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Complication rate in unprotected carotid artery stenting with closed-cell stents

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Abstract

Introduction

The discussion on the use of protection devices (PDs) in carotid artery stenting (CAS) is gaining an increasing role in lowering the periprocedural complication rates. While many reviews and reports with retrospective data analysis do promote the use of PDs the most recent multi-centre trials are showing advantages for unprotected CAS combined with closed-cell stent designs.

Methods

We retrospectively analysed 358 unprotected CAS procedures performed from January 2003 to June 2009 in our clinic. Male/female ratio was 2.68/1. The average age was 69.3 years. Seventy-three percent (261/358) showed initial neurological symptoms. All patients were treated on a standardised interventional protocol. A closed and small-sized cell designed stent was implanted in most cases (85.2%). One hundred seventy-one (47.8%) were controlled by Doppler ultrasonography usually at first in a 3-month and later in 6-month intervals.

Results

The peri-interventional and 30-day mortality/stroke rate was 4.19% (15/358). These events included three deaths, five hyperperfusion syndromes (comprising one death by a secondary fatal intracranial haemorrhage), one subarachnoid haemorrhage and seven ischaemic strokes. Only 20% (3/15) of all complications occurred directly peri-interventional. The overall peri-interventional complication rate was 0.8% (3/358). Most complications occurred in initial symptomatic patients (5.36%). The in-stent restenosis rate for more than 70% was 7% (12/171) detected at an average of 9.8 month.

Conclusion

Our clinical outcome demonstrates that unprotected CAS with small cell designed stents results in a very low procedural complication rate, which makes the use of a protection device dispensable.

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Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Institute for Neuroradiology, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany

    Marc W. K. Tietke, Tina Kerby, Karsten Alfke, Christian Riedel, Axel Rohr, Ulf Jensen & Olaf Jansen

  2. Department of Neurology, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany

    Phillip Zimmermann & Robert Stingele

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  1. Marc W. K. Tietke
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  2. Tina Kerby
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  3. Karsten Alfke
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  9. Olaf Jansen
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Correspondence to Marc W. K. Tietke.

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Tietke, M.W.K., Kerby, T., Alfke, K. et al. Complication rate in unprotected carotid artery stenting with closed-cell stents. Neuroradiology 52, 611–618 (2010). https://doi.org/10.1007/s00234-010-0672-y

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