Safety and efficacy of carotid angioplasty/stenting in 100 consecutive high surgical risk patients: immediate and long-term follow-up.
OBJECTIVE
This study analyzes the safety and efficacy of carotid angioplasty/stenting (CAS) with embolic protection devices in high surgical risk (HSR) patients. PATIENT POPULATION/METHODS: This study includes 100 consecutive HSR patients, who were followed prospectively, and had carotid duplex ultrasounds at 1 month and every 6 months thereafter. A Kaplan-Meier lifetable analysis was used to estimate survival rates, rates of freedom from stroke, and freedom from > or =50% in-stent restenosis.


RESULTS
Mean age was 69.6 years. There were 59 men and 41 women. Mean follow-up was 26.1 months (range, 1-50). Indications for CAS were symptomatic > or =50% stenosis in 47% and > or =80% asymptomatic stenosis in 53%. Procedure success rate was 100%. HSR includes 33% with restenosis and cardiac comorbidity, 21% with restenosis and cardiac/medical comorbidities, 13% with restenosis only, and 33% with cardiac/medical comorbidities. The 30-day perioperative stroke rate was 2% with no perioperative deaths or MI. Stroke-free survival rates were 95%, 91%, 83%, 79%, and 73% at 1, 2, 3, and 4 years, respectively. There were no late strokes. Stroke-free rate was 98% at 1, 2, 3, and 4 years, respectively. Freedom from > or =50% in-stent restenosis was 98%, 93%, 90%, and 79% at 1, 2, 3, and 4 years, respectively. Six patients had asymptomatic > or =80% in-stent restenosis; 3 underwent reintervention (percutaneous transluminal angioplasty). The incidence of in-stent restenosis was not statistically significant between patients who had restenosis after carotid endarterectomy and patients with primary stenting (P = .21).


CONCLUSIONS
CAS with embolic protection devices in HSR patients is safe and effective.
AbuRahma
Ali F
AF
R. C. Byrd Health Sciences Center, West Virginia University, Charleston, West Virginia. ali.aburahma@camc.org
Bates
Mark C
MC
Eads
Kris
K
Armistead
Lauren
L
Flaherty
Sarah K
SK
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex