Long-term results of carotid artery stents to manage symptomatic carotid artery stenosis and factors that affect outcome.
BACKGROUND
Limited data are available about the long-term outcomes of the use of carotid artery stents in symptomatic patients and the impact of patient variables on the durability of endovascular carotid procedures. Outcome data previously reported from registry series mix symptomatic and asymptomatic patients. We present analysis of long-term follow-up, with independent neurological assessment, for patients with symptomatic high-grade carotid lesions undergoing stenting to identify patients at risk of recurrence.


RESULTS
Prospectively collected data on 563 carotid stenting procedures in a single center were analyzed. Univariate and multivariate techniques were used to identify risk groups and beneficial technical adaptations. Ipsilateral stroke rates for all patients were 4.8%, 7.0%, and 9.5% at 30 days, 1 year, and 4 years, respectively. The rates improved to 2.7%, 4.1%, and 4.5% when patients were treated with optimal therapy. Retinal events had a lower risk of long-term recurrent ipsilateral stroke (hazard ratio=0.228, CI=0.082 to 0.632, P=0.004) than cerebral events. A recurrent or residual stenosis of >50% had a statistically significant effect on long-term stroke recurrence in multivariate analysis (hazard ratio=2.187, CI=1.173 to 4.078, P=0.014).


CONCLUSIONS
Patients with retinal presentations are a lower risk group to treat. Residual stenosis or restenosis >50% has a statistically significant trend to an increased risk of recurrence for ipsilateral stroke in the long term in this population. In our patients, a combination of procedural modifications and pharmacological changes seems to improve outcomes.
Randall
Marc S
MS
Neurology Department, Sheffield Teaching Hospitals National Health Service Foundation Trust, Royal Hallamshire Hospital, UK.
McKevitt
Fiona M
FM
Kumar
Sanjeev
S
Cleveland
Trevor J
TJ
Endean
Keith
K
Venables
Graham S
GS
Gaines
Peter A
PA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D016893:Carotid Stenosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D000077144:Clopidogrel; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D015607:Stents / Q000706:statistics & numerical data; D020521:Stroke; D016019:Survival Analysis; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome; D014786:Vision Disorders
D000077144:Clopidogrel; D013988:Ticlopidine