Patient- and lesion-tailored algorithm of endovascular treatment for arterial occlusive disease of extracranial arteries supplying the brain: safety of the treatment at 30-day follow-up

Abstract

IntroductionAlthough surgical endarterectomy remains the treatment of choice for carotid artery stenosis, stenting plays an important role as an alternative treatment modality, especially in high-risk patients. The actual safety profile associated with stenting procedures is probably better than that reported by randomized controlled trials.AimTo assess the safety of stent implantations in extracranial arteries supplying the brain, and also to identify risk factors associated with this procedure.Material and methodsThis was a post hoc analysis, with 30-day follow-up. We analyzed the results of treatment of 372 patients who underwent 408 procedures, 197 such procedures in asymptomatic, and 211 in symptomatic individuals. Stenting procedures were performed using a technique and armamentarium which were tailored to the type and anatomy of lesions.ResultsThere were 6 (1.5%) strokes, including 2 (0.5%) major strokes, 1 ipsi- and 1 contralateral, and 4 (1.0%) minor strokes. In asymptomatic patients there was 1 (0.3%) minor stroke. Transient ischemic attacks occurred in 5 (1.2%) patients. There were 2 (0.5%) non-STEMI myocardial infarctions and 2 (0.5%) non-stroke related fatalities. Risk factors of these adverse events were diabetes mellitus, lesions localized in a tortuous segment of the artery, embolic material in the filter and bilateral stenoses of carotid arteries. Additional risk factors in asymptomatic patients were renal impairment and advanced coronary artery disease; and in symptomatic patients, grade 3 arterial hypertension, dislipidemia, cigarette smoking and lesions requiring predilatation.ConclusionsStenting procedures of extracranial arteries supplying the brain, which are tailored to the type and anatomy of lesions, seem to be relatively safe.

Early results of endovascular treatment of patients with bilateral stenoses of the internal carotid arteries using proximal protection systems at 30-day follow-up

“…Stabile et al [14] have reported that adverse events after carotid stenting with the use of PPS are less likely when the procedure is performed by operators who have already performed more than 100 such treatments. Expertise of the operator as an independent factor associated with reduced complication rate has also been demonstrated by other studies, and there seems to be a learning curve with significant drop in the incidence of adverse events with more than 200 procedures performed [5][6][7][18][19][20].…”

Mid-term and late results of endovascular treatment for symptomatic carotid artery stenosis under proximal protection.

“…Finally, an experience of the interventionalists should not be ignored [ 29 ]. There seems to be a learning curve with significant drop in the incidence of adverse events after more than 200 procedures performed [ 29 , 30 ]. Other studies have already reported the expertise of the operator as an independent factor associated with fewer complications.…”

Hybrid one-day coronary artery bypass grafting and carotid artery stenting – cardiac surgeons’ perspective on the procedure’s safety

“…Carotid artery stenting was performed under local anesthesia through percutaneous transfemoral access using different embolic protection devices and different stent types according to the tailored CAS algorithm [ 8 – 10 ]. After the procedure, the patient was immediately transferred to the cardiac operating room, where additional neurological assessment was performed.…”