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Carotid artery stenting in a community hospital: a success story
Ghassan Dalloul1, Dustin Feldman, Nassim Haddad
1Division of Cardiology, Providence Hospital and Medical Center, Southfield, MI 48075 USA. gdalloul79@hotmail.com
Insights
Carotid artery stenting (CAS) is a safe and effective stroke prevention method for high-risk patients, with outcomes comparable to large trials. Further research is needed to generalize findings to other hospitals and patient groups.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid artery atherosclerosis increases stroke risk.
- Carotid endarterectomy (CEA) is a standard treatment.
- Carotid artery stenting (CAS) offers an alternative for select patients.
Purpose of the Study:
- Evaluate the safety and efficacy of CAS in a high-risk population at a community hospital.
- Compare CAS outcomes with results from major clinical trials like CREST and SAPPHIRE.
Main Methods:
- Retrospective review of 280 consecutive patients undergoing CAS (January 2005 - December 2011).
- 271 patients included in the final analysis.
- Primary endpoints: perioperative cerebrovascular accident, myocardial infarction, and death.
Main Results:
- 95.6% of carotid interventions were successful.
- Low complication rates: 0.7% minor neurologic events, 0.35% patient death.
- No perioperative myocardial infarctions observed.
Conclusions:
- CAS can be safely and effectively implemented in a community hospital setting for high-risk patients.
- Outcomes are comparable to those reported in large-scale clinical trials.
- Further studies should explore generalizability to other centers and refine physician qualification criteria.
Background:
Carotid endarterectomy (CEA) is an effective procedure for reducing the risk of stroke in patients with carotid artery atherosclerosis. The evolution of carotid artery stenting (CAS) has made this a viable alternative to CEA in appropriate patient populations. We sought to evaluate the safety and efficacy of CAS in a high-risk population, in an effort to report such results in a medium-size community hospital. The data were then compared with the results published in the CREST and SAPPHIRE trials.
Methods:
The records of 280 consecutive patients undergoing carotid artery stenting between January 2005 and December 2011 were reviewed. A total of 271 patients were included in the final analysis. The clinical endpoints included cerebrovascular accident, myocardial infarction, and death in the perioperative period.
Results:
A total of 155 men (57.2%) and 116 women (42.8%) underwent CAS. A total of 259 carotid interventions (95.6%) were successful. Two of 271 patients (0.7%) experienced a minor neurologic event post procedure, with 1 patient death (0.35%) recorded. No perioperative myocardial infarctions were encountered.
Conclusion:
Our findings indicate that our institution has been able to safely and effectively introduce and carry out CAS as a substitute to CEA in patients that are at high risk for surgery with results comparable to those published in large-scale clinical trials. Further studies are needed to verify whether these results can be generalized to other community hospitals, as well as to refine qualification criteria for performing physicians. Furthermore, the applicability of these results to normal-risk patients is currently being investigated.