Complications of carotid artery stenting

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Cerebrovascular Disease

Background:

• Carotid artery stenting (CAS) is a common procedure for managing carotid artery stenosis.
• In-stent restenosis following CAS can lead to significant complications.
• Vascular surgery offers potential solutions for managing complex CAS complications.

Purpose of the Study:

• To evaluate the management of complications arising from carotid artery stenting (CAS).
• To assess the efficacy and safety of open surgical conversion for recurrent in-stent restenosis after CAS.
• To determine the optimal operative technique for recurrent in-stent restenosis.

Main Methods:

• A retrospective analysis of 171 patients who underwent CAS between March 2000 and May 2004.
• Interventions included CAS with percutaneous transluminal angioplasty (PTA), CAS alone, and PTA alone.
• Patients with recurrent in-stent restenosis were treated with re-PTA, followed by open surgery if necessary.

Main Results:

• Among 171 patients, 5 experienced stroke and 3 had transient ischemic attacks within 7 days post-CAS.
• Twenty-one percent developed in-stent restenosis >50% within 6 months.
• Eight patients undergoing conversion to open surgery (patch angioplasty or PTFE interposition) for recurrent restenosis experienced no morbidity or mortality.

Conclusions:

• Open conventional operation with stent removal and patch angioplasty or graft interposition is the preferred technique for recurrent in-stent restenosis.
• This surgical approach is associated with low risk, as demonstrated by the absence of morbidity and mortality in the study cohort.
• The procedure is safe and effective, with no reported cranial nerve lesions.