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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Carotid stenting in high-risk patients: early and late outcomes
John J Gribar1, Monica Jiddou, Nishit Choksi
1Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Insights
Carotid artery stenting (CAS) offers a safe option for high-risk patients with severe carotid stenosis, showing low 30-day adverse events. However, long-term survival remains a concern, with high mortality unrelated to stroke within five years.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Severe carotid stenosis poses a significant risk for stroke.
- Some patients are unsuitable for carotid endarterectomy (CEA) due to comorbidities.
- Carotid artery stenting (CAS) is an alternative revascularization technique.
Purpose of the Study:
- To evaluate the early and late outcomes of CAS in patients at high risk for CEA.
- To assess the safety and efficacy of CAS in a high-risk population.
Main Methods:
- An institutional registry of 186 high-risk patients undergoing CAS between 2002 and 2009.
- Primary endpoint: 30-day major adverse cardiac and cerebrovascular events (MACCE), including death, stroke, and myocardial infarction.
- Secondary endpoints: Technical success, procedural success, clinical success, nonstroke neurological events, and 5-year death and ipsilateral stroke rates.
Main Results:
- 30-day MACCE occurred in 2.6% of patients (1 death, 3 strokes, 1 myocardial infarction).
- Strokes were predominantly nonfatal (1.6%), with 1.1% major strokes.
- At 5 years, Kaplan-Meier analysis showed 47.5% all-cause mortality and 4.5% ipsilateral stroke rate.
Conclusions:
- CAS can be performed with low 30-day MACCE and 5-year ipsilateral stroke rates in high-risk patients for CEA.
- Despite procedural success, nearly half of these high-risk patients experience mortality from non-stroke-related causes within five years.
Purpose:
Some patients with severe carotid stenosis have anatomical or clinical comorbidities that place them at high risk for carotid endarterectomy (CEA). The early and late outcomes after carotid artery stenting (CAS) were evaluated in patients at high risk for CEA.
Methods:
Between 2002 and 2009, 186 patients were enrolled in a high-risk CAS institutional registry. The primary outcome was major adverse cardiac and cerberovascular events (MACCEs) at 30 days, including death, stroke, and myocardial infarction. Secondary outcomes were technical, procedural, and clinical success; nonstroke neurological events; and death and ipsilateral stroke at 5 years.
Results:
Twenty-five patients (13.2%) were symptomatic. Thirty day MACCE occurred in 2.6%, including death in 1 (0.5%), stroke in 3 (1.6%), and myocardial infraction in 1 (0.5%) patient. Strokes were nonfatal in 3 (1.6%), major in 2 (1.1%), and minor in 1 (0.5%) patients. Other neurological events included transient ischemic attack in 9 (4.7%) and retinal artery occlusion in 2 (1.1%) patients. After stroke, 2 patients had complete resolution of neurological deficit within 30 days, and 1 patient had improvement in neurological deficit. By Kaplan--Meier analysis, all-cause mortality was 47.5% and ipsilateral stroke was 4.5% at 5 years.
Conclusions:
In patients who are high risk for CEA, CAS can be performed with low MACCE at 30 days and ipsilateral stroke at 5 years. However, nearly half of these patients die within 5 years from causes unrelated to stroke.