Carotid artery stenting: a single-centre experience with up to 8 years’ follow-up

Abstract

Carotid artery stenting (CAS) may be an alternative to surgical endoarterectomy not only in highrisk patients. We report results in the endovascular treatment of carotid artery disease with up to 8 years' follow-up. In this retrospective study, we analysed data from 853 consecutive patients (946 arteries) treated for carotid artery stenosis between April 1999 and March 2007; 491 (52%) arteries were symptomatic and 455 (48%) were asymptomatic. Preprocedural evaluation of the patients was performed with echo Doppler, magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) and a neurological examination. A cerebral protection device was used in 879 (92.9%) procedures. Anti-platelet therapy was administered before and after the procedure. All patients were included in a followup of up to 8 years. Technical success was achieved in 943 (99.6%) lesions. At 30 days, there was a 0.21% (n=2) death rate, a 0.42% major stroke rate, a 1.69% minor stroke/transient ischaemic attack (TIA) rate and a combined 2.32% TIA/stroke and death rate. During follow-up, echo Doppler evidenced restenosis in 39 (4.85%) cases; of these, only five, presenting restenosis >80%, were treated with an endovascular reintervention. At the long-term follow-up, two strokes (0.23%) were reported, which both occurred within the first 2 years. In our experience, carotid artery stenting seems to be a safe and effective treatment, providing satisfactory long-term clinical results.

In Stent Restenosis Predictors after Carotid Artery Stenting

“…Specific risk factors in the development of restenosis after CAS remains to be elucidated: some studies have identified advanced age [27, 28], hyperglycemia [27, 29], smoke [27] and previous CEA [30]. In our study group, out of all the evaluated clinical radiological and procedural variables, multivariate analysis reveal that the residual stenosis after CAS is a stronger predictor of restenosis with a consistent increased risk of restenosis (1.091 per % unit of residual stenosis).…”

“…The role of diabetes has been described as a predictor of carotid [27, 28] and coronary in-stent restenosis [40] and may be due to smooth muscle cell proliferation common in diabetic patients [41]. The role of neoplasms in the restenosis occurrence is prone to speculative interpretations, in fact a series of cell proliferation regulatory pathways have been associated with plaque progression, stenosis and restenosis after angioplasty as well as in cancer progression [42].…”

Correlation between US-PSV and 64-Row MDCTA with Advanced Vessel Analysis in the Quantification of 50–70% Carotid Artery Stenosis

“…Many trials showed that the risk of ischemic events increases with the degree of stenosis and can be markedly reduced with endarterectomy or carotid artery stenting (CAS) [8, 10, 23]. …”

“…It was estimated by the panelists that as many as 80% of patients in the United States undergo carotid endarterectomy after a US examination as the only preoperative imaging study. In our experience more that 1004 CAS, all patients were submitted to CT or MR evaluation pre-stent [23, 26–29]. Therefore, it is of utmost importance that information provided by the US examination be reproducible and reliable [30].…”

Safety of Early Carotid Artery Stenting after Systemic Thrombolysis: A Single Center Experience

“…The patients, under light sedation, were kept conscious. The procedure adopted in our institution has been previously described [11]. A single self-expandable stent was implanted to cover the entire lesion in all patients.…”