title: Carotid artery stenting in clinical practice results from the Carotid Artery Stenting (CAS)-registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK).
abstract: BACKGROUND
  Carotid artery stenting (CAS) for symptomatic and asymptomatic carotid stenosis seems to be on the doorstep of more widespread use. However, its feasibility and safety in clinical practice at a broad spectrum of hospitals needs to be determined.
  
  
  METHODS
  We analyzed data of the prospective multi-centre Carotid Artery Stenting (CAS) Registry of the German Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK).
  
  
  RESULTS
  From 7/1996 to 5/2004 1888 patients from 28 hospitals were included in the CAS Registry. The median hospital stay from CAS until hospital discharge was 3 days (quartiles: 2-6 days). Median patients age was 70 years (quartiles: 64-76 years) with 72.1% males. CAS for symptomatic stenosis was performed in 55% of cases. Patients treated with CAS suffered from coronary artery disease in 66.5%, had arterial hypertension in 91.7%, hyperlipidemia in 86.3% and 34.2% were diabetics. The intended CAS procedure was completed in 98.1% of cases. A stent was implanted in 97.3% of completed cases. The median intervention time was 43 min (quartiles: 30-60 min). During the hospital stay death rate was 0.3% (5/1888) and the rate of ipsilateral stroke 3.2% (58/1840). A contralateral ischemic event occurred in 1.4% (26/ 1840) of patients. The combined rate of all death or strokes was 3.8% (70/1841). Between 1996 and 2004 there was a steady increase in the use of protection devices during CAS (0% in 1996 and 97.9% in 2004; p for trend <0.0001). There was also an increase in the proportion of patients treated for asymptomatic stenoses (p for trend <0.0001). We observed a decrease of the combined endpoint of death or stroke from 6.3% in 1996 to 1.9% in 2004 (p for trend=0.021).
  
  
  CONCLUSIONS
  The multi-centre ALKK CAS Registry data confirm the feasibility and shot-term safety of CAS even in daily clinical practice. There was a rapid penetration of the use of embolic protection devices, an increase in treatment of asymptomatic carotid stenoses and a decrease in acute complication rates from 1996 to 2004.
authors.affiliation: Herzzentrum Ludwigshafen, Kardiologie, Bremserstrasse 79, 67063 Ludwigshafen, Germany. erzahn@aol.com
authors.forename: R
authors.initials: R
authors.lastname: Zahn
authors.forename: E
authors.initials: E
authors.lastname: Roth
authors.forename: T
authors.initials: T
authors.lastname: Ischinger
authors.forename: B
authors.initials: B
authors.lastname: Mark
authors.forename: M
authors.initials: M
authors.lastname: Hochadel
authors.forename: U
authors.initials: U
authors.lastname: Zeymer
authors.forename: K
authors.initials: K
authors.lastname: Haerten
authors.forename: K E
authors.initials: KE
authors.lastname: Hauptmann
authors.forename: E-R
authors.initials: ER
authors.lastname: von Leitner
authors.forename: A
authors.initials: A
authors.lastname: Schramm
authors.forename: W
authors.initials: W
authors.lastname: Kasper
authors.forename: J
authors.initials: J
authors.lastname: Senges
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000401:mortality / Q000628:therapy*; D002423:Cause of Death / Q000639:trends; D015897:Comorbidity; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D020766:Intracranial Embolism / Q000401:mortality / Q000517:prevention & control; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data*; D012955:Societies, Medical; D015607:Stents / Q000639:trends*; D015996:Survival Rate