BACKGROUND: Although the management of carotid disease is well established for symptomatic lesions ⩾70%, carotid revascularization for symptomatic low-grade (⩽50%) stenosis is not actually supported by data from randomized clinical trials. Such patients may occasionally have recurrent neurological symptoms despite optimal medical treatment owing to vulnerable plaques. In such cases, carotid artery stenting (CAS) may represent an option for treatment but this has not been tested in clinical trials. This study analyzed early and long-term outcomes of CAS performed in patients with low-grade symptomatic recurrent carotid stenosis. METHODS: From a prospective registry of 322 carotid revascularization in symptomatic patients, 21 consecutive patients with low-grade symptomatic recurrent carotid stenosis who underwent CAS with proximal cerebral protection device Mo.Ma, after ruling out any other source of cerebral embolization, were involved in the study.All patients had suggestive evidence of unstable plaque or plaque ulceration. RESULTS: Procedural technical success rate was 100%. No 30-day stroke or death occurred, and no patients had recurrent neurological events related to the revascularized hemisphere during follow up. No 30-day local complications were reported. No late carotid occlusions were detected. There was one late death, and no stroke-related deaths. Survival rates were 100% at 1 year and 96% at 3 years. CONCLUSIONS: This study shows that CAS is a well-tolerated, effective and durable treatment for patients with recurrent symptomatic low-grade carotid stenosis associated with a vulnerable plaque. Patients had excellent protection against further ischemic events and survived long enough.
BACKGROUND: Although the management of carotid disease is well established for symptomatic lesions ⩾70%, carotid revascularization for symptomatic low-grade (⩽50%) stenosis is not actually supported by data from randomized clinical trials. Such patients may occasionally have recurrent neurological symptoms despite optimal medical treatment owing to vulnerable plaques. In such cases, carotid artery stenting (CAS) may represent an option for treatment but this has not been tested in clinical trials. This study analyzed early and long-term outcomes of CAS performed in patients with low-grade symptomatic recurrent carotid stenosis. METHODS: From a prospective registry of 322 carotid revascularization in symptomatic patients, 21 consecutive patients with low-grade symptomatic recurrent carotid stenosis who underwent CAS with proximal cerebral protection device Mo.Ma, after ruling out any other source of cerebral embolization, were involved in the study.All patients had suggestive evidence of unstable plaque or plaque ulceration. RESULTS: Procedural technical success rate was 100%. No 30-day stroke or death occurred, and no patients had recurrent neurological events related to the revascularized hemisphere during follow up. No 30-day local complications were reported. No late carotid occlusions were detected. There was one late death, and no stroke-related deaths. Survival rates were 100% at 1 year and 96% at 3 years. CONCLUSIONS: This study shows that CAS is a well-tolerated, effective and durable treatment for patients with recurrent symptomatic low-grade carotid stenosis associated with a vulnerable plaque. Patients had excellent protection against further ischemic events and survived long enough.
Authors: J Biller; W M Feinberg; J E Castaldo; A D Whittemore; R E Harbaugh; R J Dempsey; L R Caplan; T F Kresowik; D B Matchar; J F Toole; J D Easton; H P Adams; L M Brass; R W Hobson; T G Brott; L Sternau Journal: Circulation Date: 1998-02-10 Impact factor: 29.690
Authors: Alexandra A J de Rotte; Martine T B Truijman; Anouk C van Dijk; Madieke I Liem; Floris H B M Schreuder; Anja G van der Kolk; Jelle R de Kruijk; Matt J A P Daemen; Anton F W van der Steen; Gert Jan de Borst; Peter R Luijten; Paul J Nederkoorn; Marianne Eline Kooi; Aad van der Lugt; Jeroen Hendrikse Journal: Stroke Date: 2015-01-06 Impact factor: 7.914
Authors: A R Naylor; J-B Ricco; G J de Borst; S Debus; J de Haro; A Halliday; G Hamilton; J Kakisis; S Kakkos; S Lepidi; H S Markus; D J McCabe; J Roy; H Sillesen; J C van den Berg; F Vermassen; P Kolh; N Chakfe; R J Hinchliffe; I Koncar; J S Lindholt; M Vega de Ceniga; F Verzini; J Archie; S Bellmunt; A Chaudhuri; M Koelemay; A-K Lindahl; F Padberg; M Venermo Journal: Eur J Vasc Endovasc Surg Date: 2017-08-26 Impact factor: 7.069
Authors: M K Salem; R D Sayers; M J Bown; K West; D Moore; T G Robinson; A R Naylor Journal: Eur J Vasc Endovasc Surg Date: 2012-12-25 Impact factor: 7.069
Authors: Bernhard Reimers; Horst Sievert; Gerhard C Schuler; Thilo Tübler; Klaus Diederich; Andrej Schmidt; Paolo Rubino; Harald Mudra; Dariusz Dudek; Gioacchino Coppi; Joachim Schofer; Alberto Cremonesi; Mathias Haufe; Maurizio Resta; Volker Klauss; Alberto Benassi; Carlo Di Mario; Luca Favero; Dierk Scheinert; Luigi Salemme; Giancarlo Biamino Journal: J Endovasc Ther Date: 2005-04 Impact factor: 3.487
Authors: H J M Barnett; D W Taylor; R B Haynes; D L Sackett; S J Peerless; G G Ferguson; A J Fox; R N Rankin; V C Hachinski; D O Wiebers; M Eliasziw Journal: N Engl J Med Date: 1991-08-15 Impact factor: 91.245
Authors: Alan R Moody; Rachael E Murphy; Paul S Morgan; Anne L Martel; G S Delay; Steve Allder; Shane T MacSweeney; William G Tennant; John Gladman; John Lowe; Beverley J Hunt Journal: Circulation Date: 2003-06-09 Impact factor: 29.690