Safety Outcome of Carotid Artery Stenting in Long Carotid Lesion with Proximal versus Distal Embolic Protection Devices

Objective: To compare safety outcome in patients with long carotid lesion (u003e10mm) undergoing carotid artery stenting (CAS) with either proximal embolic protection devices (PPD) or distal filter embolic protection devices (DPD). Background: Embolic Protection Devices can prevent the atherosclerotic emboli during carotid artery stenting (CAS) and reduce the risk of stroke. Long carotid lesion u003e10mm have been reported with increased stroke and cardiovascular events. Theoretically, there is a higher risk of embolism during deployment of DPD in patients with long lesions. Newer PPD reverses the flow of blood in the internal carotid artery and may reduce that risk. Our study aims to analyze the difference in safety outcome between DPD and PPD in carotid lesion u003e10mm. Design/Methods: We conducted a retrospective review of consecutive patients undergoing CAS with either PPD or DPD respectively at an academic tertiary care center. Long carotid lesions u003e10mm were identified. Peri-procedural outcomes including minor/major stroke and myocardial infarction (MI) were recorded. Results: From January 2010 to December 2014, we included 43 consecutive patients with long carotid lesion undergoing CAS, 20 in the PPD group and 23 in the DPD group. There was a technical success rate of 100% in stent placement with either protection device. Mean lesion length was 14.9±1.3mm vs. 17.3±2.94mm for PPD and DPD respectively. In PPD group, none of the patients developed coronary or stroke event, whereas 2/23 patient in DPD group developed a minor (NIHSS ≤4) and a major stroke (NIHSS u003e4) respectively (p=0.345). Conclusions: Patients with carotid lesion length u003e10mm undergoing CAS with PPD shows a trend to better safety outcomes including perioperative stroke than patients with DPD. A larger prospective study is needed to confirm this finding. Disclosure: Dr. Saini has nothing to disclose. Dr. Atchaneeyasakul has nothing to disclose. Dr. Goswami has nothing to disclose. Dr. Ambekar has nothing to disclose. Dr. Ramdas has nothing to disclose. Dr. Guada has nothing to disclose. Dr. Yavagal has received personal compensation for activities with Medtronic and Guidepoint as a consultant.