Mid-term and late results of endovascular treatment for symptomatic carotid artery stenosis under proximal protection

Paweł Latacz; Marian Simka; Marcin Krzanowski; Katarzyna Krzanowska; Paweł Brzegowy; Bartłomiej Łasocha; Tadeusz J. Popiela

doi:10.5114/wiitm.2020.94519

eISSN: 2299-0054
ISSN: 1895-4588

Videosurgery and Other Miniinvasive Techniques

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1/2021
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Vascular surgery

abstract:

Original paper

Mid-term and late results of endovascular treatment for symptomatic carotid artery stenosis under proximal protection

Paweł Latacz

¹

,

Marian Simka

²

,

Marcin Krzanowski

³

,

Katarzyna Krzanowska

³

,

Paweł Brzegowy

⁴

,

Bartłomiej Łasocha

⁴

,

Tadeusz J. Popiela

⁴

Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
Department of Anatomy, University of Opole, Opole, Poland
Department of Nephrology, Jagiellonian University Medical College, Krakow, Poland
Chair of Radiology, Jagiellonian University Medical College, Krakow, Poland

Videosurgery Miniinv 2021; 16 (1): 175–182

DOI: https://doi.org/10.5114/wiitm.2020.94519

Online publish date: 2020/04/20

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Introduction
Although filters are still preferred during carotid stenting, proximal protection systems (PPS) are increasingly used during these procedures. PPS seem to be safer than distal systems, especially in symptomatic patients, but evidence supporting their use is limited.

Aim
This was a post hoc survey with 30-day mid-term and long-term follow up, which was aimed at assessment of the safety and efficacy of stenting of the internal carotid artery under PPS in symptomatic patients.

Material and methods
We analysed the results of stenting in 120 symptomatic patients presenting with at least 60% stenosis. Patients were aged 67.9 ±9.8 years, and 12 patients were older than 80 years. An occlusion of contralateral artery was found in 5 patients and bilateral stenosis in 26 patients. The primary endpoint of this study was the proportion of patients who had new neurological events, including transient ischemic attack and minor or major stroke in 30-day follow-up. The secondary endpoint was a composite of technical and clinical success. During long-term follow-up we assessed new neurological events and stenoses of implanted stents.

Results
The incidence of new neurological events during 30-day follow-up was 0.8%. The rate of technical success defined by secondary endpoint was 100%. Mean internal carotid artery stenosis before and after stent implantation was 93.8 ±9% and 8.4 ±6.3%, respectively (p < 0.001). Procedural success was achieved in all cases. During long-term follow-up there were two (1.7%) asymptomatic in-stent stenoses and no (0%) new neurological events.

Conclusions
Endovascular management of symptomatic carotid stenosis under PPS is safe, feasible, and appears to be a good alternative to surgical endarterectomy.

keywords:

Mid-term and late results of endovascular treatment for symptomatic carotid artery stenosis under proximal protection

Paweł Latacz 1 , Marian Simka 2 , Marcin Krzanowski 3 , Katarzyna Krzanowska 3 , Paweł Brzegowy 4 , Bartłomiej Łasocha 4 , Tadeusz J. Popiela 4

stroke, stenting, carotid stenosis, proximal protection

Paweł Latacz

¹

,

Marian Simka

²

,

Marcin Krzanowski

³

,

Katarzyna Krzanowska

³

,

Paweł Brzegowy

⁴

,

Bartłomiej Łasocha

⁴

,

Tadeusz J. Popiela

⁴