Elective carotid stenting fulfills quality standards defined in guidelines.

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Neurology

Background:

• Current guidelines recommend carotid endarterectomy (CEA) over elective carotid artery stenting (CAS) as second-line therapy.
• Randomized trials comparing CAS and CEA are over a decade old.
• Quality assurance challenges exist in differentiating elective from emergency CAS interventions.

Purpose of the Study:

• To evaluate neurologically controlled CAS results in an experienced center.
• To determine if elective CAS meets strict quality criteria.
• To compare complication rates between elective and emergency CAS interventions for acute ischemic stroke.

Main Methods:

• Analysis of 141 elective CAS procedures (symptomatic and asymptomatic stenoses) and 158 emergency CAS procedures for acute stroke between 01/2012 and 07/2022.
• Neurologically controlled data collection for complication rates.
• Assessment of CAS-related complications and clinical outcome (NIHSS progression).

Main Results:

• Elective CAS for symptomatic stenosis had a low stroke/death rate of 0.8%.
• No complications were observed for CAS of asymptomatic stenoses.
• Emergency CAS procedures showed a significantly higher complication rate (7.8%) compared to elective CAS (p < 0.006).

Conclusions:

• Elective CAS can comply with strict S3 Guideline 2022 quality criteria, even with limited indications and case numbers.
• Emergency CAS interventions carry significantly higher complication rates and require separate quality assurance considerations.
• Elective and emergency CAS are not directly comparable due to differing conditions and outcomes.