Carotid artery stenting performed with a flow-reversal technique: Improved technical performance

• Published in: Journal of neuroradiology Vol. 40; no. 1; pp. 29 - 37
• Main Authors: Castro-Afonso, Luis Henrique de, de Oliveira, Lívia, Pontes-Neto, Octávio Marques, Fábio, Soraia Ramos Cabette, Wajnberg, Eduardo, Abud, Daniel Giansante
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.03.2013
• Subjects: Aged; Aged, 80 and over; Anesthesia; Angiography; Arteriosclerosis; Blood Vessel Prosthesis; Bradycardia; Brain; Carotid artery; Carotid artery stenosis; Carotid artery stenting; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - surgery; Carotid stent; Cerebral protection devices; Embolic Protection Devices; Equipment Design; Equipment Failure Analysis; Evolution; Female; Flow reversal; Hemodynamics; Humans; Magnetic resonance imaging; Male; Middle Aged; Myocardial infarction; Neuroimaging; Prosthesis Implantation - instrumentation; Prosthesis Implantation - methods; Radiography; Radiology; Stenosis; Stents; Stroke; Transient ischemic attack; Treatment Outcome; Ultrasound; Watersheds; Cerebral protection devices; Carotid stent; Carotid artery stenting; Flow reversal; Carotid artery stenosis
• ISSN: 0150-9861
• DOI: 10.1016/j.neurad.2012.03.001

To report our experience in carotid artery stenting (CAS) with GORE flow reversal system®, focusing the assessment of its efficacy, security and practice procedure evolution. Twelve patients treated for atherosclerotic carotid stenosis were prospectively evaluated. All patients were symptomatic. Carotid symptoms were embolic stroke in eight, watershed stroke in two and transient ischemic attack (TIA) in two patients. All patients underwent carotid ultrasound, brain magnetic resonance image and magnetic resonance angiography before CAS procedure. The procedure time and the flow reversal time were registered. Neurological outcome was evaluated before treatment, during the first 48hours post-treatment and after 3 months. CAS was successful in all cases. Mean procedure time was 33.8minutes. Mean flow reversal time was 7.3minutes. Temporary bradycardia occurred with six patients without associated hemodynamic instability. NIHSS patients’ scores ranged from 0 to 5 (average 1.1) on admission and remained unchanged during 48hours after treatment. mRS patients’ scores ranged from 0 to 3 (average 1.6) on admission and remained unchanged during the follow-up of 3 months. There were no complications concerning groin puncture, or general anesthesia, or myocardial infarct or death. In our present selected subjects, the CAS procedure using the GORE flow reversal system appeared to be safe and effective, with improved technical performance of the procedure. This was observed in particular with the flow-reversal times achieved. Thus, studies comparing the GORE system and other protection devices are suggested to ascertain all of the benefits of flow reversal during CAS.