Safety of balloon pre-dilatation in the treatment of severe carotid artery stenosis

M. Sahin, M.V. Yazicioglu, G. Acar, S. Demir, M.E. Kalkan, B. Ozkan, G. Alici, T. Akgun, M. Akcakoyun, B. Boztosun

Department of Cardiology, Kartal Kosuyolu Yuksek Ihtisas Heart-Education and Research Hospital, Istanbul, Turkey. gokselacar81@hotmail.com

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• Cardiology

AIM: To assess early outcome of predilatation prior stenting of severe carotid artery stenosis and to evaluate early major adverse cardiovascular and cerebral events (MACCE).

PATIENTS AND METHODS: The study group consisted of 265 consecutive patients (200 males, 65 female, mean age 66.7 ± 8.6 years) in whom 275 percutaneous transluminal angioplasty (PTA) procedures of carotid arteries were performed. Staged carotid stenting was performed in patients with bilateral carotid stenosis. Neuroprotection with a distal protection device was used in all cases. The patients were divided into two groups: direct carotid stent implantation without previous pre-dilation was performed in 233 patients (direct stenting group) and predilatation was performed in 42 patients (predilatation group). Early events were recorded and analyzed subsequently.

RESULTS: We treated 275 carotid stenoses and the stent was implanted in all patients. Ten patients (3.7%) were treated by staged carotid artery stenting (CAS) due to bilateral carotid artery disease. The technical success rate was 97.1%. During 1-month follow-up, the prevalence of primary endpoint was 2.18%. The prevalence of MACCE at 30 days was higher in the predilatation group (2.4% vs. 2.1%; p = 0.924). Also periprocedural rate of hypotension was higher in predilatation group (7.1% vs. 1.7%; p = 0.04).

CONCLUSIONS: Balloon predilatation prior to stenting can be performed to treat severe carotid artery stenosis with acceptable periprocedural complication rate.

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