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Home > Vascular Annual Meeting > RR5. Carotid Highly-Calcified “De Novo” Stenosis...

RR5. Carotid Highly-Calcified “De Novo” Stenosis and Cutting-Balloon Angioplasty: A Tool to Prevent Haemodynamic Depression?

Setacci Carlo, Setacci Francesco, Sirignano Pasqualino, Chisci Emiliano, Galzerano Giuseppe, de Donato Gianmarco
University of Siena, Siena, Italy

OBJECTIVES: Severe highly-calcified “de-novo” lesions of carotid arteries are important predictors of haemodynamic depression (HD) after carotid artery stenting (CAS). Cutting-balloon angioplasty (CBA) using low-inflation pressures has been described as an effective method to achieve important luminal gain and avoid HD.

METHODS: From January 2005 to December 2007 one hundred and two consecutive patients (mean age 76.36±7.54 years) with severe highly-calcified “de novo” lesions of carotid artery undergoing CAS were prospectively observed and randomized in two groups: group 1 (n=50) underwent standard CAS, group 2 (n=52) underwent CAS with CBA. Patients with prior ipsilateral carotid endarterectomy (CEA), beta-blockers therapy or arrhytmias were excluded. HD was defined as periprocedural hypotension (systolic blood pressure <90 mmHg) or bradycardia (heart rate <60 beats/min). CBA angioplasty was carried-out using CB coronary device, 0.014 inch compatible, from 3 to 4 mm or CB peripheral device, 0.018 inch compatible, from 5 to 6 mm in diameter, inflated at a mean-maximum value of 8.6 atmospheres; the average number of cuts per lesion was 2.7.

RESULTS: Demographic and clinical characteristic of both groups at the basal conditions were comparable. HD occurred in 18/50 (36%) procedures in Group 1, while in 3/52 (5.76%) in Group 2. The difference between the two groups concerning HD incidence was statistically significant (p<0.001). There was a strong (p<0.001) association between HD and CBA and the OR=0.109 (95%CI 0.019-0.425) confirmed the protective role of CBA. No major intraprocedural complications were observed in this series. Post-procedural Doppler Ultrasound scan showed one case (2%) of in-stent “restenosis” in Group 1 representing early failure due to recoil, and only one (1.92%) neurological adverse event (TIA) in group 2.

CONCLUSIONS: Following the experience in coronary and other districts and in carotid ISR36 , we extended the potential benefits of the CB technique applying CBA to severe highly-calcified “de novo” lesions of carotid arteries. HD is a common occurrence after CAS, especially in patients with both long and calcified plaque. Only a tailored procedure with a correct remodelling of the plaque allows to avoid both HD and elastic recoil of the target lesion.

AUTHOR DISCLOSURES: S. Carlo, None; S. Francesco, None; S. Pasqualino, None; C. Emiliano, None; G. Giuseppe, None; D. Gianmarco, None.