Frank J Criado, MD, FACS, FSVM
The important technical issue surrounding safety of pre and post-ballooning during CAS was examined in a recent paper published in JVS by Obeid et al. (J Vasc Surg 2015;62:616-623). The objective of the study was to analyze the effect of pre-ballooning (before stent placement) and post-ballooning (after stent placement) on hemodynamic depression (HD) and perioperative stroke or death.
The authors conducted a retrospective analysis of all patients who had CAS between 2005 and 2014 in the Vascular Quality Initiative database. They performed logistic regression analyses of the effect of different pre and post-ballooning combinations on HD and the 30-day stroke and death rates.
The study included 3,772 CAS patients. The overall perioperative stroke and death rate was 3%. Compared with pre-ballooning-only technique, the combined pre and post-ballooning technique was associated with a 2.1-fold increase in HD and 2.4-fold increase in perioperative stroke and death rate.
Compared with pre-ballooning alone, the practice of post-ballooning increased the chances of perioperative HD and stroke and death in patients undergoing CAS. The investigators concluded that post-ballooning should be avoided if possible, and only used to treat severe residual stenosis after stent deployment.