Carotid artery stenting in patients with high-risk anatomy for carotid endarterectomy.
OBJECTIVE
To report the results of carotid artery stenting (CAS) in patients considered to have high-risk anatomical characteristics for carotid endarterectomy.


METHODS
CAS was performed in 39 carotid arteries of 37 consecutive patients (26 men; mean age 72 +/- 8 years, range 56-88) who met the criteria for high-risk surgical anatomy: previous ipsilateral carotid endarterectomy (20/39, 51.3%), common carotid bifurcation above the mandibular angle (5/39, 12.8%), contralateral carotid artery occlusion (15/39, 38.5%), or previous radiation therapy to the neck (1/39, 2.6%). Palmaz, Integra, or Wallstents were deployed via a percutaneous femoral artery access. Independent neurological evaluation was performed at specified time points, and a dedicated committee adjudicated all clinical events.


RESULTS
Procedural success was 100%, with no major in-hospital complications. Neurological events were rare. Only 1 (2.6%) transient ischemic attack occurred prior to discharge; at 30 days, 1 (2.6%) additional minor stroke had been observed, giving a 2.6% cumulative 30-day "death plus any stroke" rate. Over a mean 11 +/- 6-month follow-up, 2 (5.4%) patients died of nonneurological causes, but there were no strokes.


CONCLUSIONS
CAS is a viable endovascular revascularization technique that can be performed safely and effectively in patients with high-risk anatomy for carotid endarterectomy.
Dangas
G
G
Knox Hill Heart & Vascular Institute, Cardiovascular Research Foundation, New York, New York 10022, USA. gdangas@crf.org
Laird
J R
JR
Mehran
R
R
Satler
L F
LF
Lansky
A J
AJ
Mintz
G
G
Monsein
L H
LH
Laureno
R
R
Leon
M B
MB
D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000601:surgery*; D000075202:Contraindications; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D011183:Postoperative Complications; D012307:Risk Factors; D012449:Safety; D015607:Stents; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome