Procedural and Short-Term Outcomes of Carotid Artery Stenting: A Single-Center Experience

Background Carotid artery stenting is a well-established alternative treatment to carotid endarterectomy for carotid artery stenosis for preventing stroke. This study assessed the procedural and clinical outcomes in patients undergoing carotid artery stenting in a tertiary care center in India. Methods A total of 39 patients underwent carotid artery stenting from January 2022 to December 2023, with different embolic protection devices and carotid stents. All the patients had symptomatic carotid artery stenosis with at least 50% stenosis as per the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Procedural and technical success was assessed, and patients were followed for 20 ± 7 months for survival, new-onset stroke, and quality of life. Results The mean age was 64.8 ± 9.1 years and 25 (64.1%) of the patients were males. A total of 26 (66.7%) patients were hypertensive and 21 (53.9%) patients had a history of diabetes mellitus. Out of 39 patients, 2 (5.1%) had recurrent transient ischemic attacks while the rest (37; 94.9%) had a subacute and chronic ischemic stroke. A total of 37 (94.9%) patients had carotid artery stenosis of more than 70%. In this study, 9 (23.1%) patients had a history of sub-acute ischemic stroke of a 1 to 3-week duration. Two patients underwent bilateral staged stenting over a gap of one month. The overall procedural success rate was 39 (100%) and none of the patients had access site-related major complications. Out of the total 41 implants, 21 (51.2%) were self-expanding carotid WALLSTENT (Boston Scientific, Marlborough, Massachusetts, US) and 20 (48.8%) implants were Protégé RX tapered self-expanding carotid stent (Medtronic, Dublin, Ireland). A FilterWire EZ (Boston Scientific) embolic protection device was used in 23 (56.1%) cases and Spider FX (Medtronic) in 18 (43.9%) cases. None of our patients had an intraprocedural death. One patient had postprocedural ipsilateral third nerve palsy, which was resolved partially on the next day of carotid angioplasty. We used dual-antiplatelet drug therapy post-procedure for a month followed by a single antiplatelet drug lifelong. All patients were followed for a minimum of six months and a maximum of 30 months. A total of three (7.7%) patients have died, and 2 (5.1%) patients had a new-onset ischemic stroke with one on the same side of the carotid stenting. A total of 31 (79.5%) patients were doing well and in the recovery phase while those two patients who had a recurrent stroke were bedridden. None of the patients had clinically significant restenosis that needed revascularization of the carotid artery over a mean follow-up period. Conclusion Carotid artery stenting is an effective method to reduce the recurrence of ischemic stroke in significant symptomatic carotid stenosis patients. Experience in neuro-interventional procedures at our center leads to an acceptable rate of peri-procedural stroke, recurrence, and mortality in carotid artery stenting procedures.