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Double-wire technique in balloon-protected carotid artery stenting.

OBJECTIVES
To evaluate the safety and efficacy of a double-wire technique in carotid artery stenting (CAS) with a distal occlusion balloon system, PercuSurge GuardWire.


METHODS
Fifty-one consecutive patients with 53 de novo lesions were scheduled to undergo balloon-protected CAS with the "double-wire technique," the use of two wires, one for independent predilatation and the other for stent implantation.


RESULTS
Fifty consecutive patients underwent a total of 52 balloon-protected CAS except for 1 patient with one lesion that could not be accessed. The use of a 1.5-mm coronary balloon was necessary in only 2 cases (3.8%) to let the PercuSurge GuardWire cross critically stenotic lesions. The placement of the PercuSurge GuardWire into the internal carotid artery was successful in all cases. Technical success was obtained in all cases. Fifty lesions (96.2%) were treated with one inflation of the distal occlusion balloon during the entire procedure consisting of predilatation, stent implantation, and aspiration, and among them three lesions (5.8%) required postdilatation. The mean occlusion time of cerebral blood flow for 50 lesions was 266 +/- 37 seconds. Out of 50 procedures, 45 (90.0%) had occlusion times of 300 seconds or less. Neurological intolerance requiring intravenous anesthesia was seen in 4 cases (7.7%) and periprocedural neurological complication in 2 cases (3.8%).


CONCLUSIONS
The "double-wire technique" is safe and effective for the shortening of occlusion time during predilatation, stent implantation, and aspiration, leading to satisfactory technical and clinical outcomes, in most cases. This technique should be considered for balloon-protected CAS using the PercuSurge GuardWire.