Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices

Objective: The purpose of the study was to assess the effectiveness of cere bral protection devices during carotid artery angioplasty and stent placeme nt. Methods: Between September 1998 and September 1999, carotid angioplasty and stenting were performed in 46 patients with symptomatic (39.1%) or asympto matic (60.9%) severe carotid artery stenosis. Wallstents were used in all p atients with selective predilatation. Cerebral protection devices were used in 25 of these patients. Primary end points were perioperative neurologic complications and mortality. Data were collected prospectively. Results: The overall combined end point of all neurologic deficits and deat h rate was 4.34%. Two neurologic events (one transient ischemic attack and one minor stroke) occurred in the unprotected group (9.53%) versus none in the group with cerebral protection. This difference is not statistically si gnificant. The mortality rate was 0% for both groups. On an intention to tr eat basis, the overall technical success rate for carotid angioplasty was 9 7.8%, and for placement of cerebral protection devices it was 100%. An impo rtant number of particles of different sizes were captured in all cases in which cerebral protection devices were used. Conclusion: Experience has shown that cerebral protection during carotid an gioplasty and stenting is technically feasible and appears to be effective in preventing procedure-related neurologic complications. Further investiga tion is warranted.