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[Endovascular treatment of carotid disease in patients at high surgical risk]
A López-Real1, S Mosteiro, M Seoane
1Complejo Hospitalario Universitario Juan Canalejo, 15006 A Coruna, Espana. analr_2000@yahoo.com
Insights
Endovascular therapy using stent angioplasty is effective for carotid stenosis in high-risk surgical patients. This treatment demonstrates favorable outcomes, including low perioperative complications and high rates of stroke-free survival.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Context:
- Carotid stenosis poses a significant risk of stroke.
- Patients with high surgical risk often require alternative treatments.
- Endovascular therapy offers a less invasive approach.
Purpose:
- To evaluate perioperative outcomes of endovascular therapy for carotid stenosis in high-risk patients.
- To assess long-term survival, stroke-free rates, and restenosis.
- To determine the efficacy of stent angioplasty in this patient cohort.
Summary:
- A retrospective study analyzed 100 patients with symptomatic (>50%) or asymptomatic (>70%) carotid stenosis undergoing endovascular therapy.
- Perioperative morbi-mortality was 6%. Long-term follow-up showed 7% mortality, with 3- and 5-year survival rates of 93% and 89%.
- At one year, 98.9% of patients were stroke-free, and stent restenosis occurred in 5%.
Impact:
- Stent angioplasty is a viable and effective treatment for carotid stenosis in patients unsuitable for surgery.
- Adherence to patient selection and complication avoidance protocols is crucial for optimal results.
- This approach can significantly reduce stroke risk and improve long-term outcomes in select populations.
Aims:
To analyse the perioperative morbi-mortality rates during the first 30 days following endovascular therapy in patients with carotid stenosis and important risk factors for surgery. We also sought to determine the survival rate, the percentage of patients that were stroke-free and the percentage of cases of restenosis during the follow-up period.
Patients And Methods:
A retrospective study was conducted on a series of 100 patients with symptomatic > 50% and asymptomatic > 70% carotid stenosis, who underwent endovascular therapy between January 2000 and December 2006 because of the important risk factors they presented. Monitoring was clinical and was performed by means of carotid Doppler scanning.
Results:
The mean age of the sample: 72.2 years (46-86). Perioperative morbi-mortality of the series: 6% (confidence interval, CI 95% = 0.8-11.2) and in the symptomatic stenosis group: 5.7% (CI 95% = 1.8-12.9). The mean follow-up time was 23.4 months (0-94). Total mortality of the series during the follow-up was 7% (CI 95% = 1.4-12.5). The probability of survival at 3 and 5 years is 93 and 89%, respectively. At one year, 98.9% of the patients remained stroke-free. Restenosis of the stent occurred in 5% (CI 95% = 1.6-11.2). The probability of restenosis not occurring was 96.75% at 6 months and 94% at 3 years.
Conclusions:
Stent angioplasty is an effective form of treatment in carotid stenosis in patients with important risk factors for surgery and it is therefore important to fulfil patient selection protocols and avoid perioperative complications.
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