BACKGROUND: Carotid artery stenting is an alternative method to surgical endarterectomy for treatment of carotid artery stenosis. METHODS AND RESULTS: Three hundred and seventy-one consecutive patients (71+/-9 years) undergoing 405 carotid artery interventions at a single cardiologic center were studied prospectively within a therapy registry. In general, the interventional procedure was performed using neuroprotective devices to prevent distal embolization. Stents were used routinely whenever possible. Independent neurological assessment took place prior to and after carotid stenting. The neurological event rate was assessed in the early (<30 days) and late post interventional period. In asymptomatic patients, 286 interventions were done with a 30-day stroke rate of 1.3% (ipsilateral 1.0%). In symptomatic patients, strokes occurred in a significantly (p<0.005) higher rate of 5.0% after 119 interventions (all ipsilateral). At long-term follow-up (mean 728+/-548 days) additional strokes occurred ipsilateral to the side of carotid intervention in 0.4% of asymptomatic patients (1.7% of symptomatic patients); contralateral strokes were seen at long-term follow-up in 1.1% of asymptomatic (1.7% of symptomatic) patients. Due to their comorbidities, 1.6% of patients died early, and an additional 11.1% late after carotid stenting. CONCLUSION: Carotid artery stenting with the general use of neuroprotective devices yields acceptable shortterm results with respect to neurological events. Asymptomatic patients have significantly less periprocedural strokes than symptomatic patients. Neurological events during long-term follow-up are rare, in particular ipsilateral to the side of carotid stenting. Thus, carotid artery stenting with neuroprotection is a safe method for carotid revascularization, with acceptable periprocedural events, particularly in asymptomatic patients, and a good long-term neurologic outcome.
BACKGROUND: Carotid artery stenting is an alternative method to surgical endarterectomy for treatment of carotid artery stenosis. METHODS AND RESULTS: Three hundred and seventy-one consecutive patients (71+/-9 years) undergoing 405 carotid artery interventions at a single cardiologic center were studied prospectively within a therapy registry. In general, the interventional procedure was performed using neuroprotective devices to prevent distal embolization. Stents were used routinely whenever possible. Independent neurological assessment took place prior to and after carotid stenting. The neurological event rate was assessed in the early (<30 days) and late post interventional period. In asymptomatic patients, 286 interventions were done with a 30-day stroke rate of 1.3% (ipsilateral 1.0%). In symptomatic patients, strokes occurred in a significantly (p<0.005) higher rate of 5.0% after 119 interventions (all ipsilateral). At long-term follow-up (mean 728+/-548 days) additional strokes occurred ipsilateral to the side of carotid intervention in 0.4% of asymptomatic patients (1.7% of symptomatic patients); contralateral strokes were seen at long-term follow-up in 1.1% of asymptomatic (1.7% of symptomatic) patients. Due to their comorbidities, 1.6% of patients died early, and an additional 11.1% late after carotid stenting. CONCLUSION: Carotid artery stenting with the general use of neuroprotective devices yields acceptable shortterm results with respect to neurological events. Asymptomatic patients have significantly less periprocedural strokes than symptomatic patients. Neurological events during long-term follow-up are rare, in particular ipsilateral to the side of carotid stenting. Thus, carotid artery stenting with neuroprotection is a safe method for carotid revascularization, with acceptable periprocedural events, particularly in asymptomatic patients, and a good long-term neurologic outcome.
Authors: P A Ringleb; J Allenberg; H Brückmann; H-H Eckstein; G Fraedrich; M Hartmann; M Hennerici; O Jansen; G Klein; A Kunze; P Marx; K Niederkorn; W Schmiedt; L Solymosi; R Stingele; H Zeumer; W Hacke Journal: Lancet Date: 2006-10-07 Impact factor: 79.321
Authors: Alberto Cremonesi; Carlo Setacci; Angelo Bignamini; Leonardo Bolognese; Francesco Briganti; Germano Di Sciascio; Domenico Inzitari; Gaetano Lanza; Luciano Lupattelli; Salvatore Mangiafico; Carlo Pratesi; Bernard Reimers; Stefano Ricci; Gianmarco de Donato; Ugo Ugolotti; Augusto Zaninelli; Gian Franco Gensini Journal: Stroke Date: 2006-08-10 Impact factor: 7.914
Authors: Robert W Hobson; Virginia J Howard; Gary S Roubin; Thomas G Brott; Robert D Ferguson; Jeffrey J Popma; Darlene L Graham; George Howard Journal: J Vasc Surg Date: 2004-12 Impact factor: 4.268
Authors: Ralph L Sacco; Robert Adams; Greg Albers; Mark J Alberts; Oscar Benavente; Karen Furie; Larry B Goldstein; Philip Gorelick; Jonathan Halperin; Robert Harbaugh; S Claiborne Johnston; Irene Katzan; Margaret Kelly-Hayes; Edgar J Kenton; Michael Marks; Lee H Schwamm; Thomas Tomsick Journal: Circulation Date: 2006-03-14 Impact factor: 29.690
Authors: H Mudra; M Ziegler; M C Haufe; M Hug; A Knape; A Meurer; H Pitzl; W Büchele; C Spes Journal: Dtsch Med Wochenschr Date: 2003-04-11 Impact factor: 0.628