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December 23, 2005
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Marc Bosiers1, Patrick Peeters2, Koen Deloose1, Jurgen Verbist2, Horst Sievert3, Jennifer Sugita3, Fausto Castriota4, Alberto Cremonesi4.
1AZ St-Blasius, Dendermonde, Belgium, 2Imelda Hospital, Bonheiden, Belgium, 3CardioVascular Center, Frankfurt, Germany, 4Villa Maria Cecelia Hospital, Ravenna, Italy.
OBJECTIVE:
During carotid stenting (CAS), it is generally accepted that predilation is only mandatory in cases of severe stenosis which might complicate retrieval of the stent delivery system. We compared the long-term results of CAS after predilation and primary stenting as observed in 4 high-volume centers.
METHODS:
Between 1993 and 2004, 2069 CAS procedures were performed: 1455 lesions were stented primarily, 614 lesions underwent predilation. Embolic protection devices were used in 1282 of the primary stenting and 550 predilated lesions. Follow-up was carried out according to the clinical protocols of each center.
RESULTS:
The stroke/death-rate for predilation was significantly lower than after primary stenting (p=0.0022), and was 0.5% vs. 1.4% after 30 days; 2.7% vs. 4.6% after 1 year; 5.0% vs. 11.8% after 3 years; and 10.5% vs. 17.1% after 5 years, respectively. Subgroup analyses in the registry indicate that carotid patients presenting as symptomatic, with echolucent plaques, with diagnosed hypertension, polyvascular disease, hypercholesterolemia have a better outcome if stenting is preceded by predilation.
CONCLUSIONS:
Although primary stenting remains the standard of care for CAS, the ELOCAS-registry indicates predilation is advisable in specific subgroups. Nevertheless, prospective multicenter randomized trials are mandatory to support this thesis.
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Does predilation affect the clinical outcome of carotid artery stenting: subanalysis of the ELOCAS-registry
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Marc Bosiers1, Patrick Peeters2, Koen Deloose1, Jurgen Verbist2, Horst Sievert3, Jennifer Sugita3, Fausto Castriota4, Alberto Cremonesi4.
1AZ St-Blasius, Dendermonde, Belgium, 2Imelda Hospital, Bonheiden, Belgium, 3CardioVascular Center, Frankfurt, Germany, 4Villa Maria Cecelia Hospital, Ravenna, Italy.
OBJECTIVE:
During carotid stenting (CAS), it is generally accepted that predilation is only mandatory in cases of severe stenosis which might complicate retrieval of the stent delivery system. We compared the long-term results of CAS after predilation and primary stenting as observed in 4 high-volume centers.
METHODS:
Between 1993 and 2004, 2069 CAS procedures were performed: 1455 lesions were stented primarily, 614 lesions underwent predilation. Embolic protection devices were used in 1282 of the primary stenting and 550 predilated lesions. Follow-up was carried out according to the clinical protocols of each center.
RESULTS:
The stroke/death-rate for predilation was significantly lower than after primary stenting (p=0.0022), and was 0.5% vs. 1.4% after 30 days; 2.7% vs. 4.6% after 1 year; 5.0% vs. 11.8% after 3 years; and 10.5% vs. 17.1% after 5 years, respectively. Subgroup analyses in the registry indicate that carotid patients presenting as symptomatic, with echolucent plaques, with diagnosed hypertension, polyvascular disease, hypercholesterolemia have a better outcome if stenting is preceded by predilation.
CONCLUSIONS:
Although primary stenting remains the standard of care for CAS, the ELOCAS-registry indicates predilation is advisable in specific subgroups. Nevertheless, prospective multicenter randomized trials are mandatory to support this thesis.
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