Carotid artery stenting: technical considerations.
OBJECTIVE
Carotid endarterectomy (CEA) is one of the most frequently performed operations in the United States. To offer patients a less invasive means to achieve the same goal, carotid artery stenting (CAS) is investigated as an alternative treatment to CEA.


METHODS
Three hundred ninety patients underwent CAS, with 451 vessels treated. CAS was performed using a coaxial system with a 7F 90-cm sheath for predilation, stent placement, and stent dilation. Pretreatment antiplatelet therapy was administered. We currently practice same-day admissions and 23-hour discharges.


RESULTS
The technical success rate was 98%. The 30-day mortality/morbidity rates were as follows: death, 1.7% (two [0.5%] neurologic and five [1.2%] systemic] major strokes, 0.9% (two of four were related to the intervention); minor strokes, 5.5%. Among 25 patients who suffered minor strokes, 14 achieved complete recovery. On an annual basis, the incidence of minor stroke declined from 6.8% (1994-1995), to 5.8% (1995-1996), 5.3% (1996-1997), and then 4% (1997-1998), with no major strokes or neurologic deaths occurring during the 1997 to 1998 period.


CONCLUSIONS
CAS is an effective treatment for carotid stenosis. With proper selection of patients and meticulous technique, complication rates compare favorably with those of CEA.
Vitek
J J
JJ
New York Heart and Vascular Institute at Lenox Hill Hospital, New York, USA.
Roubin
G S
GS
Al-Mubarek
N
N
New
G
G
Iyer
S S
SS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D015607:Stents / Q000009:adverse effects