Abstract 230: Comparison of clinical outcomes and complications in patients undergoing Carotid Artery Stenting (CAS) with or without pre and poststent balloon angioplasty.

Background and Objective Carotid artery stenting (CAS) is a procedure that has been established as a safe and effective alternative to carotid endarterectomy in high surgical risk patients. There are procedural questions that remain unanswered, specifically, the safety of pre‐stent balloon angioplasty versus post‐stent versus both. The objective of our study is to understand the risk and safety of these procedural techniques. Methods Multicenter retrospective data related to angioplasty balloons, stents, complications due to pre and post‐stent angioplasty along with the modified Rankin score (mRS) before and after the procedure were collected from January of 2015 until December of 2022. Statistical analysis was performed to correlate this data with risks of complications and clinical outcomes. Results A total of 1355 patients were enrolled. We found that patients who underwent pre‐stent angioplasty, or both (pre and post‐stent angioplasty) had a higher risk of complications compared to those who only had post‐stent angioplasty. There were more complications in patients who did not undergo post‐stent angioplasty as compared to those who did undergo angioplasty (p=0.018, OR=0.513). Follow‐up MRS at 30‐90 days was higher if the balloons in both pre‐stent angioplasty (p=0.016) and post‐stent angioplasty (p=0.020) stent angioplasty were not inflated to nominal pressure. Follow up MRS was statistically higher (p=0.01) in patients with open‐cell stents than closed‐cell stents. Open‐cell stents were more likely to undergo post‐stent angioplasty (p<0.001) while closed‐cell stents were more likely to undergo pre‐stent angioplasty (p=0.002). Conclusions Patients who underwent post‐stent angioplasty alone had less risks of complications compared to pre‐stent angioplasty or combination. This is contrary to prior studies published on this subject and could be related to improvement in technique and in technology in recent years. There is a higher rate of post‐stent angioplasty in patient who received open cell stents, but these also had higher mRS at 30‐90 days compared to closed cell stents.