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[Carotid revascularisation using angioplasty and stent in 134 consecutive cases in a reference hospital: a risky
G Parrilla1, J Zamarro, M Espinosa de Rueda
1Servicios de Neurología, Hospital Universitario Virgen de la Arrixaca, Murcia, España. gpr1972@gmail.com
Insights
Angioplasty and stenting (ASC) effectively prevents ischemic stroke. With strict protocols and specialist teams, ASC achieves low complication rates comparable to endarterectomy.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Context:
- Carotid revascularisation (CR) via angioplasty and stenting (ASC) is crucial for preventing ischemic stroke.
- However, studies show controversial morbidity and mortality rates associated with ASC.
- This study analyzes ASC outcomes at a specific university hospital.
Purpose:
- To evaluate the epidemiology, indications, and complications of carotid angioplasty and stenting (ASC).
- To assess the effectiveness and safety of ASC in a real-world clinical setting.
- To identify factors contributing to successful ASC outcomes.
Summary:
- 134 ASC procedures were analyzed, with a mean patient age of 72.7 years (75% male).
- Common comorbidities included hypertension (81%), smoking (66.4%), and diabetes (38.1%).
- Successful revascularization (<30% residual stenosis) was achieved in 98.5% of cases, with a 3.7% complication rate (reperfusion syndrome, stent thrombosis).
Impact:
- ASC is a complex procedure requiring specialized teams and strict protocols for optimal outcomes.
- A minimum annual procedure volume and neurology-led admission protocols are essential for minimizing complications.
- Under these conditions, ASC demonstrates morbidity and mortality rates comparable to carotid endarterectomy.
Introduction:
Carotid revascularisation (CR) using angioplasty and stent (ASC) is an effective procedure in the prevention of ischaemic stroke, but with a controversial morbidity and mortality in the different studies conducted in this field.
Methods:
The results of the ASCs performed in the Virgen de la Arrixaca University Hospital (Murcia) between January 2006 and April 2009 were analysed (epidemiology, indication, grade of residual stenosis and procedure complications). All patients subjected to ASC were pre-selected and followed up by neurologists, and they followed a strict medical protocol for performing the procedure. All ASCs were performed by a team consisting of two surgeons, an anaesthetist and a nurse.
Results:
A total of 134 ASC were performed. The mean age of our patients was 72.7 years, with the large majority (75%) being male. The most prevalent diseases were, high blood pressure (81%), smoking (66.4%), and diabetes (38.1%). The most common indications for CR were symptomatic carotid stenosis with a level of stenosis of 75-99%, either in the left (33.6%) or right (32.1%), followed by asymptomatic stenosis combined with risk factors (11.2% in the left side and 10.4% in the right side). A level of stenosis less than 30% was achieved in 132 of the 134 ASC (98.5%). performed. Five patients (3.7%) had complications associated with the procedure, of which four were different clinical presentations of a re-perfusion syndrome and one an asymptomatic thrombosis of the stent.
Conclusions:
ASC is a complex technique that must be performed by appropriately trained specialists. The performing a minimum number of procedures per year and an admission protocol controlled by Neurology are essential conditions for a low rate of complications. Under these conditions, the morbidity and mortality of the technique is no higher than that of endarterectomy.
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