Short- and long-term outcome after carotid artery stenting with neuroprotection: single-center experience within a prospective registry.
BACKGROUND
Carotid artery stenting is an alternative method to surgical endarterectomy for treatment of carotid artery stenosis.


RESULTS
Three hundred and seventy-one consecutive patients (71+/-9 years) undergoing 405 carotid artery interventions at a single cardiologic center were studied prospectively within a therapy registry. In general, the interventional procedure was performed using neuroprotective devices to prevent distal embolization. Stents were used routinely whenever possible. Independent neurological assessment took place prior to and after carotid stenting. The neurological event rate was assessed in the early (<30 days) and late post interventional period. In asymptomatic patients, 286 interventions were done with a 30-day stroke rate of 1.3% (ipsilateral 1.0%). In symptomatic patients, strokes occurred in a significantly (p<0.005) higher rate of 5.0% after 119 interventions (all ipsilateral). At long-term follow-up (mean 728+/-548 days) additional strokes occurred ipsilateral to the side of carotid intervention in 0.4% of asymptomatic patients (1.7% of symptomatic patients); contralateral strokes were seen at long-term follow-up in 1.1% of asymptomatic (1.7% of symptomatic) patients. Due to their comorbidities, 1.6% of patients died early, and an additional 11.1% late after carotid stenting.


CONCLUSIONS
Carotid artery stenting with the general use of neuroprotective devices yields acceptable shortterm results with respect to neurological events. Asymptomatic patients have significantly less periprocedural strokes than symptomatic patients. Neurological events during long-term follow-up are rare, in particular ipsilateral to the side of carotid stenting. Thus, carotid artery stenting with neuroprotection is a safe method for carotid revascularization, with acceptable periprocedural events, particularly in asymptomatic patients, and a good long-term neurologic outcome.
Spes
Christoph H
CH
Städtisches Klinikum München GmbH, Klinikum Neuperlach, Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Oskar Maria Graf Ring 51, 81737, München, Germany.
Schwende
Andreas
A
Beier
Florian
F
Hug
Martin
M
Hein
Ralph
R
Strohm
Henning
H
Büchele
Wolfgang
W
Haufe
Mathias C
MC
Mudra
Harald
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000209:etiology / Q000517:prevention & control; D002339:Carotid Arteries; D016893:Carotid Stenosis / Q000628:therapy*; D002548:Cerebral Revascularization / Q000379:methods; D015897:Comorbidity; D004617:Embolism / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000209:etiology*; D016896:Treatment Outcome
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