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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Thirty-day outcome following carotid artery stenting: a 10-year experience from a single center
Christos D Karkos1, Dimitrios G Karamanos, Konstantinos O Papazoglou
1Fifth Department of Surgery, Medical School, Hippocrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. ckarkos@hotmail.com
Insights
Carotid angioplasty and stenting (CAS) is a safe and effective procedure for carotid artery stenosis. Risk factors for stroke or death include hyperlipidemia and smoking.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid artery stenosis poses a significant risk for stroke.
- Carotid angioplasty and stenting (CAS) has emerged as an alternative to carotid endarterectomy.
- Technological advancements and increasing experience have refined CAS techniques.
Purpose of the Study:
- To present institutional experience with CAS from 1997-2007.
- To evaluate the evolution and safety of CAS over a decade.
- To identify risk factors associated with CAS outcomes.
Main Methods:
- Retrospective analysis of 333 patients undergoing 336 CAS procedures.
- Comparison of balloon-expandable versus self-expandable stents.
- Inclusion of cerebral protection devices in later procedures.
- Analysis of perioperative neurological events and mortality.
Main Results:
- Overall mortality was 0.9%, and the combined stroke/death rate was 2.4%.
- Perioperative stroke occurred in 1.8% and transient ischemic attack in 4.5%.
- Hyperlipidemia and current or ex-smoking were significant independent risk factors for death/stroke.
Conclusions:
- CAS is a safe and effective treatment for carotid artery stenosis.
- Acceptable rates of mortality, stroke, and cardiovascular complications were observed.
- While technological and experience factors are important, hyperlipidemia and smoking remain key risk factors.
Abstract:
We aimed to present our experience with carotid angioplasty and stenting (CAS) and to document how the technique evolved over the last decade (1997-2007). A retrospective study of 333 patients (259 men; median age, 69 years) who underwent 336 CAS procedures. Of these, 118 (35%) patients were symptomatic and 164 (49%) lesions involved the left carotid bifurcation. The first 163 patients received a balloon-expandable stent, whereas the remaining 173 received a self-expandable one. Cerebral protection devices were used in the last 84 (25%) procedures. Access was via the femoral artery in all but six cases, in which direct puncture of the common carotid was necessary. The left common carotid originated from the innominate artery in 18 cases (5%). Conversion to open endarterectomy was necessary in two patients due to inability to remove the filter. Perioperative neurological events included stroke in 6 patients (1.8%), transient ischemic attack in 15 (4.5%), and hyperperfusion syndrome in 10 (3.0%). Three patients died during the first 30 days. As a result, the mortality and the combined stroke/death rate were 0.9 and 2.4%, respectively, with no differences between symptomatic and asymptomatic patients. Bradycardia was noted in 48 patients (14%), and hypotension in 45 (13%). Univariate analysis identified hypertension (P = 0.03), hyperlipidemia (P = 0.02), and current or ex-smoking (P = 0.02) as significant risk factors for death/stroke. On multivariate analysis using logistic regression, only hyperlipidemia [odds ratio (OR), 53.90; 95% confidence interval (CI), 4.19-693.47; P = 0.002] and current or ex-smoking (OR, 63.84; 95% CI,: 4.80-848.68; P = 0.001) remained statistically significant. In conclusion, CAS can be performed safely and effectively, with acceptable mortality, stroke/death, and cardiovascular complication rates. Although technological advances (stent design, cerebral protection devices), perioperative pharmacological management, and increasing experience are all clinically significant factors influencing the short-term results, none appeared to be statistically significant in this patient sample.