Research Article| Volume 290, P74-79, November 2019

The impact of post-dilatation on periprocedural outcomes during carotid artery stenting: A single-center experience


      • Carotid artery stenting is well known therapy modality in setting of carotid artery disease.
      • Post-dilatation is not associated major adverse events at 30 days.
      • Post-dilatation independent predictor of silent cerebral ischemia in patients undergoing CAS.
      • Post-dilatation should be limited only in cases with severe residual stenosis after stenting during CAS as possible as.


      Background and aims

      Carotid artery stenting (CAS) is an accepted treatment modality for carotid artery disease. However, CAS is associated with periprocedural embolic events, and the effect of balloon post-dilatation has not been sufficiently investigated in large studies. We assessed the effect of post-dilatation on periprocedural outcomes during CAS.


      The study included 128 patients who underwent CAS. The patients were divided into groups according to whether post-dilatation was (post-dilatation [+], group 1) or was not (post dilatation [−], group 2) performed after stent deployment. Major adverse events were defined as death, minor or major stroke, and transient ischemic attack at 30 days. Silent ischemia was assessed using diffusion-weighted magnetic resonance imaging.


      No significant between-group differences were found in baseline characteristics, comorbid diseases, or lesion characteristics. The degree of stenosis and procedure duration was greater in group 1 than in group 2. The rate of major adverse events at 30 days was similar between the two groups (5.1% vs. 4.3%, p = 0.844). The silent ischemia rate and number of high-intensity signals were higher in group 1 than in group 2 (45.8% vs. 26.1%, p = 0.020 and 1.01 [1.2] vs. 0.42 [0.79], p = 0.002). Multivariate analysis revealed that post-dilatation was associated with a 2.4-fold increase in silent ischemia (95% confidence interval: 1.15–5.20, p = 0.020).


      Although post-dilatation was not associated with an increase in major adverse events, it significantly increased the incidence of periprocedural silent ischemia. Therefore, post-dilation should be performed only in cases with severe residual stenosis after CAS.

      Graphical abstract


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