Clinical outcomes following protected carotid artery stenting in symptomatic and asymptomatic patients

Alfonso Ielasi, Azeem Latib, Cosmo Godino, Andrew S.P. Sharp, Rasha Al Lamee, Matteo Montorfano, Flavio Airoldi, Mauro Carlino, Alaide Chieffo, Giuseppe Massimo Sangiorgi, Antonio Colombo

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12 Scopus citations

Abstract

Purpose: To evaluate clinical outcomes in patients undergoing carotid artery stenting (CAS) with routine use of a cerebral embolic protection device (EPD). Methods: A retrospective cohort analysis was conducted of 490 consecutive patients (365 men; mean age 70.7±8.5 years) who underwent CAS with EPD between January 1999 and December 2007 at 2 institutions with large referral practices. There were 163 symptomatic patients with stenosis ≥50% and 327 asymptomatic patients with ≥80% diameter stenosis treated in 536 CAS procedures. Nearly a quarter (116, 23.7%) of the cohort had diabetes. High-risk surgical features were present in 141 (28.8%): 73 (14.9%) aged ≥80 years, 25 (5.1%) with significant heart disease, 23 (4.6%) with postsurgical restenosis, and 16 (3.2%) with contralateral carotid occlusion. An EPD was successfully placed in 512 (95.5%) patients. Results: The incidence of any stroke within 30 days was 3.3% (16/490), of which the majority (13, 2.6%) were ipsilateral [5 (1.0%) major and 8 (1.6%) minor]. The incidence of major adverse events (MAE), i.e., any stroke, death or myocardial infarction, within 30 days was 3.7% (18/490); the incidence of 30-day any stroke/death was 3.7% (18/490), while the cumulative incidence of any stroke/death at 1 year was 6.1% (30/490). In symptomatic patients, the 30-day MAE rate was 6.7% (11/163) versus 2.1% (7/237) in the asymptomatic group (p=0.02). A subgroup analysis based on surgical risk showed that the 30-day MAE rate was similar between high-risk and non-high-risk patients [4.9% (7/144) versus 3.2% (11/346); p=0.5]. Conclusion: In this large real-world cohort, CAS with routine use of EPDs was technically feasible, clinically safe, and associated with a low rate of periprocedural and 1-year events; results were similar irrespective of surgical risk.

Original languageEnglish (US)
Pages (from-to)298-307
Number of pages10
JournalJournal of Endovascular Therapy
Volume17
Issue number3
DOIs
StatePublished - Jun 2010
Externally publishedYes

Keywords

  • Angioplasty
  • Carotid artery
  • Embolic protection device
  • Filter
  • Outcome analysis
  • Stent

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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