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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Safety and efficacy of elective carotid artery stenting in high-risk patients
F Shawl1, W Kadro, M J Domanski
1Department of Interventional Cardiology, Washington Adventist Hospital, Takoma Park, Maryland 20912, USA. fshawl@adventisthealthcare.com
Insights
Carotid artery stenting (CAS) is a safe and effective procedure for high-risk patients, demonstrating a low stroke rate and minimal restenosis. This study confirms CAS as a viable alternative to traditional surgery for carotid artery disease.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid endarterectomy (CE) is effective but has limitations.
- Carotid artery stenting (CAS) offers a potential alternative, especially for high-risk individuals.
- High-risk patients often face exclusion from traditional clinical trials.
Purpose of the Study:
- To evaluate the safety and efficacy of CAS.
- To assess CAS outcomes in a cohort of high-risk patients.
- To compare CAS results against established criteria like NASCET.
Main Methods:
- Prospective evaluation of 170 consecutive patients undergoing CAS on 192 carotid arteries.
- Inclusion of a high-risk population, with 76% excluded from CE trials and 32% referred by vascular surgeons.
- Neurologic examinations performed pre- and post-procedure; detailed risk factor and outcome assessment.
Main Results:
- 99% procedural success rate, including those with concurrent coronary interventions.
- Significant reduction in carotid artery stenosis from 78% to 2%.
- Low 30-day stroke rate (2.9% for patients, 2.6% for arteries); no myocardial infarctions or deaths; no strokes in NASCET-eligible patients.
Conclusions:
- CAS is a feasible and safe revascularization option for high-risk patients.
- The procedure is associated with a low rate of restenosis (2% at follow-up).
- CAS provides a valuable alternative to CE in challenging patient populations.
Objectives:
We sought to evaluate the safety and efficacy of carotid artery stenting (CAS) in high risk patients.
Background:
Carotid endarterectomy (CE) has been shown to be more effective than medical therapy, but it has limitations. Carotid artery stenting may be a reasonable alternative, particularly in high-risk patients.
Methods:
We prospectively evaluated the safety and efficacy of CAS in 170 consecutive patients who underwent the procedure in 192 carotid arteries. Of the patients enrolled, 129 (76%) would have been excluded from the major trials of CE and 54 (32%) were referred by vascular surgeons. This series represents a very high-risk group that included patients with unstable angina, previous ipsilateral CE, contralateral carotid artery occlusion and other severe comorbid illnesses. Only 25 (24%) of 104 symptomatic patients would have met the North American Symptomatic Carotid Endarterectomy Trial (NASCET) entry criteria. The patients' mean age was 73 +/- 8 years (95 confidence interval [CI] 57 to 89), and 42 patients (25%) were > or = 80 years old. Patients had an independent neurologic examination before and after the procedure.
Results:
The procedural success rate was 99%, including 73 patients who had a coronary intervention. Mean carotid artery stenosis was 78 +/- 10% before (95 CI 58 to 98) and 2 +/- 3% after the procedure (95 CI -4 to 8). During the initial hospital period and 30 days after CAS, there was one major and two category 2 minor strokes, as well as two category 1 minor strokes (total 30-day stroke rate was 2.9% for treated patients or 2.6% for treated arteries). There were no myocardial infarctions or deaths during or within 30 days of CAS. None of the NASCET-eligible patients had a stroke. At a mean follow-up of 19 +/- 11 months, three patients (2%) had asymptomatic restenosis. No other major strokes or neurologic deaths occurred.
Conclusions:
Carotid artery stenting is feasible, can be performed even in high-risk patients and is associated with a low restenosis rate.
