Original title: Evaluation of proximal protection devices during carotid artery stenting as the first choice for embolic protection. Reference: Hornung M et al. EuroIntervention. 2014; Epub ahead of print.
This series of the Frankfurt CardioVascular Center included 124 consecutive patients undergoing carotid angioplasty with proximal protection. The first 92 patients received the Gore Flow Reversal System (WL Gore; Flagstaff, AZ). After this device became unavailable the Mo.Ma Ultra was used (Medtronic; Minneapolis, MN).
After procedure, all patients were prescribed 100 mg of aspirin indefinitely, and 75 mg of clopidogrel daily for at least 30 days. 21% of the population presented a symptomatic lesion; mean time between index neurological event and stenting was 50.5 days.
Predilation was necessary in 33.1% of lesions and most commonly employed stents were the Protege (Ev3 Endovascular; Plymouth, MN; 56.5%) and the Xact (Abbott Vascular; Santa Clara, CA; 24.2%).
The primary end point, a combination of new transitory ischemic accident and minor or major stroke within 30 days, was observed in one patient only. This patient had no procedural complications but suffered a stent thrombosis 9 days after discharge.
Transitory neurological symptoms due to intolerance of antegrade flow interruption during balloon occlusion were observed in 10 patients (8.1%), but were promptly and completely solved once flow was reestablished.
Only 2 patients were not able to benefit from the proximal embolic protection device, which had a technical success of 98.4%. None of these patients presented neurological complications.
Conclusion
Proximal protection devices are safe and can be used as first choice for embolic protection during carotid artery stenting.
Editorial Comment
Neurological complications rate with proximal protection (both in the meta-analysis and the current series) is lower than rates reported by the majority of studies comparing carotid stenting with distal protection vs endarterectomy. Outcomes of this study, from one center only, with very few expert operators, may not be transferable to other centers.
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