Has carotid artery stenting found its place? A 10-year regional centre perspective.
BACKGROUND
The post-Carotid Revascularization Endarterectomy versus Stenting Trial era has seen a dramatic decline in the practice of carotid artery stenting (CAS). A retrospective review of prospectively collected CAS outcomes over a 10-year period by a single operator was undertaken to determine if this change in practice is justified and to identify the place of carotid stenting in current practice.


METHODS
One hundred fifty-nine carotid stent procedures were undertaken on 137 patients from 2002 to 2012. Cases were selected for CAS only if they fulfilled the inclusion criteria for the SAPPHIRE trial. Post-procedural outcomes were compared against those of a contemporaneous cohort of patients undergoing carotid endarterectomy (CEA) by the same operator and against published meta-analyses. The measure of CAS durability was need for re-intervention, based on the presence of ultrasound-detected re-stenosis >70%.


RESULTS
No significant difference was identified in 30-days' complication rates between patients undergoing CAS and those having CEA. Compared to published meta-analyses of CAS, our practice was accompanied by a significantly lower rate of peri-procedural stroke (1.26% versus 6%, P = 0.014) while carrying equivalent 30-days' death and myocardial infarction. Four stented arteries had re-intervention, due to asymptomatic in-stent stenosis of >70%. Further intervention was declined in a fifth case. This represents a re-stenosis rate of 3.1% over a mean follow-up of 40.2 ± 27.6 months.


CONCLUSIONS
CAS can provide a safe and durable treatment option for selected patients with carotid artery disease, in the hands of appropriately trained proceduralists who meet accepted standards of practice.
School of Medicine, Deakin University, Geelong, Victoria, Australia.|Department of Vascular and Endovascular Surgery, The Geelong Hospital, Geelong, Victoria, Australia.
Nathan G
NG
Biggs
Department of Vascular and Endovascular Surgery, The Geelong Hospital, Geelong, Victoria, Australia.
Shrikkanth
S
Rangarajan
School of Medicine, Deakin University, Geelong, Victoria, Australia.|Department of Vascular and Endovascular Surgery, The Geelong Hospital, Geelong, Victoria, Australia.|Geelong Vascular Service, Deakin University, Geelong, Victoria, Australia.
David N
DN
McClure
D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000601:surgery*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
carotid artery; in-stent re-stenosis; peri-procedural complications; single centre; stenting