• Arthur Kerner, Luis Gruberg, Sirush Pitchersky, Efim Kouperberg, Majdi Halabi, Eugenia Nikolsky, Aharon Hoffman, and Rafael Beyar.
• Division of Invasive Cardiology, Rambam Medical Center and the Technion-Israel Institute of Technology, Haifa, Israel.
• Harefuah. 2006 May 1; 145 (5): 338-41, 399, 398.

UnlabelledRecent studies have shown that percutaneous carotid artery angioplasty and stenting can be safely performed in patients with carotid artery stenosis, especially those considered to be at high-risk for surgery.AimWe evaluated the safety and feasibility of carotid artery angioplasty and stenting, with and without distal protection devices in patients at high-risk for surgical endarterectomy.MethodsA total of 169 consecutive patients underwent 185 procedures and 189 stents were deployed successfully in 195 lesions. The majority of patients (51%) had restenosis after a prior carotid endarterectomy, 40% were considered to be ineligible for carotid endarterectomy by both the vascular surgeons and the interventional cardiologist and 7% were considered ineligible for surgery due to hostile neck anatomy.ResultsDistal embolic protection devices were used in 52% of all cases. Procedural success was achieved in 181 of 185 procedures (98%). The overall rate of in-hospital major adverse cerebrovascular events (death, major stroke, and myocardial infarction) was 2.4%. In-hospital event rates in patients with prior carotid endarterectomy were comparable to patients with de novo lesions with 3.3% vs. 1.1% death/ stroke at 30 days, and 3.3% and 3.3% stroke/death rates at 30 days, respectively. When distal protection devices were used death/stroke rates were 0% as compared to 4.7% when distal protection was not used (p = NS). However, minor embolic phenomena were observed in both primary and secondary lesions independent of the use of distal protection.ConclusionsThese results support the use of carotid artery angioplasty and stenting in high-risk patients with significant primary or secondary carotid artery stenosis. In both types of lesions, acceptable results justify its use as a valid revascularization method. While clinical embolic events occur in a minority of patients in both lesion types, they are not entirely prevented by distal protection devices.

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