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Updated: May 16, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Carotid artery stenting: analysis of a 12-year single-center experience
Fabrizio Fanelli1, Emanuele Boatta, Alessandro Cannavale
1Vascular and Interventional Radiology Unit, Department of Radiological Sciences, "Sapienza" University of Rome, Italy. fabrizio.fanelli@uniroma1.it
Insights
Carotid artery stenting (CAS) is a safe and effective treatment for carotid occlusive disease, demonstrating a low rate of complications. Pre-procedure evaluation of plaque morphology is crucial for optimizing patient outcomes.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid artery stenosis poses a significant risk for ischemic stroke.
- Carotid artery stenting (CAS) offers a minimally invasive alternative to endarterectomy.
- Cerebral protection devices are employed during CAS to mitigate embolic events.
Purpose of the Study:
- To evaluate the 12-year outcomes of carotid artery stenting (CAS) utilizing cerebral protection.
- To identify factors influencing neurological adverse events following CAS.
- To assess the long-term efficacy and safety of CAS for carotid occlusive disease.
Main Methods:
- Retrospective analysis of 636 patients undergoing CAS between 1999 and 2011.
- Inclusion criteria aligned with NASCET guidelines for de novo or restenosis.
- Cerebral protection devices used in 94.7% of procedures; follow-up included duplex ultrasound and clinical evaluation.
Main Results:
- Technical success achieved in all cases with a 3.2% rate of neurological events within 30 days.
- Higher event rates observed in symptomatic patients (>4.5%), those >80 years (6.4%), and with complex plaque (6.1%).
- Primary patency rate of 98.7% with a low in-stent stenosis rate of 1.3%.
Conclusions:
- Carotid artery stenting (CAS) is a valid and effective treatment for carotid occlusive disease.
- Complex plaque morphology is a significant predictor of neurological complications.
- Thorough pre-procedural lesion assessment is essential for successful CAS outcomes.
Purpose:
To analyze a 12-year experience performing carotid artery stenting (CAS) with cerebral protection.
Methods:
In accord with NASCET criteria, 672 patients underwent CAS at our hospital between November 1999 and September 2011 for de novo or postsurgical restenosis; among these, 636 patients (474 men; mean age 68 ± 6.8 years, range 63-85) had a minimum 6-month follow-up, which qualified them for this analysis. The majority of patients (381, 59.9%) were symptomatic; 47 patients had staged bilateral CAS procedures (total of 683 procedures). A cerebral protection device was used in 94.7%. Patients underwent duplex ultrasound and clinical evaluation during follow-up. Neurological adverse events were correlated with plaque morphology, patient age >80 years, learning curve, and spasm.
Results:
Technical success was achieved in all cases. Neurological events [3 (0.4%) major strokes, 8 (1.2%) minor strokes, and 11 (1.6%) transient ischemia attacks] occurred in 22 (3.2%) of the 683 cases within 30 days of the procedure (no events in follow-up). These involved 5 (2.0%) of the 255 asymptomatic patients and 17 (4.5%) of the 381 symptomatic patients (p=0.001). Neurological events proved to be higher in patients >80 years (6.4% vs. 2.7% of patients <80 years, p<0.05) and in those with complex plaque morphology (6.1% vs. 1.0% in stable plaques, p<0.001). After a mean follow-up of 76 ± 32.4 months, 478 (70%) patients were alive, with a 30-day mortality of 1.9% (none due to stroke). In-stent stenosis occurred in 9 (1.3%) stents and was resolved with angioplasty or re-stenting. The primary patency rate was 98.7%.
Conclusion:
CAS is a valid technique for the treatment of carotid occlusive disease, with a very low rate of in-stent stenosis. Neurological complications were correlated with complex plaque morphology, which makes accurate pretreatment evaluation of the lesion mandatory if good CAS outcomes are to be achieved.
