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.