Global experience in cervical carotid artery stent placement

Abstract

The purpose of this article is to review and update the current status of carotid artery stent placement in the world. Surveys to major interventional centers in Europe, North and South America, and Asia were initially completed in June 1997. Subsequent information from these 24 centers in addition to 12 new centers has been obtained to update the information. The survey asked the various questions regarding the patients enrolled, procedure techniques, and results of carotid stenting, including complications and restenosis. The total number of endovascular carotid stent procedures that have been performed worldwide to date included 5,210 procedures involving 4,757 patients. There was a technical success of 98.4% with 5,129 carotid arteries treated. Complications that occurred during the carotid stent placement or within a 30-day period following placement were recorded. Overall, there were 134 transient ischemic attacks (TIAs) for a rate of 2.82%. Based on the total patient population, there were 129 minor strokes with a rate of occurrence of 2.72%. The total number of major strokes was 71 for a rate of 1.49%. There were 41 deaths within a 30-day postprocedure period resulting in a mortality rate of 0.86%. The combined minor and major strokes and procedure-related death rate was 5.07%. Restenosis rates of carotid stenting have been 1.99 % and 3.46% at 6 and 12 months, respectively. The rate of neurologic events after stent placement has been 1.42% at 6 -12-month follow-up. Endovascular stent treatment of carotid artery atherosclerotic disease is growing as an alternative for vascular surgery, especially for patients that are high risk for standard carotid endarterectomy. The periprocedure risks for major and minor strokes and death are generally acceptable at this early stage of development and have not changed significantly since the first survey results. Cathet. Cardiovasc. Intervent. 50:160 -167, 2000.

Estenose de carótida extracraniana

“…Os benefícios da endarterectomia em pacientes sintomáticos com estenose entre 50 e 69% no NASCET, ECST e outros foram claramente menores do que naqueles com estenose maior [32][33][34][35] . Assim, nesse grupo, a endarterectomia tem maior valor para aqueles com alto risco de acidente vascular cerebral, como nos homens com 75 anos ou mais, sintomas hemisféricos e acidente vascular cerebral há 3 meses ou menos 1 .…”

“…Vários outros estudos têm sido realizados nesta direção, incluindo dados de registros multicêntricos que reuniram mais de 5000 pacientes submetidos à angioplastia com stent 35 apresentando baixas taxas de complicações imediatas e resultado favorável a longo prazo. Entretanto, séries de casos e registros não podem substituir os dados seguros e eficazes de estudos randomizados 36 .…”

Endarterectomy and Stenting for Asymptomatic Carotid Stenosis

“…Significant information about safety and feasibility of stenting was derived from large case series with periprocedural stroke and mortality and patency not too dissimilar from CEA trials. 25 An international survey by Wholley et al, 26,27 from major centers perform-ing CAS, reported 12 392 procedures performed in 11243 patients and suggested an acceptable periprocedural stroke and mortality of 4.75% that falls somewhere between NASCET and ACAS rates. The validity of these results is hampered by the uncontrolled nature of the data and potential verification and reporting bias of complications.…”

Técnica de proteção cerebral na angioplastia e "stent" de carótida: um procedimento eficaz contra embolia

“…As suas manifestações clínicas são dependentes das alterações hemodinâmicas locais e distais provocadas pela placa, sendo causa frequente de acidente vascular cerebral isquêmico 2 . Até há pouco tempo, as alternativas de tratamento desta doença resumiam-se ao uso de antiagregantes plaquetários e/ou anticoagulantes, associados a medidas clínicas de controle dos fatores de risco ou à endarterectomia carotídea 2,3 . As indicações de tratamento cirúrgico da placa de ateroma foram bem definidas após vári-os estudos multicêntricos [4][5][6][7] .…”

“…Um dos marcos mais importantes nessa evolução foi a sua associação com o uso de "stents", que se mostraram importantes na manutenção dos resultados imediatos e a longo prazo 1,2,8,9 . Essa modalidade terapêu-tica apresenta êxito indiscutível no tratamento de estenoses de artérias coronárias, renais e da circulação arterial periférica 3,4,8,10,11 . Devido às complicações embólicas, seu uso na doença carotídea era limitado aos pacientes com alto risco cirúrgico 1,3,11,12 .…”