Article Text

PDF
Favourable outcomes from carotid artery stenting in asymptomatic patients
  1. A Ielasi1,
  2. A Latib1,
  3. RT Gerber1,2,
  4. M Montorfano1,
  5. M Carlino1,
  6. GM Sangiorgi1,2,
  7. C Godino1,
  8. V Magni1,
  9. A Chieffo1,
  10. A Colombo1,2
  1. 1San Raffaele Hospital, Milan, Italy
  2. 2EMO Centro Cuore Columbus, Milan, Italy

Abstract

Background Carotid artery stenting (CAS) has arisen as a feasible and safe alternative to carotid endarterectomy (CEA) for the treatment of symptomatic carotid disease, particularly among high-risk patients. However, it is still unclear whether this benefit extends to asymptomatic patients. Current guidelines still recommend CEA for asymptomatic stenosis greater than 60% if the risk of periprocedural complications is less than 3% and the life expectancy more than 5 years. We sought to evaluate the clinical outcomes in asymptomatic patients treated with CAS in our centre.

Methods All patients with asymptomatic carotid stenosis of 70% or greater treated by CAS between January 1999 and November 2006 were included in the study. The endpoint analysed was a composite of periprocedural (⩽30 days) stroke/death/myocardial infarction (MI) and ipsilateral stroke from 31 days to 1 year.

Results A total of 297 asymptomatic patients (210 men; aged 70 ± 2.7 years) was treated with CAS. Of these 70 (23.6%) had diabetes. High-risk surgical features were present in 26.3% of patients (age ⩽80 years, 11.8%; ejection fraction ⩽35%, 5.1%; controlateral carotid occlusion, 5.1%; restenosis post-CEA, 3.9%). Embolic protection devices were used in 91.2% of cases. The degree of mean angiographic stenosis was 80.2 ± 1.7%. Procedural success was achieved in 99%. One-year clinical follow-up was available for 94.5%. The 30-day event rate obtained was 2% (six) any stroke (one major; five minor), 0.3% (one) of death and no myocardial infarction (MI), with a composite of periprocedural stroke/death/MI of 2.4%. The final composite of periprocedural (⩽30 days) stroke/death/MI plus ipsilateral stroke from 31 days to 1 year remained 2.4%.

Conclusion In this large real-world experience, treatment of asymptomatic carotid artery disease with CAS was associated with a low risk of early and mid-term major adverse events. The periprocedural (⩽30 days) event rate of less than 3% in this cohort and its stability at 1 year may suggest CAS as a feasible and acceptable alternative to CEA to treat asymptomatic carotid stenosis of 80% or less in high volume CAS centres.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.