title: Carotid artery stenting: Influence of experience and cerebrovascular risk factors on outcome.
abstract: OBJECTIVE
  To evaluate technical success, complications and the influence of the learning curve on outcome in carotid artery stenting (CAS) performed in patients not suitable for surgery.
  
  
  METHODS
  One hundred and nine procedures of protected carotid stenting in 103 high risk patients were performed. All patients presented at least one factor that potentially increased the surgical risk of carotid endoarterectomy (CEA), according to SAPPHIRE criteria. Neurologic complications were quantified by the National Institutes of Health Stroke Scale (NIHSS) and were evaluated by median Rankin Scale (mRS). To evaluate the influence of experience of the operator to perform CAS, we retrospectively analyzed periprocedural and neurological complications of the first 50 procedures compared with that of the following 59 interventions.
  
  
  RESULTS
  Technical success rate was 98%. Neurological periprocedural complications were revealed in 4.5% of patients. In-hospital and 30-days neurological complications rate was 7.6 and 2.6% respectively. Periprocedural neurological complications rate was lower in the last procedures performed, according to a higher confidence of the operators.
  
  
  CONCLUSIONS
  CAS may be performed as an alternative of CEA for the treatment of severe carotid obstructive disease in patients not suitable for surgery. The learning curve positively influence complications rate.
authors: Radiology Department, Unisubria, Ospedale di Circolo, Viale Borri 57, 21100 Varese, Italy. Electronic address: gcarraf@gmail.com.
authors: G
authors: G
authors: Carrafiello
authors: Neurological Department and Stroke Unit, Unisubria, Ospedale di Circolo, Viale Borri 57, 21100 Varese, Italy.
authors: M L
authors: ML
authors: De Lodovici
authors: Vascular Surgery Department, Unisubria, Ospedale di Circolo, Viale Borri 57, 21100 Varese, Italy.
authors: G
authors: G
authors: Piffaretti
authors: Vascular Surgery Department, Unisubria, Ospedale di Circolo, Viale Borri 57, 21100 Varese, Italy.
authors: N
authors: N
authors: Rivolta
authors: Radiology Department, Unisubria, Ospedale di Circolo, Viale Borri 57, 21100 Varese, Italy.
authors: A M
authors: AM
authors: Ierardi
authors: Radiology Department, Second University of Naples, Piazza Miraglia 8, 84010 Naples, Italy.
authors: M
authors: M
authors: Petrillo
authors: Neurological Department and Stroke Unit, Unisubria, Ospedale di Circolo, Viale Borri 57, 21100 Varese, Italy.
authors: A
authors: A
authors: Facchinetti
authors: Neurological Department and Stroke Unit, Unisubria, Ospedale di Circolo, Viale Borri 57, 21100 Varese, Italy.
authors: F
authors: F
authors: Carimati
authors: Neurological Department and Stroke Unit, Unisubria, Ospedale di Circolo, Viale Borri 57, 21100 Varese, Italy.
authors: E P
authors: EP
authors: Verrengia
authors: Neurological Department and Stroke Unit, Unisubria, Ospedale di Circolo, Viale Borri 57, 21100 Varese, Italy.
authors: M
authors: M
authors: Mauri
authors: Interventional Radiology, Heraklion University Hospital, Heraklion, Crete.
authors: D
authors: D
authors: Tsetis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control*; D002983:Clinical Competence; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
keywords: Carotid stenting; Cerebrovascular risk factors; Experience; Outcomes