Efficacy of cerebral protection devices during carotid artery stenting

Deyou XUE; Derang JIAO; Binge CHANG

ABSTRACT

BACKGROUND:

There is yet no evidence about whether internal carotid artery stenting with cerebral protection devices is beneficial to reducing neurological complications.

OBJECTIVE:

To explore the safety and efficacy of carotid angioplasty and stenting with cerebral protection devices for carotid stenosis. DESIGN, TIME AND

SETTING:

Non-randomized concurrent control trial was performed at Hospital Affiliated to Medical College of Chinese People’s Armed Police Force from June 2005 to January 2007.

PARTICIPANTS:

Seventy-four patients with carotid artery stenosis underwent stenting, including 21 with cerebral protection devices (16 males and 5 females; average age of 66.4 years, range 50-79 years), and 53 with no protection devices (36 males and 17 females; average age of 69.2 years, range 52-83 years).

METHODS:

Size of cerebral protection devices was confirmed according to the diameter of normal vessel at distal carotid artery stenosis. The guide wire was sent into distal stenosis under guidance of pathway picture followed by cerebral protection device release. The stent passed over the stenosis and released to appropriate site. The protection device was removed when the stenosis was relieved confirmed by routine angiography. MAIN OUTCOME

MEASURES:

Features of stenting process; frequency of stroke attack perioperatively and during 12-month follow-up. All of them took periprocedual anticoagulation treatment, cerebral vascular angiograpgy.

RESULTS:

Seventy-six self-expandable stents were delivered in 74 patients with carotid stenosis. Twenty-one cerebral protection devices were employed including 8 Angioguard and 13 Filterwire. The patients without cerebral protection devices were predilated 20 times (37.7%) with the balloons, and all were postdilated; 3 cases (5.6%) developed brief decreased heart rate and hypotension after stent release. The patients with cerebral protection devices were predilated 6 times (28.5%) with balloons, and all were postdilated; 2 cased (9.5%) developed brief decreased heart rate and hypotension after stent release and 2 (9.5%) developed angiospasm. One patient (4.7%) with cerebral protection devices had cerebral infarction (4.7%) perioperatively and another had cerebral infarction (4.7%) during the follow up. While four patients in the group without cerebral protection devices had cerebral infarction (7.5%) perioperatively, and five had cerebral infarction (9.4%) during the follow up. There were no significant differences between two groups.

CONCLUSION:

The results of the study show that cerebral protection devices are not helpful to reduce neurological complications in patients with carotid artery stenosis after stenting.