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Updated: Mar 15, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Long-Term Outcomes of Carotid Artery Stenting in Clinical Practice
Harald Mudra1, Stephan Staubach2, Ralph Hein-Rothweiler2
1From the Department of Cardiology, Pulmonology, and Internal Intensive Medicine, Staedtisches Klinikum München GmbH, Klinikum Neuperlach, Munich, Germany (H.M., S.S., R.H.-R., M.S., H.S., J.L.); and Department of Sociology, University of Tuebingen, Germany (H.W.). harald.mudra@klinikum-muenchen.de.
Insights
Carotid artery stenting effectively prevents long-term stroke in real-world settings. Patients ineligible for clinical trials have higher risks but still benefit from this procedure.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Limited long-term data exists for carotid artery stenting outside clinical trials.
- Real-world effectiveness of carotid artery stenting for stroke prevention requires further investigation.
Purpose of the Study:
- To evaluate the long-term effectiveness of carotid artery stenting in stroke prevention within a large, real-world patient cohort.
- To assess outcomes in patients undergoing carotid artery stenting, including those ineligible for clinical trials.
Main Methods:
- An all-comer registry with prospective follow-up of 901 patients undergoing 1000 carotid artery stenting procedures.
- Included independent neurological assessments and a median follow-up of 5.5 years.
- Compared outcomes between patients eligible and ineligible for the CREST (Carotid Revascularization Endarterectomy Versus Stent Trial) protocol.
Main Results:
- The primary endpoint (stroke, death, myocardial infarction within 30 days + ipsilateral stroke beyond 30 days) occurred in 6.9% of patients.
- Outcomes were worse in symptomatic patients (9.9%) versus asymptomatic patients (5.7%).
- CREST-ineligible patients had a significantly higher event rate (11.4%) compared to CREST-eligible patients (4.9%).
Conclusions:
- Carotid artery stenting demonstrates long-term effectiveness in stroke prevention when performed in experienced centers.
- A significant proportion of patients undergoing stenting in clinical practice are ineligible for trials, carrying a higher risk of adverse events.
- Despite higher risks, carotid artery stenting remains a viable option for stroke prevention in a broader patient population.
Background:
There is a lack of long-term data and data outside of controlled clinical trials in carotid artery stenting. Thus, we sought to evaluate the long-term effectiveness in stroke prevention by carotid artery stenting in a large number of patients in a real-world setting.
Methods And Results:
The present work represents an all-comer registry with a strict, prospectively designed, follow-up protocol, including an independent pre- and postprocedural neurological assessment. Between November 1999 and March 2015, 1000 procedures in 901 patients were consecutively performed in a single center. Mean age was 71±9 years, and symptomatic stenosis was present in 262 patients (29.1%). The population was also characterized by a high comorbidity: 289 patients (32.1%) would have been excluded according to the CREST protocol (Carotid Revascularization Endarterectomy Versus Stent Trial). The median length of follow-up was 5.5 (interquartile range, 2.6-7.9) years and complete in 93% of the patients. The rate of the primary end point (composite of stroke, death, and myocardial infarction [major adverse cardiac or cerebrovascular event] by day 30 plus ipsilateral stroke beyond 30 days) was 6.9% (9.9% in symptomatic versus 5.7% in asymptomatic patients; P=0.03). The rate was higher in CREST ineligible than in CREST eligible patients (11.4% versus 4.9%; P=0.001).
Conclusions:
Long-term stroke prevention by carotid artery stenting is effective in experienced centers. A high percentage of patients who would have been excluded from controlled clinical trials undergoes carotid artery stenting in daily clinical practice. However, these patients have a substantially higher risk for an acute major adverse cardiac or cerebrovascular event.
