Selective Poststent Balloon Angioplasty for Carotid Stenting
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* D.M. Pelz
* S.P. Lownie

We read with interest the recent article1 on the selective use of poststent dilation for carotid atherosclerosis. It confirms our published findings that the omission of routine poststent balloon angioplasty does not affect the angiographic and clinical outcomes in most patients undergoing carotid stent placement procedures.2 We find it surprising that the authors have omitted from this recent review our series of 181 patients, in which both routine pre- and poststenting balloon angioplasties were not routinely performed and were only used selectively when required.3 We found that CT angiographic plaque morphology was quite accurate in predicting which patients would require balloon angioplasty to achieve a satisfactory angiographic outcome. Our approach, which we have termed “primary carotid stent” placement, results in less hemodynamic instability than standard techniques4 and has a similarly low incidence of periprocedural complications. We believe that our data would have been a useful addition to this meta-analysis.

## References

1.  1. Petr O, Brinjikji W, Murad MH, et al. Selective-versus-standard poststent dilation for carotid artery disease: a systematic review and meta-analysis. AJNR Am J Neuroradiol 2017;38:999–1005 doi:10.3174/ajnr.A5103 pmid:28302610
    
    [Abstract/FREE Full Text](http://www.ajnr.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiIzOC81Lzk5OSI7czo0OiJhdG9tIjtzOjIwOiIvYWpuci8zOC8xMS9FOTcuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2. Bussière M, Pelz DM, Kalapos P, et al. Results using a self-expanding stent alone in the treatment of severe symptomatic carotid bifurcation stenosis. J Neurosurg 2008;109:454–60 doi:10.3171/JNS/2008/109/9/0454 pmid:18759576
    
    [CrossRef](http://www.ajnr.org/lookup/external-ref?access_num=10.3171/JNS/2008/109/9/0454&link_type=DOI) 
    
    [PubMed](http://www.ajnr.org/lookup/external-ref?access_num=18759576&link_type=MED&atom=%2Fajnr%2F38%2F11%2FE97.atom) 
    
    [Web of Science](http://www.ajnr.org/lookup/external-ref?access_num=000258904400015&link_type=ISI) 

3.  3. Pelz DM, Lownie SP, Lee DH, et al. Plaque morphology (the PLAC Scale) on CT angiography: predicting long-term anatomical success of primary carotid stenting. J Neurosurg 2015;123:856–61 doi:10.3171/2014.9.JNS14811 pmid:25816084
    
    [CrossRef](http://www.ajnr.org/lookup/external-ref?access_num=10.3171/2014.9.JNS14811&link_type=DOI) 
    
    [PubMed](http://www.ajnr.org/lookup/external-ref?access_num=25816084&link_type=MED&atom=%2Fajnr%2F38%2F11%2FE97.atom) 

4.  4. Bussière M, Lownie SP, Lee D, et al. Hemodynamic instability during carotid artery stenting: the relative contribution of stent deployment versus balloon dilation. J Neurosurg 2009;110:905–12 doi:10.3171/2008.9.JNS08509 pmid:19231933
    
    [CrossRef](http://www.ajnr.org/lookup/external-ref?access_num=10.3171/2008.9.JNS08509&link_type=DOI) 
    
    [PubMed](http://www.ajnr.org/lookup/external-ref?access_num=19231933&link_type=MED&atom=%2Fajnr%2F38%2F11%2FE97.atom) 
    
    [Web of Science](http://www.ajnr.org/lookup/external-ref?access_num=000265501500014&link_type=ISI) 

*   © 2017 by American Journal of Neuroradiology