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Eight-year experience with carotid artery stenting for correction of symptomatic and asymptomatic post-endarterectomy
Enrico Maria Marone1, Giovanni Coppi, Yamume Tshomba
1Vascular Surgery, Scientific Institute H. San Raffaele, Vita-Salute University School of Medicine, Via Olgettina 60, 20132 Milan, Italy.
Insights
Carotid artery stenting (CAS) is a safe and effective treatment for technical defects after carotid endarterectomy (CEA). This minimally invasive approach offers a quick alternative to surgery, with promising long-term results for both symptomatic and asymptomatic patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid endarterectomy (CEA) prevents stroke but requires low complication rates ( <3% asymptomatic, <6% symptomatic).
- Technical defects like intimal flaps, dissection, or thrombosis are common causes of post-CEA neurological complications.
- Traditional correction involves standard surgical techniques.
Purpose of the Study:
- To evaluate the safety and feasibility of carotid artery stenting (CAS) for treating technical defects after CEA.
- To assess CAS as an alternative to repeat surgical intervention.
Main Methods:
- Retrospective analysis of 34 patients who underwent CAS after CEA between January 2001 and June 2009.
- Data collected from operating room and Interventional Cardiology laboratory registries.
- Inclusion criteria: intimal flaps, dissection, or partial thrombosis post-CEA.
Main Results:
- CAS was performed in 34 out of 5012 CEAs (0.6%).
- 100% immediate technical success was achieved.
- One major cerebrovascular event (3%) occurred in the perioperative period.
- Mean follow-up of 18.6 months showed no neurological symptoms or hemodynamic in-stent restenosis.
- Five patients with >4-year follow-up remained event-free.
Conclusions:
- CAS is a safe and technically feasible option for post-CEA complications in symptomatic and asymptomatic patients.
- CAS offers a valid and rapid alternative to surgical revision.
- Long-term outcomes for CAS in this patient group appear promising.
Background:
Carotid endarterectomy (CEA) has been shown to be superior to medical therapy alone in the prevention of stroke only if it can be safely performed (ie, with a complication rate less than 3% in asymptomatic patients and less than 6% in symptomatic patients). Technical defects are the most common cause of neurological complications after CEA, and their correction has traditionally been performed through standard surgical techniques.
Methods:
From 1999, we started to treat intimal flaps, dissection, or partial thrombosis after CEA with carotid artery stenting (CAS). A retrospective analysis of the operating room registry and of the registry of our Interventional Cardiology laboratory was conducted in order to identify all the patients that underwent stenting of the internal carotid artery after CEA between January 2001 and June 2009.
Results:
During the time period considered, 5012 CEA were performed at our institution and a total of 34 patients (34/5012; 0.6%) were found to have received carotid stenting after CEA, both for symptomatic and asymptomatic defects. Immediate technical success was obtained in all patients. One major cerebrovascular adverse event (1/34; 3%) in the immediate perioperative period was recorded. At a mean follow-up of 18.6 months (range, 3-84 months; median, 12 months), we did not observe any neurological symptoms related to the treated carotid artery, nor hemodynamic in-stent restenosis. Long-term follow-up (ie, equal or greater than 4 years) was available for five patients: all patients remained event-free during the entire period.
Conclusions:
Our study adds to the assumption that CAS in post-CEA symptomatic and asymptomatic patients is safe and technically feasible, and represents a valid and quick alternative to standard surgical revision. Even if in a small group of patients, long-term results seem promising.
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