Carotid artery stenting: Influence of experience and cerebrovascular risk factors on outcome
G Carrafiello1, M L De Lodovici2, G Piffaretti3
1Radiology Department, Unisubria, Ospedale di Circolo, Viale Borri 57, 21100 Varese, Italy.
Insights
Carotid artery stenting (CAS) is a safe alternative to surgery for high-risk patients with severe carotid artery disease. Operator experience, or learning curve, significantly reduces complication rates in CAS procedures.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Severe carotid artery obstructive disease poses a significant stroke risk.
- Carotid endarterectomy (CEA) is the traditional treatment but carries surgical risks.
- Carotid artery stenting (CAS) offers a less invasive alternative for high-risk patients.
Purpose of the Study:
- To assess the technical success and complication rates of CAS in patients unsuitable for CEA.
- To evaluate the impact of the operator's learning curve on CAS outcomes.
Main Methods:
- 109 protected CAS procedures were performed on 103 high-risk patients meeting SAPPHIRE criteria.
- Neurological outcomes were assessed using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS).
- Complications from the first 50 procedures were compared to the subsequent 59 to analyze the learning curve effect.
Main Results:
- Technical success rate for CAS was 98%.
- Periprocedural neurological complication rates were 4.5%, with in-hospital and 30-day rates at 7.6% and 2.6%, respectively.
- A significant reduction in periprocedural neurological complications was observed with increasing operator experience.
Conclusions:
- CAS is a viable alternative to CEA for severe carotid obstructive disease in high-risk surgical candidates.
- The learning curve in CAS positively influences complication rates, indicating improved safety with experience.
Aim:
To evaluate technical success, complications and the influence of the learning curve on outcome in carotid artery stenting (CAS) performed in patients not suitable for surgery.
Patients And Methods:
One hundred and nine procedures of protected carotid stenting in 103 high risk patients were performed. All patients presented at least one factor that potentially increased the surgical risk of carotid endoarterectomy (CEA), according to SAPPHIRE criteria. Neurologic complications were quantified by the National Institutes of Health Stroke Scale (NIHSS) and were evaluated by median Rankin Scale (mRS). To evaluate the influence of experience of the operator to perform CAS, we retrospectively analyzed periprocedural and neurological complications of the first 50 procedures compared with that of the following 59 interventions.
Results:
Technical success rate was 98%. Neurological periprocedural complications were revealed in 4.5% of patients. In-hospital and 30-days neurological complications rate was 7.6 and 2.6% respectively. Periprocedural neurological complications rate was lower in the last procedures performed, according to a higher confidence of the operators.
Conclusions:
CAS may be performed as an alternative of CEA for the treatment of severe carotid obstructive disease in patients not suitable for surgery. The learning curve positively influence complications rate.
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