Introduction: The carotid artery angioplasty and stenting (CAS) recent trials support the use of CAS for symptomatic disease based on clinical equipoise. In the Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis (CREST) trial Carotid Endarterectomy (CEA) was associated with higher rate of Myocardial Infarction (MI) and CAS was associated with higher stroke rate Stenting-associated strokes may be due to placement of rigid 8 and 9 Fr guide catheters and stiff wires around the aortic arch in tortuous calcified brachiocephalic anatomy, leading to emboli liberation. We propose that a 6 Fr system helps prevent arch trauma especially in angulated atherosclerotic conditions.

Methods: We performed a retrospective chart review of 224 consecutive CAS patients over 10 years. All patients were treated using a 6 Fr technique with distal protection; 6fr SIM2 in over 90% of the time was used to deliver the filter wire, angioplasty balloon, and stent. Patients were awake under neuroleptanalgesia. Heparinized saline flush was used with all devices whenever possible. Dual antiplatelet therapy was carefully monitored. Carotid Doppler was performed at 1, 6, and 12 months and yearly thereafter

Results: There were 136 males and 88 females. Symptomatic and asymptomatic carotid stenosis were equally represented. Our patient demographics are comparable with CREST. One year post-operatively there were 2 (0.89%) ischemic strokes, 4(1.79%) TIAs and 2 (0.89%) MIs. Five (2.23%) patients required balloon angioplasty due to high grade restenosis. No patients required additional stents. There were 11 deaths, only two (0.89%) were associated with neurologic sequela. One patient was lost to follow up.

Conclusions: The 6Fr technique is a feasible, safe and less traumatic to the arch and brachiocephalic vessels, potentially reducing the stroke risk. A pooled analysis comparing these results to the national data may be necessary.

Patient Care: suggesting an alternative safer intervention for carotid stenosis treatment

Learning Objectives: Using 6 Fr systems for carotid stenting which is safe and feasible alternative

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