Patient- and lesion-tailored algorithm of endovascular treatment for arterial occlusive disease of extracranial arteries supplying the brain: safety of the treatment at 30-day follow-up.
BACKGROUND
Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, stenting plays an important role as an alternative treatment modality, especially in high-risk patients. The actual safety profile associated with stenting procedures is probably better than that reported by randomized controlled trials.


OBJECTIVE
To assess the safety of stent implantations in extracranial arteries supplying the brain, and also to identify risk factors associated with this procedure.


METHODS
This was a post hoc analysis, with 30-day follow-up. We analyzed the results of treatment of 372 patients who underwent 408 procedures, 197 such procedures in asymptomatic, and 211 in symptomatic individuals. Stenting procedures were performed using a technique and armamentarium which were tailored to the type and anatomy of lesions.


RESULTS
There were 6 (1.5%) strokes, including 2 (0.5%) major strokes, 1 ipsi- and 1 contralateral, and 4 (1.0%) minor strokes. In asymptomatic patients there was 1 (0.3%) minor stroke. Transient ischemic attacks occurred in 5 (1.2%) patients. There were 2 (0.5%) non-STEMI myocardial infarctions and 2 (0.5%) non-stroke related fatalities. Risk factors of these adverse events were diabetes mellitus, lesions localized in a tortuous segment of the artery, embolic material in the filter and bilateral stenoses of carotid arteries. Additional risk factors in asymptomatic patients were renal impairment and advanced coronary artery disease; and in symptomatic patients, grade 3 arterial hypertension, dislipidemia, cigarette smoking and lesions requiring predilatation.


CONCLUSIONS
Stenting procedures of extracranial arteries supplying the brain, which are tailored to the type and anatomy of lesions, seem to be relatively safe.
Department of Vascular Surgery, University Hospital, Krakow, Poland.
Paweł
P
Latacz
Department of Angiology, Private Healthcare Institution SANA Outpatient, Pszczyna, Poland.
Marian
M
Simka
Chair of Radiology, Jagiellonian University Medical College, Krakow, Poland.
Paweł
P
Brzegowy
Department of Neurology, Murcki Hospital, Katowice, Poland.
Piotr
P
Janas
Department of Vascular Surgery, John Paul II Hospital, Krakow, Poland.
Marek
M
Kazibudzki
Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.
Piotr
P
Pieniążek
3 Department of Cardiology, Medical University of Silesia, Katowice, Poland.
Andrzej
A
Ochała
Chair of Radiology, Jagiellonian University Medical College, Krakow, Poland.
Tadeusz
T
Popiela
Department of Vascular Surgery, University Hospital, Krakow, Poland.
Tomasz
T
Mrowiecki
carotid artery stenting; distal protection system; proximal protection system