Stroke risk following carotid stenting elevated by re-inflating balloon

The risk of stroke and death can be doubled by a common practice in carotid stenting, new research has found.

Used to treat patients with blocked neck arteries, carotid stenting involves propping open narrowed blood vessels with a mesh stent. A balloon is typically used to make room for the stent, and is often re-inflated once it is in place.

Blocked neck or carotid arteries are a condition known as carotid stenosis, which means said arteries suffer from a build-up of fat and calcium deposits, causing them to become stiff. This in turn weakens their ability to carry oxygen-rich blood to the brain and makes the condition a significant stroke risk - hence the need for carotid stenting.

Published in the Journal of Vascular Surgery, the study showed that the practice of ballooning the vessel once the mesh is in place can double the risk of death and stroke both during and shortly after the surgery.

Senior author of the study Dr Mahmoud Malas, associated professor of surgery at the Johns Hopkins University School of Medicine, said: "Ballooning after placing the stent appears to cause the very complication it's intended to prevent. Surgeons should avoid doing it. Period." 

The researchers believe that the elevated risk is caused by the balloon pushing the stent into the vessel walls. This then disturbs the build-up of fatty plaque, causing it to splinter off. Once released, this plaque can then travel to the brain and cause a stroke.

To carry out their study, the researchers analysed carotid stenting patients aged 19 to 89, who underwent the procedure in US hospitals between in 2005 and 2014, using data from the Vascular Quality Initiative. The patients occupied three groups: one had only pre-stent ballooning, another just post-stent ballooning, and the final group a combined treatment.

They found that patients treated with the combined method were twice as likely to experience a stroke or die, though the overall risk of the procedure remains low despite these findings. 

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