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Abstract

Purpose

To report the results of carotid artery stenting (CAS) in symptomatic patients (stroke/transient ischemic attack) after recent percutaneous transluminal coronary angioplasty (PTCA) for acute coronary syndrome (ACS).

Methods

Between January 2009 and July 2011, 28 consecutive patients (18 women; mean age 66 years, range 42–82) underwent protected CAS for symptomatic carotid stenosis following recent PTCA that included bare or drug-eluting stents requiring uninterrupted dual antiplatelet therapy. Primary technical success, neurological complications, major adverse cardiovascular events, and death were evaluated at 30 days and over midterm follow-up.

Results

Technical success was 96%; 1 patient suffered a nonfatal major stroke (3.5% 30-day stroke rate) during the procedure. During a median 21.6-month follow-up, 4 (14%) patients died of myocardial infarction (all diabetic smokers with ejection fractions <40%), but there were no new neurological events. Estimated survival was 89.3% at 2 years. Further coronary interventions were performed in 2 diabetic patients with a body mass index >34 kg/m².

Conclusion

This preliminary experience demonstrated that CAS is a reasonable, safe, and effective treatment for patients with symptomatic carotid artery stenosis who were recently treated with coronary stents requiring uninterrupted dual antiplatelet therapy.

Keywords

carotid artery stenting carotid stenosis stroke coronary angioplasty coronary artery disease percutaneous coronary intervention cerebral protection myocardial infarction

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Carotid Artery Stenting in Patients With Acute Coronary Syndrome: A Possible Primary Therapy for Symptomatic Carotid Stenosis