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Carotid artery stenting in patients with symptomatic coronary artery disease
1Department of Internal Medicine, Yonsei Cardiovascular Center, Seoul, Korea.
Insights
Carotid artery stenting is a safe and feasible option for patients with both carotid and coronary artery disease, demonstrating favorable long-term outcomes with low restenosis rates.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurology
Background:
- Carotid artery stenting (CAS) is an alternative to carotid endarterectomy for significant carotid artery stenosis.
- Patients with carotid stenosis often have coexisting coronary artery disease, requiring careful management.
- Evaluating CAS safety and efficacy in this complex patient group is crucial.
Purpose of the Study:
- To assess the feasibility, safety, and long-term outcomes of CAS in patients with concurrent symptomatic coronary artery disease.
- To determine the success rate and complication profile of CAS in this specific high-risk population.
Main Methods:
- A prospective study involving 36 patients with 48 carotid artery lesions (60% stenosis) and symptomatic coronary artery disease.
- Carotid artery stenting was performed using various stent types (Wallstent, Palmaz, Microstent II).
- Coronary interventions (stenting or bypass surgery) or medical management were performed concurrently or sequentially.
Main Results:
- Carotid artery stenting was technically successful in all 48 lesions.
- One major and one minor stroke occurred during procedures; no deaths within 30 days.
- Follow-up (14 months) showed no deaths or neurological events; 4.5% asymptomatic restenosis rate.
Conclusions:
- Percutaneous carotid artery stenting is a feasible and safe procedure for patients with coexisting carotid and coronary artery disease.
- Favorable long-term outcomes with low restenosis rates support CAS in this patient cohort.
- The study highlights the successful management of complex cardiovascular and cerebrovascular disease through combined interventions.
Abstract:
Carotid artery stenting has been accepted as a potential alternative to carotid endarterectomy in patients with significant carotid artery stenosis. The objective of this study was to evaluate the feasibility, safety and long-term outcome of percutaneous stenting of carotid artery stenosis in patients with coexisting symptomatic coronary disease. Between May 1996 and May 1999, we performed carotid artery stenting at 48 lesions in 36 patients with carotid stenosis of 60% and symptomatic coronary artery stenosis. Twenty-one patients (58%) had neurologic symptoms. Carotid stenting was performed in 43 internal, 2 external and 3 common carotid lesions. We used Wallstent in 46 lesions, Palmaz stent in 2 lesions and Microstent II in 1 lesion. Staged or combined coronary intervention was performed in 18 patients (50%) and staged coronary artery bypass surgery was performed in 6 patients (17%). In the other 12 patients (33%), medical treatments were performed. Carotid stenting was successful in all lesions. Simultaneous bilateral carotid stenting was performed in 11 patients (31%). One major and 1 minor stroke developed during the procedure. There were no deaths during the procedures and within 30 days post-procedure. During the follow-up of 14 +/- 7 (3 to 40) months, there were no deaths or neurological events. On follow-up (6 +/- 1 months) angiography and/or duplex sonography of 44 eligible lesions in 32 patients, there were 2 cases of asymptomatic restenosis (4.5%) which developed in Palmaz stents implanted at the external carotid artery and the common carotid artery, respectively. In conclusion, carotid artery stenting in patients with coexistent carotid and coronary artery disease is feasible, safe and shows favorable follow-up outcomes.