Stent Induced Carotid Remodeling: A Balloon Sparing Technique for Carotid Revascularization

Background— Carotid artery stent placement is widely utilized to treat high-risk carotid stenosis patients but is
associated with a greater risk of peri-procedure stroke than carotid endarterectomy in standard-risk populations. We
explore a technique designed to lower this risk by avoiding the use of angioplasty intra-procedurally and allowing
more gradual carotid remodeling to occur.
Methods—We compare two groups of consecutively treated subjects. The first group was treated with the traditional
combination of stent placement and angioplasty (AG; 18 subjects), while the second group utilized stent insertion
alone (NAG; 20 subjects). All subjects were treated at a single institution with retrospective data collection. Procedural
and clinical data were collected for analysis.
Results— No differences in clinical outcome were noted between the two groups. There was a trend toward more
significant immediate residual stenosis in the NAG group than the AG groups (22% versus 5%; p=0.06), but at follow
up imaging, there was no difference between the groups, with the NAG group showing interval luminal gain of 7.5%
accounting for the equalization.
Conclusion— Avoidance of angioplasty during carotid stent placement is associated with similar clinical and
radiographic outcomes; more immediate luminal gains are observed with angioplasty versus more gradual gains with
stent placement alone. Given the physiologic reasons to believe this technique could reduce peri-procedure stroke,
further evaluation of this technique in a larger population is warranted.