuropsychiatric lupus: a retrospective study from a tertiary level hospital in Bangladesh

Clinical features contributing to the sit-to-stand transfer in people with Parkinson’s disease: a systematic review

Pathophysiology of SARS-CoV-2-associated ischemic stroke is variegated