Carotid artery stenting: analysis of data for 105 patients at high risk

• Published in: Journal of vascular surgery Vol. 37; no. 6; pp. 1234 - 1239
• Main Authors: Hobson, Robert W, Lal, Brajesh K, Chaktoura, Ellie, Goldstein, Jonathan, Haser, Paul B, Kubicka, Richard, Cerveira, Joaquim, Pappas, Peter J, Padberg, Frank T, Jamil, Zafar
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Mosby, Inc 01-06-2003; Elsevier
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Blood Vessel Prosthesis Implantation - adverse effects; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - mortality; Carotid Stenosis - surgery; Cohort Studies; Diseases of the cardiovascular system; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Outcome Assessment (Health Care); Postoperative Complications; Radiography; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Risk Assessment; Severity of Illness Index; Stents - adverse effects; Stroke - diagnostic imaging; Stroke - etiology; Stroke - mortality; Survival Rate; Time Factors; Human; Endoprosthesis; Nervous system diseases; Stroke; Prognosis; Treatment efficiency; Instrumentation therapy; Stenosis; Cardiovascular disease; Stent; Cerebral disorder; Incidence; Arterial disease; Vascular disease; Restenosis; Treatment; Carotid; Cohort study; Central nervous system disease; Complication; Cerebrovascular disease
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/S0741-5214(02)75448-7

Objectives: Carotid artery stenting (CAS) has been recommended as an alternative to carotid endarterectomy (CEA) by some clinicians. However, recently published clinical trials have reported 30-day stroke and death rates of 10% to 12%. This prompted review of our experience with CAS in patients at high risk, to document our results and guide further use of CAS.
Methods: From September 1996 to the present, we performed 114 consecutive CAS procedures in 105 patients. Sixty-three patients were men (60%) and 42 patients were women (40%), with mean age of 70 years (range, 45–93 years). Indications for CAS included recurrent stenosis after previous CEA in 74 patients (65%), primary lesions in 32 patients at high risk (28%), and carotid stenosis with previous ipsilateral radiation therapy in 8 patients (7%). Asymptomatic stenosis (>80%) was managed in 70 patients (61%), and symptomatic lesions (>50%) were treated in 44 patients (39%).
Results: CAS was technically successful in all patients. Mean severity of stenosis before CAS was 87% ± 6%, compared with 9% ± 4% after CAS. Two patients (1.9%) died, 1 of reperfusion-intracerebral hemorrhage and 1 of myocardial infarction 10 days after discharge; and 1 patient (0.95%) had a stroke (retinal infarction), for a 30-day stroke and death rate of 2.85%. Two patients (1.9%) had transient neurologic events. No cranial nerve deficits were noted. No neurologic complications have been noted in the last 27 patients (26%).
Conclusions: A 30-day stroke and death rate of 2.85% in our experience demonstrates acceptability of CAS as an alternative to repeat operation or primary CEA in patients at high risk or in patients with radiation-induced stenosis. We recommend further clinical investigation of CAS and participation in clinical trials by vascular surgeons.