RESUMO
AIMS: To evaluate the feasibility of lesion related treatment strategies in patients treated for severe carotid artery disease with angioplasty and stenting (CAS) under embolic protection devices (EPD). METHODS AND RESULTS: From December 2001 to August 2004 a total of 377 consecutive patients were enrolled to undergo CAS. The procedure was conducted by using several types of stents (cobalt-alloy frame, nitinol frame) and of EPD (filter-wires, proximal endovascular clamping devices) applied to specific lesions and/or anatomies.Primary endpoint was to assess the death and stroke rate at discharge.Secondary endpoints were to test the feasibility and safety of tailored CAS (angiographic success, any -complication between discharge and 30 days, death of any cause at 30 days).The procedural success was achieved in 377/377 patients (100%).Adverse events included:1. during procedure: 2 TIAs (0.53%)2. at discharge: 1 death procedure related (0.27%), 1 major stroke (0.27%), 2 minor strokes (0.53%), 4 TIAs (1.06%), 1 intracranial hemorrhage (0.27%); all adverse event rate at discharge 2.92%; all strokes and death rate at discharge 1.06%;3. at 30 day f.u.: one death not procedure related (0.27%), 1 minor stroke (0.27%);4. overall procedure related stroke and death rate: 1.33%. CONCLUSIONS: Our data suggest that using new materials/devices matched to specific lesions or anatomies is safe and effective.
RESUMO
PURPOSE: To evaluate the impact of cerebral protection devices on the procedural safety and outcome of carotid stent procedures. METHODS: From June 1997 to July 2001, 275 consecutive patients (208 men; mean age 71 +/- 7.4 years) underwent percutaneous angioplasty and/or stenting of the extracranial carotid artery. In the first 125 (45.4%) patients, the procedures were performed without cerebral protection. After January 2000, protection devices were routinely used (150 [54.6%] patients), including the Angioguard filter, GuardWire occlusion system, TRAP Vascular Filtration System, EPI Filter Wire, NeuroShield, Parodi Anti-Embolism System, and Medicorp occlusive balloon. RESULTS: The percutaneous procedures were effective in 273 (99.3%) patients. No death or major stroke occurred in either group. In the unprotected group, 5 (4.0%) complications occurred: 3 (2.4%) minor strokes, 1 (0.8%) transient ischemic attack (TIA), and 1 (0.8%) subarachnoid hemorrhage. In the patients treated under cerebral protection, there were 2 (1.3%) complications: 1 (0.7%) minor stroke and 1 (0.7%) subarachnoid hemorrhage. There were 4 (3.2%) periprocedural embolic complications in the unprotected group versus 1 (0.7%) in the protected patients. CONCLUSIONS: Our data suggest that percutaneous dilation and stenting of the carotid arteries protected by cerebral protection devices is feasible and effective. In a consecutive series, the use of the cerebral protection systems reduced the acute neurological event rate related to embolic complications by 79%.