Direct Carotid Stenting Not Inferior to Predilation


January 25, 2010

January 25, 2010 – Direct stenting of the carotid arteries is a feasible technique and is not inferior to predilation, according to a new study published in the International Journal of Cardiology (Feb. 4, 2010, vol. 138, issue 3, pages 233-238).

A controversial aspect of carotid artery stenting (CAS) is the placement of a stent with or without predilation. The study was designed to test the hypothesis that direct stenting (DS) was not inferior to CAS with predilation. The stud was conducted by researchers at the Institute of Cardiology, University of Milan, Centro Cardiologico Monzino, Milan, Italy.

Elective CAS with filter protection was performed in 205 consecutive, unselected patients with carotid artery stenosis (more than 50 percent if symptomatic and equal to or more than 75 percent if asymptomatic by Doppler assessment) who were randomly assigned to CAS with predilation (n=100) or direct stenting (DS, n=105). Filter and stent selection were left to the operator's discretion. The study end-point was the angiographic success, defined as less than or equal to 30 percent angiographic residual stenosis after CAS without abnormal angiographic findings in cerebral circulation, and without cross-over to predilation in the DS group.

At baseline, patient clinical characteristics and stenosis anatomic features did not differ between groups. Angiographic success was 99 percent in predilation and 97 percent in DS. No cross-over to predilation occurred in the DS group. Procedural time was shorter in DS as compared to predilation (about 24.3 minutes versus about 19.9 minutes). Visible debris were more frequently captured in predilation as compared to DS (50 versus 36 percent).

No periprocedural and 30-day death or major stroke occurred in either group.

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