New perspectives in carotid percutaneos revascularization

Introduction: In this moment we can say that percutaneous coronary and lower limbs revascularization has become a certainty, but the data extracted from the registers regarding carotid angioplasty, analyzed by the current medical guidelines indicates at this moment the superiority of surgical revascularization resulting from the lower incidence of stroke rate after procedure compared with stenting.
Objective: The purpose of this study was to present the experience and results of our clinic in percutaneous carotid revascularization using a new type of stent that is based on a technological innovation specifically designed to reduce the incidence of microembolism.
Methods: The Carotid Angioplasty Stent (CGUARD) used in this study is based on a new technological concept: the innovation is that the stent is covered in a double layer of MicroNet mesh which gives it a 165μ pore diameter (2.3 times smaller than classical stents from the registries) lowering significantly the risk of embolisation. The study was conducted in a single center and included 39 patients with carotid stenosis >70%, reported as symptomatic after a neurological evaluation. All patients had neurological evaluation prior revascularization. After procedure all patients were clinically monitored in hospital for at least 48 hours. The follow-up period was 30 days and the parameters we followed up were: mortality, stroke and MI.
Results: Clinical characteristics of patients: age 71.6± 7.5 years, males 65% (25), arterial hypertension 90%, dyslipidemia 58% (22), type 2 diabetes mellitus 37% (14), transient ischemic attack of the revascularized carotid territory 63% (24), stroke in the revascula-rized carotid territory 37% (14), previous MI 26% (10). Procedural features: all procedures were performed by femoral approach using 7F (100%) long sheath (90 cm). In all procedures (100%) we used a Spider FX dis-tal protective filter. In 28 cases (71%), predilatation was performed and in 36 (92%) postdilatation was perfor-med. The mean diameter of the stents was 8.4±0.6 mm and the length was 40 mm. The procedural success was 100%. At 30 days of follow up were recorded: 0% mortality, 0% stroke, 0% MI.
Conclusions: Interventional treatment of atherosclerotic arterial disease has experienced a fulminant development over the past decade, especially due to technological innovations. The main disadvantage of carotid angioplasty is micro-embolization that can occur during procedure and within the first 24 hours after procedure by plaque prolapse through the stent pores. This study presents the experience of our clinic using a new stent that brings a technological innovation regar-ding embolic protection with very good results.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)