Re: Ogata A et al. Carotid artery stenting without post-stenting
balloon dilatation. J NeuroIntervent Surg 2013; Dec 6: (Epub ahead of
print)
We read with interest this article regarding carotid stenting (CAS)
without post-stent balloon angioplasty. The authors believe that this
method reduces the risk of embolic complications. They point out that
every passage of a device across a carotid stenosis can generate emboli,
and that the post-stent angioplasty is the most embologenic part of
standard CAS techniques.
Our group and others (1,2) have shown that primary carotid stenting
(PCS), in which a self-expanding stent alone, without the use of an
embolic protection device or balloon angioplasty, can safely and
effectively treat the majority of carotid stenoses. PCS is particularly
effective in patients with moderate amounts of "soft" plaque and minimal
plaque calcification. PCS minimizes the potential for embolus generation,
results in less hemodynamic depression, is faster and cheaper and may be
safer than standard techniques. Although re-stenosis rates are higher,
these patients are rarely symptomatic and re-angioplasty of recurrent
lesions with neointimal formation is usually straightforward.
Ogata et al are on the right path towards making CAS safer, but in
appropriate patients, PCS may be an even better option.
1. Bussiere M, Pelz DM, Kalapos P et al. Results using a self-
expanding stent alone in the treatment of severe, symptomatic carotid
bifurcation stenosis. J Neurosurg 2008; 109: 454-460
2. Baldi S, Zander T, Rabellino M, Gonzalez G, Maynar M. Carotid artery
stenting without angioplasty and carotid protection: a single center
experience with up to 7 years follow-up. AJNR Am J Neuroradiol 2011; 32
(4): 759-763
David M. Pelz, MD, FRCPC
Department of Medical Imaging
Stephen P. Lownie, MD, FRCSC
Department of Clinical Neurological Sciences
Division of Neurosurgery
Schulich School of Medicine and Dentistry
Western University, London, Ontario
Canada
Conflict of Interest:
None declared
Re: Ogata A et al. Carotid artery stenting without post-stenting balloon dilatation. J NeuroIntervent Surg 2013; Dec 6: (Epub ahead of print)
We read with interest this article regarding carotid stenting (CAS) without post-stent balloon angioplasty. The authors believe that this method reduces the risk of embolic complications. They point out that every passage of a device across a carotid stenosis can generate emboli, and that the post-stent angioplasty is the most embologenic part of standard CAS techniques.
Our group and others (1,2) have shown that primary carotid stenting (PCS), in which a self-expanding stent alone, without the use of an embolic protection device or balloon angioplasty, can safely and effectively treat the majority of carotid stenoses. PCS is particularly effective in patients with moderate amounts of "soft" plaque and minimal plaque calcification. PCS minimizes the potential for embolus generation, results in less hemodynamic depression, is faster and cheaper and may be safer than standard techniques. Although re-stenosis rates are higher, these patients are rarely symptomatic and re-angioplasty of recurrent lesions with neointimal formation is usually straightforward.
Ogata et al are on the right path towards making CAS safer, but in appropriate patients, PCS may be an even better option.
1. Bussiere M, Pelz DM, Kalapos P et al. Results using a self- expanding stent alone in the treatment of severe, symptomatic carotid bifurcation stenosis. J Neurosurg 2008; 109: 454-460 2. Baldi S, Zander T, Rabellino M, Gonzalez G, Maynar M. Carotid artery stenting without angioplasty and carotid protection: a single center experience with up to 7 years follow-up. AJNR Am J Neuroradiol 2011; 32 (4): 759-763
David M. Pelz, MD, FRCPC Department of Medical Imaging
Stephen P. Lownie, MD, FRCSC Department of Clinical Neurological Sciences Division of Neurosurgery
Schulich School of Medicine and Dentistry Western University, London, Ontario Canada
Conflict of Interest:
None declared