Carotid artery stenting with filter protection in high-risk patients showing severe electroencephalographic alterations during carotid endarterectomy

Purpose: To describe the results and efficacy of stent treatment in patients with carotid stenosis who had aborted carotid endarterectomy procedures due to the appearance of severe electroencephalographic (EEG) alterations. Methods: A retrospective study was conducted of 18 patients (11 men; mean age 72 years, range 62–84) with symptomatic high-grade carotid artery stenoses ( 70%) who experienced severe EEG alterations during carotid endarterectomy, causing the procedure to be aborted. Twelve patients had shown no hemodynamic alterations during preoperative transcranial Doppler evaluation after external compression of the common carotid artery; the remaining 6 could not be evaluated. The patients were referred for carotid artery stenting (CAS); 7 had contralateral internal carotid artery stenosis and 5 had contralateral occlusion. Endovascular intervention was carried out using standard techniques under filter protection. Follow-up was scheduled at 3, 6, and 12 months. Results: All patients were successfully treated without immediate complications. The EEG did not display any significant alterations during the endovascular procedure. Mean followup was 43 months. Magnetic resonance imaging at 6 months showed no signs of cerebral ischemia. Color Doppler ultrasound imaging documented normal stent patency in all patients. Conclusion: Patients with symptomatic severe carotid stenosis ( 70%) who are considered at risk due to the appearance of severe EEG alterations during surgical treatment may benefit from CAS with respect to both major and minor complications. Larger studies are needed to confirm these findings. J Endovasc Ther 2006;13:451–456 Key words: carotid endarterectomy, carotid artery, stenosis, electroencephalography, cerebral ischemia, carotid angioplasty, stent