title: Starting a carotid artery stenting program is safe.
abstract: BACKGROUND
  Little is known on the performance of newly initiated carotid artery stenting (CAS) programs. The safety of the procedure is being questioned following the publication of the EVA-3S trial, a study criticized for the limited interventional experience required to enroll patients.
  
  
  METHODS
  Within a newly started academic CAS program, patient data and outcomes were collected prospectively. The outcomes of the first 100 consecutive patients treated are reported. A CAS-fellowship-trained interventionalist was involved in all procedures. All patients underwent clinical assessment by a neurologist before and after the procedure, and serial ECG and cardiac enzymes were routinely obtained. Primary outcome measures included 30-day major adverse events (MAE), defined as death, stroke, or myocardial infarction, while on follow-up deaths and ipsilateral strokes were added.
  
  
  RESULTS
  Between July 2003 and November 2006, 92 patients had a single internal carotid artery treated, while 7 underwent staged bilateral CAS. In one patient, the procedure was aborted prior to lesion treatment. The 30-day MAE rate per procedure was 1.9% (one major and one minor stroke). By a mean follow-up of 16 months (range 2-42 months), one patient had died of refractory heart failure, while one patient had a minor ipsilateral stroke and three had minor contralateral strokes, corresponding to total MAE per patient of 4%. The rate of any stroke or death was 7%. The rate of restenosis >or=50% per lesion by ultrasound was 3.8%.
  
  
  CONCLUSIONS
  This single center experience suggests that it is safe to start a CAS program following dedicated fellowship.
authors.affiliation: Department of Cardiology, University Hospital, Zurich, Switzerland. marco.roffi@usz.ch
authors.forename: Marco
authors.initials: M
authors.lastname: Roffi
authors.forename: Matthias
authors.initials: M
authors.lastname: Greutmann
authors.forename: Franz R
authors.initials: FR
authors.lastname: Eberli
authors.forename: Lisa
authors.initials: L
authors.lastname: Rainoni
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.forename: Beatrice
authors.initials: B
authors.lastname: Amann-Vesti
authors.forename: Urs
authors.initials: U
authors.lastname: Schwarz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000193:education / Q000295:instrumentation; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005257:Fellowships and Scholarships; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D011446:Prospective Studies; D015641:Radiography, Interventional; D012008:Recurrence; D015607:Stents; D020521:Stroke / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome