Carotid Artery Stenting with Distal Protection Device: Early Experience

BACKGROUND AND OBJECTIVES: Carotid artery stenting (CAS) is emerging as a reasonable alternative to carotid endarterectomy, and especially for those patients with comorbidities. However, this endovascular approach has acute complications related to distal embolization. Therefore, the use of protection devices is expected to reduce the risk of embolic strokes during this procedure and to deliver more favorable outcomes. We report here on our early experiences with balloon occlusion and filter type distal protection devices that were used for CAS.

SUBJECTS AND METHODS: CAS was performed on 92 lesions of 73 patients (age:61.0 ±1 2.7 years, males:71.2%). Of these patients, 16 patients with 17 carotid lesions underwent CAS using distal protection devices. A balloon occlusion type protection device, PercuSurge GuardWire system, was used for 8 lesions and a filter type, FilterWire EX system, was used for 9 lesions. Procedural and early clinical outcomes including complications were compared between the two groups of patients who underwent CAS with the distal protection (group I) and without the distal protection (group II).

RESULTS: Carotid angioplasty and stenting was performed successfully in all the patients. Successful deployment of the protection devices was possible in all 17 carotid lesions. Among the 75 carotid lesions treated without protection device, there were two fatal strokes, one non-fatal major stroke, one minor stroke and five transient ischemic attacks (TIA), whereas one TIA and one non-neurologic death occurred among the 17 lesions treated with the protection device (p=ns).

CONCLUSION: CAS with use of the distal protection device can be performed successfully and safely. Despite the limited experience with the protection devices, our results suggest the use of distal protection device for carotid intervention may reduce acute complications related to distal embolization during the procedure.