E-105 Carotid stenting without embolic protection devices is safe: a single-center experience
Bibliographic record
Abstract
Background and purpose One of the main procedural complications with carotid artery stenting (CAS) is intra-procedural dislodgement of atheromatous plaque. Performing the procedure using a distal embolic protection device is believed to minimize the risk of cerebral embolisms and subsequent ischemic stroke. The purpose of this study to share our experience with CAS without using distal embolic protection devices. Method We performed a retrospective chart review of 102 percutaneous stenting and/or angioplasty procedures involving the extracranial carotid artery performed at our institution between January 2012 and April 2018. Ninety-Five patients underwent the procedure without the use of a distal embolic protection device. Baseline, procedural and follow-up data were prospectively collected. Technical success rate, stroke/death/myocardial infarction rate at 30 days, access-site complications, and long term follow up outcome were collected. Results All procedures were performed on patients with symptomatic carotid stenosis except one procedure which was performed on a patient with recurrent severe stenosis post carotid endarterectomy (CEA). Carotid artery percutaneous stenting and/or angioplasty was successful in 94 procedures (94%). There were no minor strokes or TIAs. Major adverse events in the peri-procedural period (0–30 days) occurred in two patients (2%), and there was one death (1%) secondary to a large intracerebral hemorrhage in a patient with hyperperfusion syndrome. One patient (1%) suffered a myocardial infarction (NSTEMI) as well as a major stroke due to acute in-stent thrombosis with complete occlusion of the stent 3 days after CAS. Three patients (3%) sustained access related complications: one patient required a blood transfusion. During the follow-up period, (range: 0 to 60 months) there were 6 deaths: 1 patient due to a massive ipsilateral stroke 8 days after a failed attempt at CAS; 2 patients died secondary to myocardial infarction, 3 patients died of non-neurological causes. Conclusion Our results of carotid artery stenting and/or angioplasty without using a distal embolic protection device demonstrates high feasibility and safety without an increased risk of intraprocedural/periprocedrual ipsilateral ischemic stroke. Disclosures N. Alharbi: None. M. Alwadai: None. A. Martyniuk: None. A. Aljuzair: None. A. Algird: None. B. Van Adel: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".