Post-Procedural Ballooning Doubles Carotid Artery Stenting Death Rate

A new study shows that combination stent ballooning is associated with increased periprocedural stroke and death rate in carotid artery stenting (CAS).

Researchers at Johns Hopkins University (Baltimore, MD, USA) performed a retrospective analysis involving 3,772 patients who underwent CAS between 2005 and 2014, studying the effect of different pre-SB and post-SB combinations on hemodynamic depression and 30-day stroke and death rate. Patients who had no protection device, those with isolated common carotid artery lesions, and those who had no ballooning at all were excluded. The researchers controlled for age, gender, co-morbidities, smoking, preoperative medications, ipsilateral stenosis, and previous ipsilateral carotid endarterectomy.

The results revealed that while the overall risk of stroke and death was relatively low, with less than 2.4% of patients experiencing a stroke within 30 days of treatment, and less than one percent dying, those treated with a combination pre- and post- SB had a 2.1-fold increase in hemodynamic depression and 2.4-fold increase in perioperative stroke and death rate. The researchers also found that those who had post-SB alone also had an elevated risk, but in the final analysis, it did not reach statistical significance. The study was published on May 30, 2015, in the Journal of Vascular Surgery.

“Although the overall risk of stroke and death is low in patients who undergo carotid stenting, the common practice of ballooning the vessel after the wire mesh is inserted can double the risk of death and stroke during or shortly after the procedure,” said senior author Associate Professor of Surgery Mahmoud Malas, MD, MHS. “The main goal of carotid stenting is not so much to restore blood flow as to contain and stabilize preexisting plaque. Our message is clear: once inside the artery, leave the stent alone.”

Repeat ballooning after stent placement can causes stroke by driving the stent deeper into the fragile vessel walls, disturbing the atherosclerotic plaque and causing emboli to make their way to the brain.

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