Routine use of cerebral protection during carotid artery stenting: results of a multicenter registry of 753 patients

Purpose To evaluate the short-term outcome of patients who underwent carotid stenting with the routine use of cerebral protection devices. Methods In five centers, 808 successful stent procedures (of 815 attempted) were performed in 753 patients (557 [74%] men; mean [± SD] age, 70 ± 8 years). Cerebral protection involved distal filter devices (n = 640), occlusive distal balloons (n = 144), or proximal balloon protection (n = 24). Results The protection device was positioned successfully in 793 (98.2%) of the 808 attempted vessels. Neurologic complications occurred within 30 days after 46 procedures (5.6%), including seven major strokes, 17 minor strokes, and 22 transient ischemic attacks. There were four deaths (one following a major stroke). The 30-day incidence of stroke and death was 3.3% (27/815). The rate of stroke or death was 3.8% (8/213) for symptomatic lesions and 3.2% (19/602) for asymptomatic lesions (P = 0.87), and 3.4% (25/729) in patients aged <80 years and 2% (2/86) in those aged ≥80 years (P = 0.81). Protection device–related vascular complications, none of which led to neurologic symptoms, occurred after nine procedures (1.1%). Conclusion In this uncontrolled study, routine cerebral protection during carotid artery stenting was technically feasible and clinically safe. The incidence of major neurologic complications in this study was lower than in previous reports of carotid artery stenting without cerebral protection.