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Short- and long-term outcome after carotid artery stenting with neuroprotection: single-center experience within a
Christoph H Spes1, Andreas Schwende, Florian Beier
1Städtisches Klinikum München GmbH, Klinikum Neuperlach, Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Oskar Maria Graf Ring 51, 81737, München, Germany.
Insights
Carotid artery stenting with neuroprotection is a safe revascularization method. Asymptomatic patients experience fewer strokes than symptomatic patients, with rare long-term neurological events.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Interventional Cardiology
Background:
- Carotid artery stenting (CAS) offers an alternative to surgical endarterectomy for carotid artery stenosis.
- The study evaluates CAS outcomes in a real-world clinical setting.
Purpose of the Study:
- To assess the safety and efficacy of carotid artery stenting with neuroprotection.
- To compare neurological event rates in asymptomatic versus symptomatic patients undergoing CAS.
Main Methods:
- Prospective study of 371 patients undergoing 405 CAS procedures at a single center.
- Routine use of neuroprotective devices during stenting.
- Independent neurological assessments pre- and post-procedure, with long-term follow-up.
Main Results:
- Low 30-day stroke rate: 1.3% in asymptomatic (1.0% ipsilateral) and 5.0% in symptomatic patients (p<0.005).
- Long-term ipsilateral stroke rates were low (0.4% asymptomatic, 1.7% symptomatic).
- Early and late mortality rates were 1.6% and 11.1%, respectively.
Conclusions:
- Carotid artery stenting with neuroprotection demonstrates acceptable short-term neurological event rates.
- Asymptomatic patients show significantly lower periprocedural stroke rates compared to symptomatic patients.
- CAS with neuroprotection is a safe revascularization option with favorable long-term neurological outcomes, especially for asymptomatic individuals.
Background:
Carotid artery stenting is an alternative method to surgical endarterectomy for treatment of carotid artery stenosis.
Methods And Results:
Three hundred and seventy-one consecutive patients (71+/-9 years) undergoing 405 carotid artery interventions at a single cardiologic center were studied prospectively within a therapy registry. In general, the interventional procedure was performed using neuroprotective devices to prevent distal embolization. Stents were used routinely whenever possible. Independent neurological assessment took place prior to and after carotid stenting. The neurological event rate was assessed in the early (<30 days) and late post interventional period. In asymptomatic patients, 286 interventions were done with a 30-day stroke rate of 1.3% (ipsilateral 1.0%). In symptomatic patients, strokes occurred in a significantly (p<0.005) higher rate of 5.0% after 119 interventions (all ipsilateral). At long-term follow-up (mean 728+/-548 days) additional strokes occurred ipsilateral to the side of carotid intervention in 0.4% of asymptomatic patients (1.7% of symptomatic patients); contralateral strokes were seen at long-term follow-up in 1.1% of asymptomatic (1.7% of symptomatic) patients. Due to their comorbidities, 1.6% of patients died early, and an additional 11.1% late after carotid stenting.
Conclusion:
Carotid artery stenting with the general use of neuroprotective devices yields acceptable shortterm results with respect to neurological events. Asymptomatic patients have significantly less periprocedural strokes than symptomatic patients. Neurological events during long-term follow-up are rare, in particular ipsilateral to the side of carotid stenting. Thus, carotid artery stenting with neuroprotection is a safe method for carotid revascularization, with acceptable periprocedural events, particularly in asymptomatic patients, and a good long-term neurologic outcome.