Carotid artery stenting with routine cerebral protection in high-risk patients

Lin, Peter H.; Bush, Ruth L.; Lubbe, Dieter F.; Cox, Mitchell M.; Zhou, Wei; McCoy, Sally A.; Felkai, Deborah; Paladugu, Ramesh; Lumsden, Alan B.

doi:10.1016/j.amjsurg.2004.08.035

« Previous Next »The American Journal of Surgery
Volume 188, Issue 6 , Pages 644-652, December 2004

Carotid artery stenting with routine cerebral protection in high-risk patients

Presented at the 56th Annual Meeting of the Southwestern Surgical Congress, Monterey, California, April 18–21, 2004

Peter H. Lin, M.D.
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Methodist Hospital, HVAMC (112), 2002 Holcombe Blvd., Houston, TX 70030, USA
- Corresponding author. Tel.: +1-713-794-7895; fax: +1-713-794-7352.
Ruth L. Bush, M.D.
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Methodist Hospital, HVAMC (112), 2002 Holcombe Blvd., Houston, TX 70030, USA
Dieter F. Lubbe, M.D.
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Methodist Hospital, HVAMC (112), 2002 Holcombe Blvd., Houston, TX 70030, USA
Mitchell M. Cox, M.D.
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Methodist Hospital, HVAMC (112), 2002 Holcombe Blvd., Houston, TX 70030, USA
Wei Zhou, M.D.
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Methodist Hospital, HVAMC (112), 2002 Holcombe Blvd., Houston, TX 70030, USA
Sally A. McCoy, N.P.
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Methodist Hospital, HVAMC (112), 2002 Holcombe Blvd., Houston, TX 70030, USA
Deborah Felkai, R.N.
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Methodist Hospital, HVAMC (112), 2002 Holcombe Blvd., Houston, TX 70030, USA
Ramesh Paladugu, M.D.
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Methodist Hospital, HVAMC (112), 2002 Holcombe Blvd., Houston, TX 70030, USA
Alan B. Lumsden, M.D.
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Methodist Hospital, HVAMC (112), 2002 Holcombe Blvd., Houston, TX 70030, USA

Received 20 July 2004; received in revised form 7 August 2004

Abstract

Background

Carotid artery stenting has emerged as an alternative treatment modality in carotid occlusive disease. This study examined our experience of carotid stenting with routine cerebral embolization protection in high-risk patients.

Methods

Clinical variables and treatment outcome of high-risk patients who underwent carotid stenting with neuroprotection were analyzed during a 26-month period.

Results

Sixty-eight high-risk patients with 72 carotid artery stenoses were treated. Procedural success was achieved in 70 cases (97%), and symptomatic lesions existed in 17 (24%) patients. Monorail Wallstents stents were used in all cases. Neuroprotective devices used were PercuSurge (28%) and Filterwire (72%). There was no periprocedural mortality or neuroprotective device-related complications. The 30-day stroke and death rate was 2.7%, and the overall complication rate was 6.9%. All stented vessels remained patent during the follow-up period (mean 15.3 ± 4.2, range 1 to 23 months). Two asymptomatic in-stent restenosis (3%) occurred at 6 and 8 months, which were both successfully treated with balloon angioplasty.

Conclusions

Our study showed that percutaneous carotid stenting with routine use of a cerebral protection device is a feasible and effective treatment in high-risk patients with carotid occlusive disease.

Keywords: Carotid artery stenting , Carotid endarterectomy , Distal protection device , High-risk patients