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Outcomes following extracranial carotid artery stenting in high-risk patients
D Paniagua1, M Howell, N Strickman
1Texas Heart Institute at St. Luke's Episcopl Hospital, Houston, TX 77030, USA.
Insights
Carotid artery stenting (CAS) is a safe and feasible alternative to carotid endarterectomy (CEA) for high-risk patients. This procedure demonstrated satisfactory long-term outcomes with low complication rates in this patient group.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid endarterectomy (CEA) carries high risks for certain patients.
- Carotid artery stenting (CAS) has emerged as a viable alternative to CEA.
- This study focuses on CAS in patients at high risk for CEA complications.
Purpose of the Study:
- To investigate the feasibility of CAS in high-risk patients.
- To assess the safety and long-term outcomes of CAS in this population.
- To compare CAS outcomes with traditional CEA risks.
Main Methods:
- Prospective follow-up of 62 high-risk patients undergoing extracranial CAS.
- Procedures performed between July 1995 and November 2000.
- Data collected on patient demographics, comorbidities, and procedural outcomes.
Main Results:
- 69 CAS procedures were performed on 62 patients (mean age 67 years).
- High prevalence of comorbidities: 95% hypertension, 58% severe coronary artery disease.
- Major complications included 2.8% minor strokes, 1.4% major stroke, and 1.4% fatal stroke.
- Mean follow-up of 17 months showed 2.8% ipsilateral neurologic events and 5.7% restenosis at 6 months.
Conclusions:
- CAS is a safe and feasible procedure for high-risk patients.
- Satisfactory long-term outcomes were achieved with CAS.
- CAS offers a viable alternative to CEA for carefully selected high-risk individuals.
Background:
Carotid artery angioplasty and stenting has become a viable alternative to carotid endarterectomy (CEA), especially for patients considered at high risk for post-operative complications. This study investigated the feasibility, safety and long-term outcome of carotid artery stenting (CAS) in high-risk patients.
Methods:
From July 1995 to November 2000, sixty-two consecutive patients considered to be at high risk for post-operative complications of CEA were followed prospectively after undergoing extracranial CAS procedures.
Results:
Sixty-two patients [37 men (60%) and 25 women (40%)] underwent a total of 69 CAS procedures. The mean age was 67 +/- 9 years (range, 32-89 years). Comorbid conditions included hypertension in 95% and severe coronary artery disease in 58%. Sixteen patients (26%) had a previous ipsilateral CEA, twenty-one percent had a history of neck radiation and 32% had a history of significant contralateral carotid artery disease. Fifty-two patients (84%) were symptomatic. All 69 CAS procedures were technically successful. The major post-operative complications were two minor strokes (2.8%), one major stroke (1.4%) and one fatal major stroke (1.4%). The mean length of follow-up was 17 months (range, 4 months to 5.6 years). Two patients (2.8%) have suffered ipsilateral neurologic events following CAS. Long-term follow-up revealed restenosis at 6 months in 4 patients (5.7%).
Conclusions:
Carotid artery angioplasty and stenting is safe and feasible. This procedure produces satisfactory outcomes in patients who are at high risk for post-operative complications of CEA.