Carotid artery stenting with pre-stenting dilatation alone: Safety and efficacy

Abstract

Background

Carotid artery stenting (CAS) is an established alternative to carotid endarterectomy for the treatment of atherosclerotic carotid stenosis. However, periprocedural ischemic stroke remains a concern, partly influenced by device selection and procedural technique. The optimal dilatation strategy, particularly the role of pre- and post-stenting balloon dilatation, remains debated. This study aimed to evaluate the safety and efficacy of CAS using pre-stenting dilatation alone compared with combined pre- and post-stenting dilatation.

Methods

A retrospective analysis was conducted of 1248 CAS procedures performed in 1158 patients at a single neurovascular center (May 2009–December 2020). Baseline characteristics, procedural details, and outcomes were compared between cases with pre-stenting dilatation alone and those with additional post-stenting dilatation. The primary endpoint was the 30-day composite stroke rate; secondary outcomes included periprocedural adverse events and long-term in-stent restenosis (ISRS > 50%).

Results

Pre-stenting dilatation was performed in all cases; additional post-stenting dilatation was used in 150 procedures (12%). The 30-day composite stroke rate was 2.6%, significantly lower in the pre-dilatation-alone group than in the combined group (2.1% vs. 7.2%; p = 0.003). At a median follow-up of 66 months, ISRS > 50% occurred in 5.9% of stents, with no significant difference between groups (5.9% vs. 5.7%).

Conclusions

In this large single-center experience, CAS using pre-stenting dilatation alone was associated with a lower periprocedural stroke rate and comparable long-term patency. These findings support a simplified procedural approach that may reduce embolic risk without compromising efficacy.