NEW ORLEANS—German researchers have reported encouraging long-term results with the use of carotid stenting for prevention of stroke in patients with carotid stenosis. Most complications were evident within 30 days of the procedure, and after follow-up as long as 10 years, the investigators observed a low incidence of neurologic events, cerebrovascular mortality, and restenosis.

“This is very important, because it is frequently assumed that the long-term results of carotid stenting are inferior to surgery,” said senior author Horst Sievert, MD, of the CardioVascular Center Frankfurt, Sankt Katharinen, Germany. “In fact, our results suggest that they are superior, although this, of course, has to be proven by randomized trials. The long-term results of carotid stenting are better than the long-term results we achieve with catheter interventions in any other vascular territory.”

ALTERNATIVE TO ENDARTERECTOMY

Stent implantation has become an alternative to endarterectomy in patients with stenoses of the internal carotid artery and is increasingly the preferred method of intervention in surgically high-risk patients, said lead author Jennifer Sugita, a medical student at Katharinen Hospital who presented the findings at the American Heart Association’s Scientific Sessions 2004. However, she noted, only limited information is available at this point on long-term outcomes in patients receiving this treatment.

Dr. Sievert and colleagues began doing carotid angioplasty in 1990 and carotid stenting in 1993 at the CardioVascular Center. They reported outcomes on 470 patients with high-grade lesions of the internal carotid artery who were treated with stent implantation. A total of 512 stents were implanted in 517 lesions; in 437 of the lesions, the procedure was performed using an embolic protection device.

Patients ranged in age from 40 to 90. A total of 202 lesions were symptomatic, and 28% of patients were ineligible for carotid endarterectomy. Contralateral stenosis greater than 50% was present in 204 patients (39%), and 46 patients (9%) had a contralateral occlusion. Mean percentage of lesions was 76 ± 11%, and the mean lesion length was 7.9 ± 5.3 mm. Concomitant medical conditions were common—59% of patients had coronary artery disease, 72% had hypertension, 31% had diabetes, 54% had hyperlipidemia, and 44% were previous or current smokers.

CAROTID STENTING YIELDS POSITIVE RESULTS

Carotid stenting was technically successful in 514 of the 517 lesions. Follow-up neurologic examination was conducted at one month and thereafter whenever an event occurred. Carotid duplex scanning was performed at one and six months, and a questionnaire was sent to patients each year afterward.

Within 30 days of the procedure, 24 patients had complications, including cerebrovascular death in three patients, nonfatal major stroke in 10, minor stroke in seven, asymptomatic occlusion in one, and noncerebrovascular death in four patients. During long-term follow-up—now totaling about 1,030 patient-years—there have been four cerebrovascular deaths, seven major strokes, two minor ipsilateral strokes, and 21 asymptomatic restenoses. Fifty-one patients have died of noncerebral causes.

“Carotid stenting is a successful technique for preventing stroke in patients with carotid stenosis,” Ms. Sugita and colleagues concluded. “Complications occur mostly within 30 days, and neurological events, cerebrovascular mortality, and restenosis throughout long-term follow-up are rare.”

NR

—Anne Howe

Suggested Reading
Rabe K, Sievert H. Carotid artery stenting: state of the art. J Interv Cardiol. 2004;17:417-426.

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