Early outcomes of carotid artery stenting

Abstract

Background and aim: Ischemic cerebrovascular events are the most common reason for patients to be bedridden and the third most common reason for death. Many studies in recent years have demonstrated that carotid artery stenting (CAS) may be an alternative to carotid endarterectomy (CEA). In this study, we aimed to report early outcomes of patients who were treated with CAS in our clinic and discuss practicability, advantages and safety of CAS.

Methods and Findings: Eighty patients who underwent CAS between December 2009 and May 2011 were eligible. The mean age was 65 years (range, 49 - 89 years). Of the study group, 73.75% were males and 26.25% were female. The percentage of asymptomatic patients was 11.7%, and the remaining patients were symptomatic. A distal embolic protection device (Angioguard®) was used in 22% of the patients whereas, in the other patients (78%), a proximal blockage system (Mo.MA®) was used. Self-expandable hybrid stents were implanted in all patients and post-dilatation was performed after implantation. None of the patients suffered from stroke, myocardial infarction or death due to CAS during their hospital stay. The mean follow-up period was 10 months (range 2 - 18 months) after discharge. None of the patients had died or had a stroke, a transient ischemic attack (TIA), or a myocardial infarction during the follow-up period. Re-stenosis was not observed in the follow-up carotid Doppler ultrasonography; flow rates were within normal limits.

Conclusion: No major complication was observed during the early follow-up period in patients who underwent CAS in our clinic. Only 2 (2.5%) patients showed transient numbness and weakness and these did not lead to morbidity. In the management guide of extracranial carotid and vertebral artery diseases, CAS, in the light of recent studies, is recommended as an alternative to CEA in recommendations for revascularization. One of the important issues emphasized in this guide is the experience of centers. Very low complication rates after CAS suggested that, with suitable patient selection and an experienced team, similar results may be obtained.

Keywords

carotid artery stenting ischemic stroke carotid artery disease carotid artery endarterectomy protection device

Get full access to this article

View all access options for this article.

References

Aydıner

Boztosun

Sirvanci

. Early and late outcomes of carotid artery stenting. Anadolu Kardiyol Derg 2007; 7: 152–157. (Turkish)

Meschia

Brott

Hobson

II . Diagnosis and invasive management of carotid atherosclerotic stenosis. Mayo Clin Proc 2007; 82(7): 851–858.

Brott

Hobson

II Howard

; CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis (CREST). N Engl J Med. 2010 Jul 1; 363(1): 11–23. Epub 2010 May 26. Erratum in: N Engl J Med. 2010 Jul 29; 363(5): 498. N Engl J Med 2010 Jul 8; 363(2): 198.

Clinical alert: benefit of carotid endarterectomy for patients with high-grade stenosis of the internal carotid artery. National Institute of Neurological Disorders and Stroke, Stroke and Trauma Division. North American Symptomatic Carotid Endarterectomy Trial (NASCET) investigators. Stroke 1991 Jun; 22(6): 816–817.

Phatouros

Higashida

Malek

. Carotid artery stent placement for atherosclerotic disease: rationale, technique, and current status. Radiology 2000 Oct; 217(1): 26–41.

ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery Developed in Collaboration With the American Academy of Neurology and Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 2011; 57: e16–e94; originally published online Jan 31, 2011; doi:10.1016/j.jacc.2010.11.00610.1016/j.jacc.2010.11.006.

Gurm

Yadav

Fayad

; SAPPHIRE Investigators. Longterm results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med 2008; 358(15): 1572–1579.

Mas

Trinquart

Leys

; EVA-3S Investigators. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol 2008; 7(10): 885–892.

Kastrup

Gröschel

Krapf

. Early outcome of carotid angioplasty and stenting with and without cerebral protection devices: a systematic review of the literature. Stroke 2003 Mar; 34(3): 813–819.

10.

Stabile

Salemme

Sorropago

. Proximal endovascular occlusion for carotid artery stenting: results from a prospective registry of 1,300 patients. J Am Coll Cardiol 2010 Apr 20; 55(16): 1661–1667.

11.

Schmidt

Diederich

Scheinert

. Effect of two different neuroprotection systems on microembolization during carotid artery stenting. J Am Coll Cardiol 2004 Nov 16; 44(10): 1966–1969.