Angiographic patterns and the procedural and clinical outcomes achieved by proximal balloon occlusion in Symptomatic Carotid Artery Stenosis Stenting

Abstract

Background and purpose The best embolic protection strategy has not yet been established for carotid-artery stenting (CAS). We report here a new simplified approach using a balloon guiding catheter, inspired by stroke therapy, in patients harboring symptomatic ICA atherosclerotic stenosis or web. In addition, we describe the 3 angiographic patterns and clinical outcomes associated with this technique, called the simple flow blockage (SFB) technique. Materials and methods This is a retrospective study with data extraction from a monocentric prospective clinical registry of consecutive patients admitted for symptomatic ICA stenosis or web. The primary study outcome (composite endpoint) was the rate of occurrence of death, symptomatic stroke or acute coronary syndrome within 30 days of intervention. Results Seventy-five symptomatic patients with\xa0>\xa050% carotid artery atherosclerotic stenosis or web were included. All procedures were successfully performed. The composite endpoint occurred in 3 patients (4.0%, 95%CI, 0.0 to 11.3): 1 had symptomatic ischemic stroke, 1 had reperfusion syndrome with symptomatic intracranial hemorrhage and 1 had acute coronary syndrome. Three angiographic patterns after proximal balloon inflation were observed: complete contrast column stagnation in the ICA (38.7%), retrograde washout of the ICA from the intracranial circulation towards the external carotid artery (35.5%), antegrade washout of contrast medium towards the intracranial circulation (25.8%). The median procedure length was 40\xa0minutes. New asymptomatic ischemic lesions were observed in 22.5% on DWI-MRI. Conclusion The SFB technique allows fast and safe procedures in CAS. A favorable angiographic pattern after proximal balloon inflation was observed in 74.2% of cases.