title: Carotid stenting in high-risk patients: early and late outcomes.
abstract: OBJECTIVE
  Some patients with severe carotid stenosis have anatomical or clinical comorbidities that place them at high risk for carotid endarterectomy (CEA). The early and late outcomes after carotid artery stenting (CAS) were evaluated in patients at high risk for CEA.
  
  
  METHODS
  Between 2002 and 2009, 186 patients were enrolled in a high-risk CAS institutional registry. The primary outcome was major adverse cardiac and cerberovascular events (MACCEs) at 30 days, including death, stroke, and myocardial infarction. Secondary outcomes were technical, procedural, and clinical success; nonstroke neurological events; and death and ipsilateral stroke at 5 years.
  
  
  RESULTS
  Twenty-five patients (13.2%) were symptomatic. Thirty day MACCE occurred in 2.6%, including death in 1 (0.5%), stroke in 3 (1.6%), and myocardial infraction in 1 (0.5%) patient. Strokes were nonfatal in 3 (1.6%), major in 2 (1.1%), and minor in 1 (0.5%) patients. Other neurological events included transient ischemic attack in 9 (4.7%) and retinal artery occlusion in 2 (1.1%) patients. After stroke, 2 patients had complete resolution of neurological deficit within 30 days, and 1 patient had improvement in neurological deficit. By Kaplan--Meier analysis, all-cause mortality was 47.5% and ipsilateral stroke was 4.5% at 5 years.
  
  
  CONCLUSIONS
  In patients who are high risk for CEA, CAS can be performed with low MACCE at 30 days and ipsilateral stroke at 5 years. However, nearly half of these patients die within 5 years from causes unrelated to stroke.
authors.affiliation: Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Gribar
authors.forename: Monica
authors.initials: M
authors.lastname: Jiddou
authors.forename: Nishit
authors.initials: N
authors.lastname: Choksi
authors.forename: Amr E
authors.initials: AE
authors.lastname: Abbas
authors.forename: Terry
authors.initials: T
authors.lastname: Bowers
authors.forename: Chris
authors.initials: C
authors.lastname: Kazmierczak
authors.forename: Chris
authors.initials: C
authors.lastname: Timms
authors.forename: Robert D
authors.initials: RD
authors.lastname: Safian
mesh_terms: D000368:Aged; D002339:Carotid Arteries; D016893:Carotid Stenosis / Q000401:mortality / Q000628:therapy*; D017023:Coronary Angiography; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012042:Registries; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome