Transcervical carotid stenting with carotid artery flow reversal: 3-year follow-up of 103 stents.
OBJECTIVE
This study evaluated the perioperative and 3-year follow-up results of 103 consecutive carotid artery stenting (CAS) procedures done with a transcervical approach using carotid flow reversal for cerebral protection that were performed over a 28-month period in 97 patients.


METHODS
The mean age of these patients was 72 years, and 82 (80%) were men. Mean preoperative internal carotid artery (ICA) peak systolic velocity was 314 cm/s, 36% of treated hemispheres were symptomatic, and 42% of patients had neurologic symptoms for >6 months. Ten patients (10%) had contralateral ICA occlusion, six (6%) had recurrent carotid stenosis, and two (2%) had previous neck radiation. Local anesthesia was used in 72 (70%) cases and general in 31 (30%). Predilatation was used in 34 cases (33%), and closed-cell self-expanding stents were deployed and postdilated in all cases.


RESULTS
Technical success was achieved in 100 cases (97%). No major strokes or deaths occurred. One ipsilateral transient ischemic attack (1%), one contralateral transient ischemic attack (1%), and two minor strokes (2%) occurred. There were two wound complications (2%) and one major arterial complication (1%). Mean operative time was 69 minutes, and mean carotid flow reversal time was 21 minutes. Three awake patients (4%) did not tolerate carotid flow reversal. Hypotension/bradycardia occurred in 24 cases (23%). No electrocardiographic myocardial infarctions were diagnosed. At 40 months of follow-up, the stent patency rate on an intention-to-treat basis was 95%, and the stroke-free survival was 91%.


CONCLUSIONS
Transcervical CAS with carotid flow reversal can be done with a high rate of technical success, a negligible rate of major adverse events, and an excellent 3-year stroke-free survival and stent patency rate. These results compare favorably with those of recently published prospective studies using distal filter protection during CAS.
Criado
Enrique
E
Section of Vascular Surgery, University of Michigan School of Medicine, Ann Arbor, MI 48109-0329, USA. ecriado@umich.edu
Fontcuberta
Juan
J
Orgaz
Antonio
A
Flores
Angel
A
Doblas
Manuel
M
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods*; D001166:Arteriovenous Shunt, Surgical; D002343:Carotid Artery, Internal / Q000503:physiopathology; D016893:Carotid Stenosis / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020766:Intracranial Embolism / Q000517:prevention & control; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D015641:Radiography, Interventional; D012039:Regional Blood Flow; D015607:Stents; D014654:Vascular Patency