Author + information
- Cinzia Moncalvo1,
- Vincenzo Puma1,
- Mario Caprile1,
- Angelo Laurenza1,
- Giuseppe Celano2,
- Eugenio Novelli2,
- Giuseppe Carosio1 and
- Paolo Cioffi1
Carotid artery stenting (CAS) may be an alternative to surgical endoarterectomy for the treatment of atherosclerotic carotid artery stenosis.
to analyze retrospectively the procedures of CAS performed in our Centre between January 2004 and December 2012.
This analysis includes 604 procedures performed in 554 patients (382 men; mean age: 72 years old). Symptomatic patients with carotid artery stenosis > 50% were the 45%; we treated asymptomatic patients affected by > 70% stenosis. 398 patients (72%) were considered at high surgical risk: 207 (37%) with severe controlateral stenosis; 136 (24%) with severe or unstable angina, poor left ventricular function, left main disease or trivascular coronary artery disease, severe cardiac valve disease; 35 patients (6%) presented restenosis after surgical treatment. 28 (5%) patients were treated with urgent coronary artery by-pass grafting (CABG) immediately after CAS; 108 (19%) patients underwent staged CABG one month after CAS. Distal cerebral protection devices were used in 85% of the procedures. Soft plaques were present in 110 patients (18%). 49 (9%) patients were submitted to CAS for bilateral carotid artery stenosis.
we obtained a successful immediate angiography result in 99% of the patients. Major complications occurred in 11 patients (1.9%) and included: death (1 fatal stroke), major stroke (3), intracerebral hemorrhagic stroke (1), minor stroke (5), acute instent thrombosis (1 patient treated with thromboendoarterectomy and stent removal). Puncture site hematoma occurred in 4 patients treated with vascular surgical repair, one patient died for hemorrhagic shock.
we have a complete follow up in 95% of the patients. Instent restenosis occurred in 6 patients (1%) and was successfully treated with a new CAS. 50 patients died (22 for cardiovascular causes), but no one died for causes directly related to CAS.
in our experience CAS is a safety procedure with low complications also in high risk patients; the long term efficacy of CAS is very good with low rate of restenosis.