title: Carotid artery stenting: analysis of a 12-year single-center experience.
abstract: OBJECTIVE
  To analyze a 12-year experience performing carotid artery stenting (CAS) with cerebral protection.
  
  
  METHODS
  In accord with NASCET criteria, 672 patients underwent CAS at our hospital between November 1999 and September 2011 for de novo or postsurgical restenosis; among these, 636 patients (474 men; mean age 68 ± 6.8 years, range 63-85) had a minimum 6-month follow-up, which qualified them for this analysis. The majority of patients (381, 59.9%) were symptomatic; 47 patients had staged bilateral CAS procedures (total of 683 procedures). A cerebral protection device was used in 94.7%. Patients underwent duplex ultrasound and clinical evaluation during follow-up. Neurological adverse events were correlated with plaque morphology, patient age >80 years, learning curve, and spasm.
  
  
  RESULTS
  Technical success was achieved in all cases. Neurological events [3 (0.4%) major strokes, 8 (1.2%) minor strokes, and 11 (1.6%) transient ischemia attacks] occurred in 22 (3.2%) of the 683 cases within 30 days of the procedure (no events in follow-up). These involved 5 (2.0%) of the 255 asymptomatic patients and 17 (4.5%) of the 381 symptomatic patients (p=0.001). Neurological events proved to be higher in patients >80 years (6.4% vs. 2.7% of patients <80 years, p<0.05) and in those with complex plaque morphology (6.1% vs. 1.0% in stable plaques, p<0.001). After a mean follow-up of 76 ± 32.4 months, 478 (70%) patients were alive, with a 30-day mortality of 1.9% (none due to stroke). In-stent stenosis occurred in 9 (1.3%) stents and was resolved with angioplasty or re-stenting. The primary patency rate was 98.7%.
  
  
  CONCLUSIONS
  CAS is a valid technique for the treatment of carotid occlusive disease, with a very low rate of in-stent stenosis. Neurological complications were correlated with complex plaque morphology, which makes accurate pretreatment evaluation of the lesion mandatory if good CAS outcomes are to be achieved.
authors.affiliation: Vascular and Interventional Radiology Unit, Department of Radiological Sciences, "Sapienza" University of Rome, Italy. fabrizio.fanelli@uniroma1.it
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fanelli
authors.forename: Emanuele
authors.initials: E
authors.lastname: Boatta
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cannavale
authors.forename: Mario
authors.initials: M
authors.lastname: Corona
authors.forename: Pierleone
authors.initials: P
authors.lastname: Lucatelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Wlderk
authors.forename: Carlo
authors.initials: C
authors.lastname: Cirelli
authors.forename: Filippo M
authors.initials: FM
authors.lastname: Salvatori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D057505:Embolic Protection Devices; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012384:Rome; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency