Related Experiment Videos
Carotid stent-supported angioplasty: a neurovascular intervention to prevent stroke
G S Roubin1, S Yadav, S S Iyer
1Division of Cardiovascular Diseases, University of Alabama of Birmingham 35294-0007, USA.
Insights
Carotid artery stenting is a safe and effective investigational procedure for preventing strokes in high-risk patients. Further clinical testing is encouraged to validate this approach for broader use.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Interventional Radiology
Background:
- Obstructive carotid artery disease is a leading cause of stroke and mortality in the US.
- Carotid artery stenting offers potential advantages over surgical revascularization (carotid endarterectomy).
Purpose of the Study:
- To evaluate the safety and efficacy of stent-supported carotid artery angioplasty in high-risk patients.
- To assess the outcomes of carotid stenting compared to projected rates for carotid endarterectomy.
Main Methods:
- Prospective observational study at the University of Alabama at Birmingham.
- 146 procedures involving 210 stents placed in 152 vessels.
- 6-month follow-up with angiography or ultrasound evaluation.
Main Results:
- 99% technical success rate with low in-hospital complications (1 death, 2 major strokes).
- Stenting resulted in fewer major events compared to projected carotid endarterectomy rates.
- Restenosis rate <5% at 6 months, though stent deformation led to discontinuation of one stent type.
Conclusions:
- Carotid stent-supported angioplasty appears safe and effective for high-risk cerebrovascular disease.
- Improvements in technique, devices, and therapies are needed for randomized trials.
- Carotid stenting remains an investigational procedure requiring further validation.
Abstract:
Obstructive carotid artery disease is responsible for 60% of strokes in the United States and is the third major cause of death. Stent-supported carotid artery angioplasty has the potential to prevent stroke in thousands of patients and offers a number of potential advantages over surgical revascularization (carotid endarterectomy). Results of the prospective observational study at the University of Alabama at Birmingham indicate that carotid stent-supported angioplasty is safe and probably effective in reducing stroke in patients with high-risk cerebrovascular disease. Technical success was achieved in 99% of 146 procedures; 210 stents were placed in 152 vessels, with only 1 instance of stent thrombosis. The rate of major in-hospital complications was unexpectedly low-only 1 death and 2 major strokes. Seven patients suffered minor strokes, but only 2 were left with minor weakness. When compared with a projected complication rate of 6% had these patients undergone carotid endarterectomy, stenting resulted in fewer major events. At 6-month follow-up, 69 of 74 patients were evaluated by angiography or ultrasound, which detected 8 cases of stent deformation and a restenosis rate of < 5%. Because of these instances of stent deformation, use of the Palmaz (biliary) stent was discontinued. Although 1 patient had a transient ischemic attack, no strokes occurred during follow-up. To date, carotid stenting is an investigational procedure. Cardiovascular interventionalists, industry, and the FDA are encouraged to validate this approach through clinical testing. However, improvements in technique, devices, and adjunctive therapies are needed before the method can be tested in randomized trials.