A Technical Strategy for Carotid Artery Stenting: Suboptimal Prestent Balloon Angioplasty Without Poststenting Balloon Dilatation

Abstract

BACKGROUND: Traditional carotid artery stenting (CAS) consists of predilatation, optional deployment of embolic protection devices, stenting, and poststent angioplasty. Each step carries a risk of thromboembolism. OBJECTIVE: To design a new and simplified procedural protocol, suboptimal balloon angioplasty without routine poststenting balloon dilatation, and to describe the efficacy this protocol in terms of procedural risks and angiographic and clinical outcomes. METHODS: Over a period of 6 years, 161 carotid artery stenoses in 156 consecutive patients were treated by CAS with embolic protection devices. Among them, 110 lesions in 107 patients (68.3%) were treated by our simplified method (symptomatic, > 50% stenosis; asymptomatic, > 70% stenosis). Overall, 98 lesions (88.3%) had severe stenosis (> 70%). RESULTS: The mean stenosis was reduced from 77% to 10% after CAS. A persistent neurological deficit developed in 2 patients from thromboembolism. Hemodynamic insufficiency developed in 14 lesions during CAS (12.7%). The ipsilateral stroke and mortality rate was 4.5% within 1 month after CAS (asymptomatic, 3.6%; symptomatic, 4.8%). Over a mean of 19 months of follow-up, additive angioplasty was performed in 2 patients as a result of progressive restenosis (>= 50%). A comparison of the balloon sizes of the prestent angioplasty for group 1 (balloon, <= 4 mm) and group 2 (balloon, >= 5 mm) showed no difference in restenosis between the groups at 15 months of follow-up after CAS. CONCLUSION: Our CAS technique with suboptimal prestenting angioplasty without routine use of poststenting dilatation is safe, simple, and efficient with acceptable risks.