Carotid artery stenting (CAS) with distal protection device (DPD) for stenosis 70% or higher is considered an alternative to carotid artery endarterectomy (CEA) and approved by the central medical service (CMS) after the results of CREST trail. However, the incidence of cerebral ischemic event (CSE) was higher in CAS group compared to the CEA in CREST trial. DPD may not be utilized to patients who possess extreme tortuous vessels or near complete carotid artery stenosis, and many potential beneficiary CAS candidates are excluded. Objective of our study is to evaluate the incidence of CIE between groups who underwent CAS with or without the use of DPD. Additionally, we like to compare the overall perioperative complications between these two groups. Methods: From a prospectively maintained database, Consecutive patient who underwent CAS were collected and retrospectively analyzed from January 2008 to December 2018. Patients demographics, procedural techniques and perioperative events were captured. Outcome was measured using modified ranking scale (mRS) and NIHSS. Results: 165 consecutive patients (74% symptomatic; stroke 35.25%, TIA 38.85%) with median age 69 (39–91) female 30.7% underwent CAS (right ICA 57.55%, left ICA 42.45%) in two community based tertiary care facilities from 2008 to 2018. Median stenosis was 79% (70%-99%). DPD was used in 66% and 35% did not receive DPD due the anatomy. Demographic characteristics were similar between DPD (baseline mRS 0.33±.67) and non-DPD group (0.59±.15). The incidence of CIE was observed in 2 cases and both developed in DPD group; TIA in one and lacunar stroke NIHSS of 2, resolved in 90 days. Non-CIE related major complications was observed in two female patients; retroperitoneal hemorrhage related cardiac arrest leading to death in one in group without DPD and femoral angioseal related occlusion in one in DPD group who required repair and achieved mRS 0 in 90 days. Minor complications related to anterior small hematoma in 3 cases without impairing baseline mRS or hospital stay. In regards to the outcomes, 90 days mRS for DPD and non-DPD group was 0.49±1.1 and 0.19±0.55 respectively. Conclusions: Our study revealed no difference in the incidence of cerebral ischemic event in carotid artery stenting patients who were either treated with the use of DPD or without DPD. However, the overall incidence of CIE was low in our study and non-CIE related events were observed more in female patients. Larger CMS sponsored studies are required.

Disclosures Y. Lodi: None. V. Reddy: None. S. Javed: None. T. Wong: None. S. Multani: None. W. Elnour: None. A. Harouni: None.