Carotid stenting

Abstract

Carotid endarterectomy (CEA) is one of the most frequently performed surgeries in the United States. To offer patients a less invasive means to achieve the same goal, we investigated carotid angioplasty with stenting (CAS) as an alternative to CEA. A total of 528 patients underwent CAS; 604 vessels/hemispheres were treated. The mean age was 69 ± 10 years; 172 patients (33%) were women. Of the patients treated, 91 (15%) presented with post-CEA restenosis. Contralateral carotid occlusion was present in 61 patients (10%). CAS was performed by using a coaxial system with a 7F, 90-cm sheath, predilatation, stent placement, and stent dilatation. Patients were pretreated with antiplatelet therapy. Same-day admissions and 23-hour discharges were typical. The technical success rate was 98.6%. The 30-day mortality rate was 1.6% (3 [0.6%] neurological, 5 [1 %] systemic). There were 6 (1 %) major strokes (4 [0.6%] related to intervention), and 29 minor strokes (4.8%). Of the 29 minor strokes, 11 (38%) resulted in complete recovery. On an annualized basis, the incidence of minor stroke declined: 7.1% (1994 to 1995), 5.8% (1995 to 1996), 5.3% (1996 to 1997), 3.2% (1997 to 1998), and 3.1% (1998 to 1999). Restenosis of ≤50% was identified in 5.3% of cases. We conclude that CAS is an effective treatment for carotid stenosis. The complication rate compares favorably with endarterectomy. Carotid endarterectomy (CEA) is one of the most frequently performed surgeries in the United States. To offer patients a less invasive means to achieve the same goal, we investigated carotid angioplasty with stenting (CAS) as an alternative to CEA. A total of 528 patients underwent CAS; 604 vessels/hemispheres were treated. The mean age was 69 ± 10 years; 172 patients (33%) were women. Of the patients treated, 91 (15%) presented with post-CEA restenosis. Contralateral carotid occlusion was present in 61 patients (10%). CAS was performed by using a coaxial system with a 7F, 90-cm sheath, predilatation, stent placement, and stent dilatation. Patients were pretreated with antiplatelet therapy. Same-day admissions and 23-hour discharges were typical. The technical success rate was 98.6%. The 30-day mortality rate was 1.6% (3 [0.6%] neurological, 5 [1 %] systemic). There were 6 (1 %) major strokes (4 [0.6%] related to intervention), and 29 minor strokes (4.8%). Of the 29 minor strokes, 11 (38%) resulted in complete recovery. On an annualized basis, the incidence of minor stroke declined: 7.1% (1994 to 1995), 5.8% (1995 to 1996), 5.3% (1996 to 1997), 3.2% (1997 to 1998), and 3.1% (1998 to 1999). Restenosis of ≤50% was identified in 5.3% of cases. We conclude that CAS is an effective treatment for carotid stenosis. The complication rate compares favorably with endarterectomy.