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  • Carotid Artery Angioplasty and Stenting for Patients Less than 70 Years of Age

    Final Number:

    Ryan David Alkins BS, MD; Charles Matouk MD; Juan P. Cruz; Tom R. Marotta MD; Walter Montanera MD; Julian Spears MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Recent studies have suggested that carotid angioplasty and stenting (CAS) is equivalent to, or safer than, carotid endarterectomy (CEA) in average risk patients <70 years of age. We examined a consecutive series of patients who underwent CAS in order to determine the influence of patient age on outcome.

    Methods: A retrospective chart review of consecutive patients who underwent CAS at St. Michael's Hospital, Canada between January 2001 and November 2010 was performed. The primary outcome measures were 30-day stroke and 30-day composite death, stroke and myocardial infarction (MI). Patients were stratified based on age <70 and =70 years.

    Results: One hundred and fifty-seven consecutive patients underwent 165 CAS procedures. The 30-day risk of stroke was 3.8% while the composite outcome of death/stroke/MI was 8.2%. Death/stroke/MI affected 6.8% of patients. When stratified by age <70 and =70 years, the 30-day stroke rate was 0 versus 7.4% (p=0.03), and the composite outcome of death/stroke/MI was 2.6 versus 13.6%, respectively (p=0.02).

    Conclusions: Patients <70 years of age undergoing CAS have a low rate of major complications, comparing favourably to published CEA adverse event rates, and supporting the recent carotid stenosis literature that in the younger population CAS has a similar or lower complication rate than CEA.

    Patient Care: Our research is supportive of the recent literature suggesting that carotid stenting has a very low adverse event rate in patients under the age of 70 years, and that it may be the preferred form of carotid revascularization in that age group.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the relative risks of stenting in patients less than 70 versus those greater than 70 years of age, 2) Be aware of the recent literature supporting carotid angioplasty and stenting in patients less than 70 as an equal or possibly superior alternative to carotid endarterectomy.

    References: 1. The CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363:11–23. 2. Carotid Stenting Trialists' Collaboration. Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patient data. Lancet. 2010;376:1062-1073. 3. Fox AJ. How to measure carotid stenosis. Radiology. 1993;186:316-318. 4. Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493-1501. 5. Hobson RW 2nd, Howard VJ, Roubin GS, Brott TG, Ferguson RD, Popma JJ, Graham DL, Howard G; CREST Investigators. Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase. J Vasc Surg. 2004;40:1106-1111.

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