Complications of Carotid Artery Stenting Are Largely Preventable : A Retrospective Error Analysis

Procedure-related complications with carotid artery stenting must be minimized for it to be a valid treatment for carotid stenosis. Failure analysis was done for 207 carotid stent procedures. All complications were reviewed and technical errors were identified. The procedure-related stroke rate was 2.9%, technical failure rate was 1.9%, and no patients died. Two strokes resulted from protocol deviations. A third stroke occurred while crossing a long, irregular lesion with a protection device instead of establishing flow reversal. Excessive instrumentation of the aortic arch resulted in 2 strokes. Distal embolization occurred after open-cell stenting a friable lesion in 1 patient. The majority of neurologic events and technical complications that occur during carotid stenting are preventable. By adhering to technical protocols, avoiding excessive instrumentation in the aortic arch, using flow reversal in selected lesions, and matching the appropriate anatomy and stent, results of carotid artery stenting can be exceptional.