Clinical research
Comparison of mid-term outcomes of carotid artery stenting for moderate versus critical stenosis
 
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Submission date: 2010-12-03
 
 
Final revision date: 2011-03-14
 
 
Acceptance date: 2011-03-31
 
 
Online publication date: 2012-02-29
 
 
Publication date: 2012-03-01
 
 
Arch Med Sci 2012;8(1):75–80
 
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ABSTRACT
Introduction: Little is known about the prognosis of moderate versus critical carotid stenosis treated by carotid artery stenting (CAS).
Material and methods : This was a retrospective analysis of a single-centre registry including 271 consecutive patients (69 ±9 years, 87% at high risk for surgery), in whom 308 procedures were performed. The study included both symptomatic (≥ 50% carotid artery stenosis) and asymptomatic (≥ 70% carotid artery stenosis) patients. The primary endpoint was the rate of adverse events during follow-up (range 1-48 months), defined as all-cause death or stroke.
Results : We treated 115 critical and 193 moderate stenoses and implanted 318 stents (56% with closed cell design). Embolic protection systems were used in 296 cases (96%). The technical success rate was 98.2% in the critical stenoses group and 99% in the moderate group (NS). During follow-up, the incidence of the primary endpoint was 12.9% (13 pts) in the critical stenoses group and 14.7% (25 pts) in the moderate stenoses group (estimated 3-year freedom from death/stroke was 0.844 vs. 0.812; log-rank test p = 0.983). Left ventricular ejection fraction < 40%, significant contralateral carotid artery occlusion or stenosis and renal insufficiency were identified as significant predictors of the primary endpoint (p < 0.03).
Conclusions : Carotid artery stenting with embolic protection systems in patients at high risk for carotid endarterectomy is safe. Patients with initially moderate and critical stenoses have an identical mid-term prognosis with regard to death and stroke.
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ISSN:1734-1922