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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Results of carotid artery stenting. Lessons learned in a Belgian 'real world' practice
Laura Kerselaers1, Sarah Gallala1, Dimitri Aerden1
1Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Vascular Surgery, Brussels, Belgium.
Insights
Carotid artery stenting (CAS) in high-risk patients for carotid endarterectomy (CEA) showed acceptable outcomes in a real-world, low-volume setting. This study found low rates of stroke and death, supporting CAS as a viable treatment option.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid artery stenting (CAS) is an alternative for patients at high risk for carotid endarterectomy (CEA).
- Concerns exist regarding real-world stroke and death rates associated with CAS.
- Belgian healthcare context limits CAS volume per center due to lack of reimbursement.
Purpose of the Study:
- To evaluate the real-world outcomes of CAS in a low-volume center.
- To assess stroke and death rates in patients undergoing CAS for carotid artery stenosis.
- To compare findings with existing literature on CAS safety and efficacy.
Main Methods:
- Retrospective analysis of 45 CAS procedures performed between January 2006 and May 2018.
- Inclusion of patient demographics, treatment indications, and procedural outcomes.
- Analysis of minor stroke, major stroke, and death rates.
Main Results:
- 18% of patients had symptomatic stenosis, 82% had asymptomatic stenosis.
- Overall minor stroke rate was 6.6% (3/45), with no major strokes or deaths.
- Among asymptomatic patients, 2.7% (1/37) experienced a peri-operative minor stroke.
Conclusions:
- CAS in high-risk patients for CEA demonstrates acceptable real-world outcomes comparable to literature.
- Low-volume centers can achieve favorable results with rigorous quality control.
- Centralization of CAS to experienced interventionalists is recommended for optimal safety and outcomes.
Objective/Background:
Carotid artery stenting (CAS) is a valuable solution for the treatment of carotid artery stenosis in a high-risk patient population for carotid endarterectomy (CEA). In literature however, there are concerns about the death and stroke rates of CAS in the 'real world' practice. Since Belgium is a small country with a broad offer of medical care, and there is no reimbursement for CAS, only small numbers of patients can be treated per vascular department.
Methods:
In our department 45 CAS were performed from January 2006 until May 2018. Patient characteristics, indication for treatment and choice of treatment, minor stroke, major stroke and death rates were analyzed retrospectively.
Results:
Of these patients 8/45 (18%) had a symptomatic carotid artery stenosis and 37/45 (82%) had an asymptomatic stenosis. A total minor stroke rate of 3/45 (6.6%) was recorded, but no major stroke (0%) or death (0%). Of the 37 patients who were asymptomatic at the start, 1 suffered a minor stroke (1/37, 2.7%) peri-operatively.
Conclusion:
Real world data from a low volume center show that CAS performed in patients with high risk for CEA yields acceptable outcome that is comparable to the literature. Since CAS is a delicate procedure we advice to centralize the procedure to an dedicated experienced interventionalist and to perform rigorous quality control of your 'real world' data.
