Perspectives in Vascular Surgery and Endovascular Therapy

 

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Perspectives in Vascular Surgery and Endovascular Therapy, Vol. 19, No. 4, 403-408 (2007)
DOI: 10.1177/1531003507310453

Complications of Carotid Artery Stenting Are Largely Preventable: A Retrospective Error Analysis

Ravi K. Veeraswamy, MD

Division of Vascular Surgery, Department of Surgery at Emory University School of Medicine, Atlanta, Georgia, veeraswamy{at}emoryhealthcare.org

Brian G. Rubin, MD

Washington University School of Medicine, Saint Louis, Missouri

Luis A. Sanchez, MD

Washington University School of Medicine, Saint Louis, Missouri

Michael A. Curi, MD

University of Maryland School of Medicine, Baltimore, Maryland

Patrick J Geraghty, MD

Washington University School of Medicine, Saint Louis, Missouri

Juan C. Parodi, MD

University of Miami School of Medicine, Miami, Florida

Gregorio A. Sicard, MD

Washington University School of Medicine, Saint Louis, Missouri

Procedure-related complications with carotid artery stenting must be minimized for it to be a valid treatment for carotid stenosis. Failure analysis was done for 207 carotid stent procedures. All complications were reviewed and technical errors were identified. The procedure-related stroke rate was 2.9%, technical failure rate was 1.9%, and no patients died. Two strokes resulted from protocol deviations. A third stroke occurred while crossing a long, irregular lesion with a protection device instead of establishing flow reversal. Excessive instrumentation of the aortic arch resulted in 2 strokes. Distal embolization occurred after open-cell stenting a friable lesion in 1 patient. The majority of neurologic events and technical complications that occur during carotid stenting are preventable. By adhering to technical protocols, avoiding excessive instrumentation in the aortic arch, using flow reversal in selected lesions, and matching the appropriate anatomy and stent, results of carotid artery stenting can be exceptional.

Key Words: carotid artery • stent • stroke


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