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Intermediate follow-up of carotid artery stent placement
Dennis R Gable1, Thomas Bergamini, Wilson V Garrett
1Department of Vascular Surgery, Baylor University Medical Center, 621 North Hall, Suite 100, Dallas, TX 75226, USA. bumcvascsurg@aol.com
Insights
Carotid artery stent placement (CAS) shows a 6% restenosis rate at 28 months, with a 3% stroke/death rate in selected patients. This study evaluates CAS outcomes for carotid artery disease.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid artery stent placement (CAS) is increasingly utilized for carotid artery disease.
- While procedural morbidity is improving, long-term outcomes and restenosis rates remain under investigation.
- This study addresses the need for intermediate- and long-term follow-up data on CAS.
Purpose of the Study:
- To evaluate the restenosis rates and clinical outcomes following carotid artery stent placement.
- To assess the safety and efficacy of CAS in patients with primary and recurrent carotid artery disease.
- To determine the intermediate- and long-term follow-up results of CAS.
Main Methods:
- A retrospective review of 31 CAS interventions in 29 patients (May 1998 - January 2002).
- Serial Doppler ultrasound follow-up at 3, 6, and then every 6 months.
- Analysis of complications, restenosis rates, and clinical outcomes.
Main Results:
- Immediate complication rate was 16% (3 TIAs, 1 stroke, 1 intrastent restenosis).
- No deaths occurred during the periprocedural period.
- At a mean follow-up of 28 months, 94% of patients remained asymptomatic with <50% stenosis. Critical restenosis (>90%) occurred in 6% of vessels, associated with new symptoms (TIA, stroke). The cumulative stroke/death rate was 6%.
Conclusions:
- CAS is a viable option with an acceptable stroke/death rate (3%) in carefully selected patients.
- The restenosis rate at a mean of 28 months post-CAS was 6% in this series.
- Long-term surveillance is crucial for identifying restenosis and managing outcomes after CAS.
Background:
Carotid artery stent placement (CAS) is becoming more popular among various specialties for the treatment of primary and recurrent carotid artery disease. The morbidity associated with this procedure is improving but the intermediate- and long-term follow-up remains unknown. We report our restenosis rates and follow-up associated with CAS.
Methods:
Thirty-one interventions on 29 patients from May 1998 to January 2002 were reviewed. All patients have undergone serial follow-up using Doppler ultrasound at 3 and 6 months and every 6 months thereafter. Ten interventions (32%) were performed on patients with recurrent carotid artery disease and 21 (68%) on patients with primary disease.
Results:
Five periprocedural complications occurred (transient ischemic attack, n = 3; major stroke, n = 1; immediate intrastent restenosis requiring lysis, n = 1) for a total immediate complication rate of 16%. No deaths occurred. Follow-up was achieved in all 29 patients (mean 28 months; range 20 to 46). Twenty-seven patients (29 vessels; 94%) remain asymptomatic with less than 50% stenosis. Two vessels (6%) have been found to have a critical restenosis of greater than 90%. Both patients were symptomatic from their recurrence (transient ischemic attack, n = 1; acute stroke, n = 1). Cumulative major stroke and death rate including all follow-up was 6%.
Conclusions:
CAS can be performed with an acceptable stroke/death rate (3%) in a properly selected patient population. In our small series of patients, the restenosis rate at a mean of 28 months after CAS is 6%.