Proximal embolic protection devices for high risk lesions/patients in "TARGET-CAS" registry of 1717 consecutive carotid artery stenting procedures

Purpose: To compare 30-day and long-term safety of carotid artery stenting (CAS) performed according to the tailored-CAS algorithm with the use of proximal or distal embolic protection devices (EPD). Methods: Since 2001 we performed 1717 CAS procedures in 1549 patients (age 38-86 years, mean 67.1±8.6 years, 50.1% symptomatic) according to the tailored-CAS algorithm that included extracranial ultrasound and CT angiography to select the most appropriate EPD and stent type. Proximal EPD and closed-cell stents were preferentially used for high-risk lesions (HR - soft/thrombus-containing/tight/ulcerated, 39.3% of all lesions) and in symptomatic patients. Results: In proximal EPD group (618 CAS) Doppler velocities (PSV 3.9±1.2, EDV 1.6±0.6 m/s) and stenosis rate (85.6±10.7%) were significantly higher than in distal EPD group (1099 CAS, PSV 3.3±1.2 m/s, EDV 1.1±0.4m/s, 80.2%±10.1; p<0.001 for all). Similarly, proportion of HR was higher in proximal EPD group (92.1% vs. 9.7% for distal EPD group, p<0.001). Death, disabling stroke, any stroke rate were similar in both groups – 0.48%, 0.3%, 1.29% in proximal EPD and 1.0%, 0%, 1.36% in distal EPD group, p>0.05 for all). In long-term follow-up (4.6±2.8y) there were no differences in stroke/death rate. Conclusions: Proximal EPD use for high-risk lesion/patient is equally safe as distal EPD use for standard-risk lesion/patient during CAS.