Stenting without post-dilation is a safe and feasible strategy in the carotid artery

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The results of a study published in the Journal of NeuroInterventional Surgery have shown that carotid stenting without post-dilation is safe and effective.

Atshushi Ogata (department of Neurosurgery, Saga University, Japan) and others say that traditional carotid artery stenting involves post-dilation at the end phase of the intervention as there is a risk of embolic stroke caused by atheromatous plaque dislodgement. The authors explain that “most emboli are produced during the post-dilation phase, which can occur if the balloon pushes the stent struts against the atheromatous plaque. Post-dilation is therefore considered to be the riskiest part of the procedure.”

Ogata and colleagues aimed, in their study, to demonstrate the safety and efficacy of carotid artery stenting without post-dilation.

One hundred and sixty nine patients with 179 carotid artery stenoses between them, which were stented without post-dilation, were included in the study. A total of 108 lesions (61.4%) were symptomatic and 68 (38.6%) were asymptomatic. Two patients were excluded because the stenting had to be performed with post-dilation. The patient data was taken from a retrospective registry that ran between May 2005 and April 2012.

“Carotid artery stenting was performed successfully for all lesions, although major adverse events [stroke, myocardial infarction or death within 30 days] occurred in four patients (2.3%),” note Ogata et al.

The authors went on to say that the results show that the overall stroke rate was 2.3% within 30 days after carotid artery stenting, there were no myocardial infarctions and no patients died. Cerebral infarction occurred in two patients (1.1%) and transient ischaemic attack in three (1.7%).

“Our carotid artery procedure is effective, particularly in symptomatic patients. Although it might be possible to employ new types of stents and embolic protection devices in the future, concepts to minimise plaque disruption are important because plaque deposits remain contained in the vessel wall in carotid stenting procedures.”

They add that in 174 lesions (98.9%) closed-cell stents were used and in two lesions open-cell stents were used, therefore no advantage of open- over closed-cell stents could be observed.

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