Journal of neurointerventional surgery · 2026
Distal embolic protection and procedural strategy in percutaneous transluminal angioplasty and stenting of very severe carotid stenosis.
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Hsieh Chi-Hsien, Sun Ching-Yu, Yu Kai-Wei, Tai Wei-An, Chen Ting-Yi, Lin Te-Ming, Yang Chung-Han, Chung Chih-Ping, Lirng Jiing-Feng, Wu Chia-Hung, Chang Feng-Chi
Аннотация
BACKGROUND AND PURPOSE: Percutaneous transluminal angioplasty and stenting (PTAS) may result in periprocedural embolism. Distal embolic protection devices (dEPDs) are commonly used to mitigate this risk; however, their efficacy in patients with very severe carotid stenosis (VSCS) remains uncertain. In this study we evaluated the periprocedural clinical and MRI outcomes following PTAS in patients with VSCS.
METHODS: We retrospectively included patients with VSCS who underwent PTAS and had periprocedural brain MRI data. Patients were categorized into protected PTAS (P/PTAS) and unprotected PTAS (UP/PTAS) groups according to dEPD use. Recent embolic ischemic lesions (REILs) on diffusion-weighted imaging were quantified within the ipsilateral middle cerebral artery (MCA) territory and categorized by size (<5 or ≥5 mm). The incidence of periprocedural infarction and recurrent ischemic stroke and stent patency were evaluated.
RESULTS: Among 152 PTAS procedures, 106 were protected and 46 were unprotected. The number of REILs in the ipsilateral MCA territory (median (IQR) 0 (0-2) vs 1 (0-3); P=0.39) and the number of large REILs (≥5 mm) (median (IQR) 0 (0-0) vs 0 (0-1); P=0.14) were compared between groups. With respect to clinical outcomes over the 1-month follow-up period, significant in-stent restenosis occurred in eight of 106 (7.5%) protected procedures and one of 46 (2.2%) unprotected procedures, whereas recurrent ischemic stroke occurred in two of 106 (1.9%) protected procedures and 0 of 46 (0%) unprotected procedures (P=0.28 and P=1.00, respectively).
CONCLUSION: In patients with VSCS undergoing PTAS, dEPD should be used when anatomically feasible. When protection cannot be safely deployed, an unprotected anatomy-adapted approach with careful lesion crossing and conservative angioplasty is an acceptable alternative.
METHODS: We retrospectively included patients with VSCS who underwent PTAS and had periprocedural brain MRI data. Patients were categorized into protected PTAS (P/PTAS) and unprotected PTAS (UP/PTAS) groups according to dEPD use. Recent embolic ischemic lesions (REILs) on diffusion-weighted imaging were quantified within the ipsilateral middle cerebral artery (MCA) territory and categorized by size (<5 or ≥5 mm). The incidence of periprocedural infarction and recurrent ischemic stroke and stent patency were evaluated.
RESULTS: Among 152 PTAS procedures, 106 were protected and 46 were unprotected. The number of REILs in the ipsilateral MCA territory (median (IQR) 0 (0-2) vs 1 (0-3); P=0.39) and the number of large REILs (≥5 mm) (median (IQR) 0 (0-0) vs 0 (0-1); P=0.14) were compared between groups. With respect to clinical outcomes over the 1-month follow-up period, significant in-stent restenosis occurred in eight of 106 (7.5%) protected procedures and one of 46 (2.2%) unprotected procedures, whereas recurrent ischemic stroke occurred in two of 106 (1.9%) protected procedures and 0 of 46 (0%) unprotected procedures (P=0.28 and P=1.00, respectively).
CONCLUSION: In patients with VSCS undergoing PTAS, dEPD should be used when anatomically feasible. When protection cannot be safely deployed, an unprotected anatomy-adapted approach with careful lesion crossing and conservative angioplasty is an acceptable alternative.