Carotid angioplasty and stenting: lesion related treatment strategies

Aims: To evaluate the feasibility of lesion related treatment strategies in patients treated for severe carotid artery disease with angioplasty and stenting (CAS) under embolic protection devices (EPD). Methods and results: From December 2001 to August 2004 a total of 377 consecutive patients were enrolled to undergo CAS. The procedure was conducted by using several types of stents (cobalt-alloy frame, nitinol frame) and of EPD (filter-wires, proximal endovascular clamping devices) applied to specific lesions and/or anatomies. Primary endpoint was to assess the death and stroke rate at discharge. Secondary endpoints were to test the feasibility and safety of tailored CAS (angiographic success, any complication between discharge and 30 days, death of any cause at 30 days). The procedural success was achieved in 377/377 patients (100%). Adverse events included: 1. during procedure: 2 TIAs (0.53%) 2. at discharge: 1 death procedure related (0.27%), 1 major stroke (0.27%), 2 minor strokes (0.53%), 4 TIAs (1.06%), 1 intracranial hemorrhage (0.27%); all adverse event rate at discharge 2.92%; all strokes and death rate at discharge 1.06%; 3. at 30 day f.u.: one death not procedure related (0.27%), 1 minor stroke (0.27%); 4. overall procedure related stroke and death rate: 1.33%. Conclusions: Our data suggest that using new materials/devices matched to specific lesions or anatomies is safe and effective.