Outcomes Of Carotid Artery Stenting Without Embolic Protection in Yemen: A Resource-Constrained Experience

BACKGROUND Carotid Artery stenting (CAS) have been reported to be safe and effective option for treating carotid atherosclerotic diseases. The published data support the use of embolic protection devices (EPDs) to reduce periprocedural stroke. However, reports and studies from resource limited countries are scarce. This study aimed to evaluate the outcome of CAS procedures without EPDs in Yemen as one of the lowest-income countries.

This is a retrospective cohort study regarding carotid artery stenting (CAS) for symptomatic carotid artery stenosis that was conducted at the stroke center of and American Modern Hospital (AMH) during the period from March 2023 to March 2025. All Patients with symptomatic carotid artery stenosis were included in the study. CAS procedures were performed by a single interventional neurologist. The primary outcome included a 30-day periprocedural mortality, stroke, and myocardial infarction or arrythmia. Any other complications are considered secondary outcomes.

A total of 62 (53 males) patients included in this study, mean age 60.2 ± 9.68 years. All Patients had symptomatic carotid artery stenosis. Technical success rate was 100%. (%). One patient developed transient dysarthria but DW-MRI was negative. Significant bradycardia occurred in two patients and responded immediately to atropine. Three patients developed mild local hematoma and one patient had femoral pseudoaneurysm. Closed-Cell Carotid Wall Stent (Boston Scientific) was used as a single stent in all patients.

CAS conducted by a trained interventional neurologist without EPDs, demonstrates a low complication rate and it is effective and safe option in countries with-limited resources. Competing Interest Statement The authors have declared no competing interest. Funding Statement None Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: None I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Conflict of interests: none to declare for this paper Fund: None Data Availability Data available upon request Abbreviations - CAS - Carotid Artery Stenting - CEA - Carotid Endarterectomy - EPDs - Embolic Protection Devices - DW-MRI - diffusion-weighted magnetic resonance imaging - NIHSS - national institute of health stroke scale - NASCET - North American Symptomatic Carotid Endarterectomy trial - LMIC - low-middle-income countries