English Polski
Vol 23, No 1 (2017)
Research paper
Published online: 2017-05-12

open access

Page views 914
Article views/downloads 1305
Get Citation

Connect on Social Media

Connect on Social Media

Safety and efficacy of endovascular treatment for carotid artery stenoses using proximal protection systems: 30-day follow-up

Pawel Latacz, Marian Simka, Marek Kazibudzki, Pawel Brzegowy, Jan J. Kesik1
Acta Angiologica 2017;23(1):1-8.


Introduction. Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, carotid artery stenting (CAS) with use of proximal protection systems (PPS) plays an important role as alternative treatment modality, especially in high risk patients. This study was aimed at the assessment of safety of CAS with use of the PPS and also at identification of risk factors associated with this procedure.

Material and methods. This was a post hoc analysis, with 30-day follow-up. We analysed results of treatment of 94 patients who underwent 97 CAS with PPS, 47 such procedures in asymptomatic, and 50 in symptomatic individuals.

Results. There were 0 strokes during 30-day follow-up. Transient ischaemic attacks occurred in 2 patients (2%) in symptomatic group. Risk factors of these adverse events comprised: tortuosity of the managed artery, chronic obstructive pulmonary disease, long lesion of the internal carotid artery and history of myocardial infarction.

Conclusions. CAS with the use of PPS seems to be a relatively very safe procedure in high risk patients.


