Related Experiment Videos
Does carotid artery stenting work on the long run: 5-year results in high-volume centers (ELOCAS Registry)
M Bosiers1, P Peeters, K Deloose
1Department of Vascular Surgery, AZ St-Blasius, Dendermonde, Belgium. marc.bosier@pandora.be
Insights
Carotid artery stenting (CAS) demonstrates favorable long-term outcomes, with low stroke/death and restenosis rates up to five years. This study confirms CAS as a valuable treatment for carotid artery disease.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid artery stenting (CAS) is an accepted treatment for carotid artery disease.
- Long-term data on CAS outcomes are crucial for understanding its sustained efficacy.
Purpose of the Study:
- To report up to 5-year outcomes of CAS, focusing on late stroke rates and patency.
- To analyze data from four high-volume European centers to assess long-term CAS effectiveness.
Main Methods:
- A retrospective and prospective analysis of 2,172 patients treated with CAS between 1993 and 2004.
- Kaplan-Meier analysis was used to evaluate stroke/death and restenosis rates at 1, 3, and 5 years.
Main Results:
- Technical success rate for CAS was 99.7%.
- Five-year stroke/death rates were 15.5%, and significant restenosis rates were 3.4%.
- Embolic protection devices (EPDs) were used in 85.9% of stenting procedures.
Conclusions:
- CAS demonstrates pleasing patency and stroke/death rates, confirming its value for long-term carotid artery disease management.
- Further multivariant analysis is needed to identify patient subgroups at higher risk for complications and restenosis.
Aim:
Although the first long-term results of Carotid Artery Stenting (CAS) became available only recently, CAS has become an accepted treatment for carotid artery disease. We report CAS data up to 5 years, both late stroke rate and patency rates as observed in 4 high-volume European centers.
Methods:
Between February 1, 1993 and December 31, 2004, 2 172 patients were selected over the 4 participating centres, with intention to treat endovascularly. Conscientious follow-up was done according to the in-hospital stipulations of each centre and was entered into a database both retrospectively and prospectively. Long-term restenosis and stroke-death rates were investigated and statistically analysed and stratified using the Kaplan-Meier method.
Results:
Of the 2 172 patients with intention to treat 2 165 (99.7%) were technically successful. Of these 306 (14.1%) were performed without and 1 859 (85.9%) with embolic protection device (EPD); 96 patients (4.4%) received balloon dilation only and stenting was performed in 2 069 (95.6%) cases. Kaplan-Meier analysis of major stroke/all death and of significant restenosis (>50%) for the total population showed stroke/death rates of 4.1% (nar=1 356), 10.1% (nar=476) and 15.5% (nar=138); and restenosis rates of 1% (nar=1 363), 2% (nar=480) and 3.4% (nar=139), after 1, 3 and 5 years respectively.
Conclusions:
The patency and stroke/death rates resulting from our database analysis are pleasing and indicate that CAS also on longer term is a valuable treatment method for carotid artery disease. Due to the fact that our dataset contains prospective as well as retrospective data, it may have its limitations. Until this moment, data indicating that certain patient subgroups are at increased risk for neurological complications and in-stent restenosis during and after CAS are sparse. Further multivariant analysis on this unique dataset is mandatory in order to identify any potential links in between plaque morphology, preprocedural neurological complications, risk factor distribution, procedural steps and clinical outcome.