Carotid artery stenting: Clinical and procedural implications for near-occlusion stenosis

Abstract Introduction and objectives The advisability of implanting a stent in carotid near-occlusion stenosis is a controversial topic. We have assessed procedural and clinical implications of stent implantation for carotid artery disease with near occlusion. Methods We included 205 patients who underwent carotid artery revascularisation with a stent. The group of patients with near-occlusion stenosis ( n  = 54) was compared to the rest of the population ( n  = 151). Results No differences were found between groups for age, sex, and the percentage of symptomatic patients (three-quarters of the population). Carotid stent revascularisation for near-occlusion stenosis presented a high procedural success rate (96%) similar to that of revascularisation processes for other lesions (98%). Stenting in cases of near-occlusion stenosis required increased use of proximal protection (54% vs. 20.5%, P P  = 0.01). The process to repair near-occlusion stenosis causes increased detachment of plaque, as shown by higher percentages of macroscopic plaque captured by protection devices (18.5% vs. 7%, P  = 0.01) and of perioperative ischaemic brain lesions (47% vs 31%, P  = 0.07). At 30 days of follow-up, the tendency towards adverse neurological events (death, major and minor stroke) was higher in the near-occlusion group (9.2% vs. 3.2%, P  = 0.08). Conclusions Stent revascularisation for near-occlusion carotid stenosis has a high procedural success rate; however, its higher plaque load was responsible for the increased rate of ischaemic brain lesions and adverse neurovascular events at 30 days post-procedure.