title: Extracranial carotid artery stenting: the Puerto Rico medical center endovascular neurosurgery service experience.
abstract: OBJECTIVE
  Extracranial carotid artery stenting (CAS) represents a viable alternative for high-risk surgical patients. The aim of this study was to determine the clinical features and outcome of 25 patients that underwent CAS at the Puerto Rico Medical Center.
  
  
  METHODS
  A retrospective review of a series of 25 high-risk surgical patients that underwent CAS from June 2005 to January 2010 was performed. Patients were followed-up at clinics with computed tomography angiography and/or digital subtraction angiography.
  
  
  RESULTS
  Patient ages ranged from 52 to 88 years. Twenty-one of the patients had severe cervical carotid stenosis (more than 80%). Those with moderate stenosis (from 50% to 80%) were treated when they were symptomatic or when stenosis recurred after carotid endarterectomy. Among the 25 patients, only 2 presented with restenosis (more than 50% luminal diameter). Both had a history of radiation-induced disease, but neither required retreatment. Five patients required post-stenting angioplasty due to a less than 50% improvement in luminal diameter. There was 1 death, and 1 patient presented delayed neurocognitive deterioration. The combined long-term morbidity and mortality in the subgroup with at least two years of follow-up was 8.3%. There were no intracerebral hemorrhages or recurrent strokes/transient ischemic attacks.
  
  
  CONCLUSIONS
  The restriction of post-stenting angioplasty to only those cases without significant revascularization appears to help reduce restenosis rates while ensuring a gradual increase in intracranial blood flow. The latter may not apply to patients with a prior history of radiotherapy.
authors.affiliation: Section of Neurological Surgery Neuroendovascular Surgery Program, Department of Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico. caleb.feliciano@upr.edu
authors.forename: Caleb E
authors.initials: CE
authors.lastname: Feliciano
authors.forename: Euclides
authors.initials: E
authors.lastname: Effio
authors.forename: Manuel S
authors.initials: MS
authors.lastname: Hernández-Gaitán
authors.forename: Amaury
authors.initials: A
authors.lastname: Garcáa
authors.forename: Rafael
authors.initials: R
authors.lastname: Rodríguez-Mercado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002342:Carotid Artery, External; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011647:Puerto Rico; D012189:Retrospective Studies; D015607:Stents