Highlights
- •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.
Abstract
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.
Methods
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.
Results
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).
Conclusions
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
Graphical Abstract
Keywords
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Article info
Publication history
Published online: September 28, 2019
Accepted:
September 27,
2019
Received in revised form:
September 6,
2019
Received:
May 17,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
