title: Carotid artery stenting in a community hospital: a success story.
abstract: BACKGROUND
  Carotid endarterectomy (CEA) is an effective procedure for reducing the risk of stroke in patients with carotid artery atherosclerosis. The evolution of carotid artery stenting (CAS) has made this a viable alternative to CEA in appropriate patient populations. We sought to evaluate the safety and efficacy of CAS in a high-risk population, in an effort to report such results in a medium-size community hospital. The data were then compared with the results published in the CREST and SAPPHIRE trials.
  
  
  METHODS
  The records of 280 consecutive patients undergoing carotid artery stenting between January 2005 and December 2011 were reviewed. A total of 271 patients were included in the final analysis. The clinical endpoints included cerebrovascular accident, myocardial infarction, and death in the perioperative period.
  
  
  RESULTS
  A total of 155 men (57.2%) and 116 women (42.8%) underwent CAS. A total of 259 carotid interventions (95.6%) were successful. Two of 271 patients (0.7%) experienced a minor neurologic event post procedure, with 1 patient death (0.35%) recorded. No perioperative myocardial infarctions were encountered.
  
  
  CONCLUSIONS
  Our findings indicate that our institution has been able to safely and effectively introduce and carry out CAS as a substitute to CEA in patients that are at high risk for surgery with results comparable to those published in large-scale clinical trials. Further studies are needed to verify whether these results can be generalized to other community hospitals, as well as to refine qualification criteria for performing physicians. Furthermore, the applicability of these results to normal-risk patients is currently being investigated.
authors.affiliation: Division of Cardiology, Providence Hospital and Medical Center, Southfield, MI 48075 USA. gdalloul79@hotmail.com
authors.forename: Ghassan
authors.initials: G
authors.lastname: Dalloul
authors.forename: Dustin
authors.initials: D
authors.lastname: Feldman
authors.forename: Nassim
authors.initials: N
authors.lastname: Haddad
authors.forename: Sachin Kumar
authors.initials: SK
authors.lastname: Amruthlal Jain
authors.forename: Jamal
authors.initials: J
authors.lastname: Zarghami
authors.forename: Marcel
authors.initials: M
authors.lastname: Zughaib
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016507:Cardiology Service, Hospital; D002340:Carotid Artery Diseases / Q000401:mortality / Q000628:therapy*; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000517:prevention & control; D062606:Tertiary Care Centers