Carotid artery stenting without using any embolic protective device

Abstract

INTRODUCTION: Despite the use of embolic protective devices in the majority of cases applied with carotid stenting to prevent embolic neurological complications related to the carotid stenting procedure, this procedure is applied to some cases without protection. The aim of this study was to present the clinical outcomes of carotid artery stent application without a cerebral embolism protective device.

MATERIAL AND METHOD: A retrospective examination was made of a total of 171 patients applied with a stent between 2014 and 2017. The patients included in the study were applied with a stent because they were symptomatic and determined with >50% narrowing in the carotid artery on angiography or asymptomatic with >60% narrowing. The degree of carotid artery narrowing was determined with Doppler ultrasonography before angiographic examination and with the North American symptomatic carotid endarterectomy trial measurement criteria during angiography. After stenting the carotid artery, patients were observed at the hospital for 24 hours.

RESULTS: In 10 (5.8%) patients, there was a mid cerebral artery branch infarct ipsilateral to the stent. No reperfusion bleeding was observed in any patient. In 5 (2.9%) patients, encephalopathy and agitation not exceeding 24 hours was observed. Hypotension was determined in 8 (4.6%) patients and headache lasting <24 hours in 53 (31%) patients. 1 (0.5%) patient, rectus abdominis bleeding developed one week after the procedure and within 24 hours, the patient was exitus.

CONCLUSION: Revascularisation interventions to be able to prevent the development of stroke are evaluated as important treatment options in patients with symptomatic or severe carotid stenosis. With careful patient selection in experienced centres and a multi-disciplinary approach both before and after the procedure, pleasing results can be obtained without the use of embolic protective devices.