Clinical Outcomes and Complications of Carotid Artery Stenting With or Without Pre-Stent and Post-Stent Balloon Angioplasty

Background and Purpose: Carotid artery stenting is a well-established method for treating carotid artery stenosis; however, there are conflicting data on prestenting versus post-stenting balloon angioplasty. Our study aims to understand the risk and safety of pre-stent balloon angioplasty (Pre-SB) and post-stent balloon angioplasty (Post-SB), or both techniques. Methods: Multicenter retrospective data on angioplasty balloons, stents, complications, and modified Rankin score (mRS) before and after the procedure were collected. Statistical analysis was performed to correlate with complication risks and clinical outcomes. Results: 1,355 patients were enrolled. Post-SB predicted fewer complications (p = 0.035) than Pre-SB or combined Pre-SB and Post-SB. Female sex was a predictor of complications (p = 0.041), while utilization of an embolic protection device predicted fewer complications (p < 0.001). Increasing age (p < 0.001) and smoking (p = 0.027) predicted increased length of stay. Using open-cell stents versus closed-cell stents did not predict follow-up modified rankin score (mRS) or complications, but using open-cell stents did predict a shorter length of stay. Conversely, open-cell stents were more likely to undergo Post-SB (p < 0.001), while closed-cell stents were more likely to undergo Pre-SB (p = 0.002). Conclusions: Unlike previous literature, our results showed that Post-SB alone was associated with fewer complications compared to either Pre-SB alone or the combination of Pre-SB and Post-SB. Open-cell stents required a higher rate of Post-SB.