Carotid angioplasty and stenting is a safe and durable procedure in a community hospital.
Carotid angioplasty and stenting (CAS) has been touted as a reasonable alternative to carotid endarterectomy (CEA) for high-risk surgical candidates. Several published CAS series, primarily from academic centers, show immediate results approaching those of CEA. However, very little is known about long-term results with CAS, particularly in the community hospital setting. Therefore, we retrospectively reviewed our CAS experience. From February 1999 to July 2003, 44 consecutive patients underwent placement of 46 stents. The mean patient age was 73 years, and 57 per cent were men. Most patients were asymptomatic (74%). High-risk categories included prior CEA (71%), other anatomic risks (13%), and/or significant medical comorbidities (16%). Technical success was achieved in all 46 cases. At 30 days, there were no deaths and one stroke, giving a combined stroke/mortality of 2 per cent. Clinical follow-up was obtained on all 44 patients at a mean follow-up of 42 months. Duplex scans performed on 44 stents (96%), at a mean follow-up of 40 months, demonstrated four 60 per cent to 79 per cent recurrent stenoses. CAS in a community hospital can have a 30-day stroke/mortality equivalent to CEA. The procedure is durable, with no critical (80%-99%) carotid restenoses and no stroke or transient ischemic attacks referable to a stented carotid artery in long-term follow-up.
Department of Surgical Education, Orlando Regional Healthcare, Orlando, Florida, USA.
Mark L
ML
Friedell
Bryan J
BJ
Sandler
Joseph G
JG
Andriole
Samuel P
SP
Martin
Michael J
MJ
Cohen
John D
JD
Horowitz
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods*; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006764:Hospitals, Community; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex