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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Internal carotid artery stenting in patients with near occlusion: 30-day and long-term outcome
A González1, A Gil-Peralta, A Mayol
1Department of Radiology, Interventional Neuroradiology, Virgen del Rocio University Hospital, Seville, Spain. jandroglez@terra.es
Insights
Carotid non-occlusion (NO) is under-recognized. Carotid artery stenting (CAS) appears beneficial for symptomatic patients with carotid NO when performed by experienced neurointerventional teams.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Neuroradiology
Background:
- The natural history and management of carotid non-occlusion (NO) are not well understood.
- Carotid artery stenting (CAS) is a potential treatment option, but its efficacy and safety in this population require further investigation.
Purpose of the Study:
- To evaluate the outcomes and complications of CAS in patients with carotid NO.
- To characterize the natural history of carotid NO following CAS.
Main Methods:
- A retrospective analysis of 116 CAS procedures in patients with carotid NO between March 2000 and March 2009.
- Patients were predominantly male (85.3%), with a mean age of 65.8 years, and 90.5% were symptomatic (TIA or minor stroke).
- Cerebral protection with a distal filter was used in 79.3% of cases.
Main Results:
- Transient hemodynamic alterations (hypotension, bradycardia, asystole) were common during balloon inflation.
- The post-CAS TIA rate was 3.4%, and stroke progression was arrested in 0.9% of patients.
- During a median follow-up of 36 months, asymptomatic restenosis (>70%) occurred in 4.3%, asymptomatic occlusion in 2.6%, and stroke in 2.6% of patients. Mortality was 11.2%, with 7 vascular deaths.
Conclusions:
- Carotid NO is an under-recognized condition.
- CAS appears to be beneficial for patients with carotid NO, particularly when performed by experienced neurointerventional teams.
- Careful patient selection and procedural technique are crucial to minimize complications.
Background And Purpose:
The natural history of the carotid NO is poorly characterized, and the management of patients remains controversial. We report the results and complications associated with CAS and follow-up.
Materials And Methods:
Between March 2000 and March 2009, 116 of 836 CAS procedures were performed in patients with carotid NO (13.9%). A total of 99 men (85.3%) and 17 women (14.7%) with a mean age of 65.8 years were included. Presenting symptoms were TIA in 44 patients (37.9%) and minor stroke or noninvalidating stroke in 61 (52.6%). One hundred five patients (90.5%) were symptomatic.
Results:
A distal filter was used for cerebral protection in 92 patients (79.3%). Transient hemodynamic alterations were frequent during balloon inflation: hypotension (37.1%), bradycardia (48.3%), and asystole in 24.1%. Four patients (3.4%) developed a TIA after CAS. Stroke in progression was arrested in the 1 patient (0.9%). The median follow-up period for patients was 36 months. Asymptomatic restenosis >70% occurred in 5 patients (4.3%); asymptomatic occlusion occurred in 3 patients (2.6%). During follow-up, 3 patients (2.6%) experienced a stroke, 1 ipsilateral (at 19 months) and 2 contralateral (at 6 and 30 months, respectively). Thirteen patients (11.2%) died, 7 from vascular causes.
Conclusions:
Our study showed that carotid NO is an under-recognized condition, and CAS would seem to be beneficial when performed by an experienced neurointerventional team.