Role of Cerebral Protection In Carotid Angioplasty And Stenting

Aim: To study the role of protective devices in improving the efficacy of percutaneous transluminal angioplasty (PTA) and stenting, in the treatment of symptomatic atherosclerotic stenosis of carotid arteries. Materials and Methods: This study was performed in a teritiary care center in a period of 4 years, which included 66 patients. A majority of the patients presented with transient ischaemic attacks, with the youngest being 19 years and oldest was 82 years. Preprocedural workup with Doppler, MR angiogram and Digital subtraction angiogram was done in all the patients. The degree of stenoses was classified on the basis of the NASCET (North American Society Carotid Endarterectomy Trial) trial. PTA and stenting with self expandable stent and balloon was done in all the patients under local anaesthesia. Cerebral protective devices were used in all the patients and the patients were regularly followed up at intervals of 1, 3, 6 and 12 months. Results: PTA and stenting with cerebral protection was done in all the patients. Technical successs was achieved in all the patients. Four patients had filter choking. Major stroke occurred in one patient. No deaths occurred in our study. Bradycardia occurred in 3 patients, hypotension in 4 patients and puncture site haematoma in 2 patients. The results of the present study were analysed and compared with the literature. Conclusion: PTA and stenting is effective for the management of carotid artery stenosis with higher success rate and less complications. The role of cerebral protection in avoiding migration of the plaque material and thus preventing cerebral circulation was emphasized.