  1. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. 1995; 273(18): 1421–1428.
  2. Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1998; 339(20): 1415–1425.
  3. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991; 325(7): 445–453.
  4. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998; 351(9113): 1379–1387.
  5. Hobson RW, Howard VJ, Roubin GS, et al. CREST Investigators. Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase. J Vasc Surg. 2004; 40(6): 1106–1111.
  6. Mas JL, Chatellier G, Beyssen B, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006; 355(16): 1660–1671.
  7. Wimmer NJ, Yeh RW, Cutlip DE, et al. Risk prediction for adverse events after carotid artery stenting in higher surgical risk patients. Stroke. 2012; 43(12): 3218–3224.
  8. Bangalore S, Kumar S, Wetterslev J, et al. Carotid artery stenting vs carotid endarterectomy: meta-analysis and diversity-adjusted trial sequential analysis of randomized trials. Arch Neurol. 2011; 68(2): 172–184.
  9. Massop D, Dave R, Metzger C, et al. SAPPHIRE Worldwide Investigators. Stenting and angioplasty with protection in patients at high-risk for endarterectomy: SAPPHIRE Worldwide Registry first 2,001 patients. Catheter Cardiovasc Interv. 2009; 73(2): 129–136.
  10. Cremonesi A, Gieowarsingh S, Spagnolo B, et al. Safety, efficacy and long-term durability of endovascular therapy for carotid artery disease: the tailored-Carotid Artery Stenting Experience of a single high-volume centre (tailored-CASE Registry). EuroIntervention. 2009; 5(5): 589–598.
  11. Pieniazek P, Musialek P, Kablak-Ziembicka A, et al. Carotid artery stenting with patient- and lesion-tailored selection of the neuroprotection system and stent type: early and 5-year results from a prospective academic registry of 535 consecutive procedures (TARGET-CAS). J Endovasc Ther. 2008; 15(3): 249–262.
  12. Ansel GM, Hopkins LN, Jaff MR, et al. Investigators for the ARMOUR Pivotal Trial. Safety and effectiveness of the INVATEC MO.MA proximal cerebral protection device during carotid artery stenting: results from the ARMOUR pivotal trial. Catheter Cardiovasc Interv. 2010; 76(1): 1–8.
  13. Pieniążek P, Tekieli L, Musiałek P, et al. Carotid artery stenting according to the tailored-CAS algorithm is associated with a low complication rate at 30 days: data from the TARGET-CAS study. Kardiol Pol. 2012; 70(4): 378–386.
  14. White RA, Sicard GA, Zwolak RM, et al. SVS Outcomes Committee. Society of vascular surgery vascular registry comparison of carotid artery stenting outcomes for atherosclerotic vs nonatherosclerotic carotid artery disease. J Vasc Surg. 2010; 51(5): 1116–1123.
  15. Doig D, Turner EL, Dobson J, et al. Predictors of stroke, myocardial infarction or death within 30 days of carotid artery stenting: results from the International Carotid Stenting Study. Eur J Vasc Endovasc Surg. 2016; 51(3): 327–334.
  16. Khan M, Qureshi AI. Factors associated with increased rates of post-procedural stroke or death following carotid artery stent placement: a systematic review. J Vasc Interv Neurol. 2014; 7(1): 11–20.
  17. Pandey AS, Koebbe CJ, Liebman K, et al. Low incidence of symptomatic strokes after carotid stenting without embolization protection devices for extracranial carotid stenosis: a single-institution retrospective review. Neurosurgery. 2008; 63(5): 867–72; discussion 872.
  18. Reimers B, Schlüter M, Castriota F, et al. Routine use of cerebral protection during carotid artery stenting: results of a multicenter registry of 753 patients. Am J Med. 2004; 116(4): 217–222.
  19. Stabile E, Salemme L, Sorropago G, et al. Proximal endovascular occlusion for carotid artery stenting: results from a prospective registry of 1,300 patients. J Am Coll Cardiol. 2010; 55(16): 1661–1667.
  20. Diuzhikov AA, Khripun AV, Malevannyĭ MV, et al. Immediate and remote results of using carotid endarterectomy and stenting of internal carotid arteries. Angiol Sosud Khir. 2013; 19(2): 102–110.
  21. Clair DG, Hopkins LN, Mehta M, et al. EMPiRE Clinical Study Investigators. Neuroprotection during carotid artery stenting using the GORE flow reversal system: 30-day outcomes in the EMPiRE Clinical Study. Catheter Cardiovasc Interv. 2011; 77(3): 420–429.
  22. Nikas D, Reith W, Schmidt A, et al. Prospective, multicenter European study of the GORE flow reversal system for providing neuroprotection during carotid artery stenting. Catheter Cardiovasc Interv. 2012; 80(7): 1060–1068.
  23. Bijuklic K, Wandler A, Hazizi F, et al. The PROFI study (Prevention of Cerebral Embolization by Proximal Balloon Occlusion Compared to Filter Protection During Carotid Artery Stenting): a prospective randomized trial. J Am Coll Cardiol. 2012; 59(15): 1383–1389.
  24. Montorsi P, Caputi L, Galli S, et al. Microembolization during carotid artery stenting in patients with high-risk, lipid-rich plaque. A randomized trial of proximal versus distal cerebral protection. J Am Coll Cardiol. 2011; 58(16): 1656–1663.
  25. Bersin RM, Stabile E, Ansel GM, et al. A meta-analysis of proximal occlusion device outcomes in carotid artery stenting. Catheter Cardiovasc Interv. 2012; 80(7): 1072–1078.
  26. Latacz P, Ochała A, Janas P, et al. Composed angioplasty of the multilevel right common and internal carotid artery stenoses with implantation stents with used of proximal and distal protection system. Kardiol Pol. 2012; 70(1): 88–90.
  27. Kouvelos GN, Patelis N, Antoniou GA, et al. Meta-analysis of the Effect of Stent Design on 30-Day Outcome After Carotid Artery Stenting. J Endovasc Ther. 2015; 22(5): 789–797.
  28. Setacci C, Speziale F, De Donato G, et al. IRON-Guard Study Group. Physician-initiated prospective Italian Registry of carotid stenting with the C-Guard mesh-stent: the IRON-Guard registry. Rationale and design. J Cardiovasc Surg (Torino). 2015; 56(5): 787–791.
  29. Kajihara Y, Sakamoto S, Kiura Y, et al. Comparison of dual protection and distal filter protection as a distal embolic protection method during carotid artery stenting: a single-center carotid artery stenting experience. Neurosurg Rev. 2015; 38(4): 671–676.
  30. Hopf-Jensen S, Marques L, Preiß M, et al. Initial clinical experience with the micromesh Roadsaver carotid artery stent for the treatment of patients with symptomatic carotid artery disease. J Endovasc Ther. 2015; 22(2): 220–225.
  31. Eckstein HH, Ringleb P, Allenberg JR, et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol. 2008; 7(10): 893–902.
  32. Ielasi A, Latib A, Godino C, et al. Clinical outcomes following protected carotid artery stenting in symptomatic and asymptomatic patients. J Endovasc Ther. 2010; 17(3): 298–307.