Introduction: Carotid artery stenting (CAS) has emerged as an important alternative to carotid endarterectomy in patients with carotid disease. The perioperative complication rate at high volume centers may be lower than the rate reported in previous clinical trials. The goal of this study is to assess the morbidity associated with Carotid artery stenting (CAS) at a high-volume cerebrovascular center, and compare the complication rate with available data from clinical trials.
Methods: A retrospective database of patients undergoing carotid artery stenting between March 2003 and September 2011 was created. Each case was then reviewed for the presence of known risk factors and perioperative adverse events. The risk factors included history of diabetes, hypertension, hypercholesterolemia, hyperlipidemia, cardiovascular disease,cerebrovascular accident and smoking (defined as active or a history of smoking in the last five years). Perioperative adverse events were defined as stroke, myocardial infarction (MI) and death within 30-days of the procedure.
Results: A total of 241 patients were identified. Major peri-operative complications were noted in 3 cases
(1.2%), which included 2 strokes (0.8%) and 1 death (0.4%). All these complications occurred in symptomatic patients, with no complications in the asymptomatic subset. Embolic protection devices were employed in 48 of the 241 cases (20%). No complications were observed in patients undergoing CAS with an embolic protection device.
Conclusions: Carotid artery stenting can be performed with a low incidence of perioperative stroke (0.8%), MI (0%), and death (0.4%) at high volume centers. These rates compare favorably with those reported in clinical trials.
Patient Care: This will aid in clinical decision making regarding CAS and the use of embolic protection devices.
Learning Objectives: safety and efficacy of Carotid artery stenting (CAS)