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Comparison of carotid artery stenting performance between cardiologists and neuroradiologists: one medical center's
Yi-Shan Wu1, Yeh-Lin Kuo, Chiung-Jen Wu
1Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Insights
Cardiologists and neuroradiologists performed carotid artery stenting (CAS) with similar recurrent stroke rates. However, neuroradiologists showed a lower restenosis rate, indicating a need for improved peri-procedural adverse event management in CAS procedures.
Area of Science:
- Interventional Cardiology
- Neurology
- Vascular Surgery
Background:
- Extracranial artery stenosis poses a significant risk for stroke.
- Carotid artery stenting (CAS) is a key intervention for managing this condition.
- Evaluating the procedural outcomes based on operator specialty is crucial for optimizing patient care.
Purpose of the Study:
- To compare the outcomes of CAS performed by cardiologists (CV) and neuroradiologists (NR).
- To assess peri-procedural adverse events (AE), restenosis, and recurrent ipsilateral stroke (RS) rates.
- To analyze CAS efficacy in a region with lower incidence of extracranial artery stenosis.
Main Methods:
- Retrospective analysis of 210 patients undergoing 231 CAS procedures between 1999 and 2008.
- Data collected from administrative records and reviewed by an independent neurologist.
- Outcomes stratified by operator specialty: cardiologists (CV) vs. neuroradiologists (NR).
Main Results:
- Neoradiologist-treated patients had a higher rate of symptomatic CAS (83.0% vs. 70.1%).
- Peri-procedural AE rates were comparable (35.9% CV vs. 24.4% NR, P=0.071).
- Recurrent stroke rates were similar (4.1% CV vs. 5.8% NR, P=0.865), but restenosis was significantly lower in the CV group (5.4% vs. 20.6%, P=0.007).
Conclusions:
- CAS outcomes in Taiwan are comparable to international data.
- Neoradiologists demonstrated a significantly lower restenosis rate post-CAS.
- Further strategies are needed to reduce peri-procedural adverse events in CAS.
Purpose:
To report the experience of carotid artery angioplasty with stenting (CAS) by cardiologists (CV) and neuroradiologists (NR) in an area with less incidence of extracranial artery stenosis.
Methods:
From 1999 to 2008, 210 patients with 231 stents were collected by claim records from the administrative office and reviewed by one independent neurologist. Outcome measures were peri-procedural adverse events (AE), restenosis and recurrent ipsilateral stroke (RS) rate, categorized into treatment groups by either CV or NR.
Results:
The average age was 69.0 years and 82.9 % of the patients were men. 63.8% of the patients with 62.8% stents were treated by CV and the remaining 36.2% of patients with 37.2% stents were done by NR. Symptomatic CAS was evident in 70.1% of the CV cases and 83.0% in NR treated patients (P = 0.017). The peri-procedural AE rate was 31.6%; 35.9% in CV group and 24.4% in the NR group (P = 0.071). RS rate was 4.8% in 663.3 days; 4.1% in 920.8 days in the CV group and 5.8% in 354.2 days in the NR group (P = 0.865). The restenosis rate was 10.9% in 630.5 days; 5.4% in the CV group in 224.8 days and 20.6% in the NR group in 817.8 days (P = 0.007).
Conclusions:
The restenosis and recurrent stroke rates after carotid artery stenting in Taiwan appears to be consistent with other published and well organized trials. Measures to minimize peri-procedural AR rates are definitely warranted.
