Ten years outcomes of carotid artery stenting (CAS): a monocentric experience in 582 patients

Objective: Even if carotid endarterectomy (CEA) still remains the gold standard treatment for carotid artery stenosis, carotid artery stenting (CAS) has emerged as a therapeutic alternative for high-risk patients, with good early and long-term results. Arranging a randomized clinical trial (RCT) which compares CAS to CEA is a hard matter, as different standards of care exist for CAS. Multicenter prospective registries and single-centres experience are thus essential to validate the technique, however they all have some limitations. We report early and long-term results of our experience in CAS. Methods: From January 1999 to June 2010, 1612 patients were admitted to our department for a significant carotid stenosis. Of them, 582 patients (36.1%) were proposed for CAS according to our ‘intention to treat’. Indications for CAS included 88 patients (15.1%) who had restenosis after endarterectomy and 12 patients who presented (2.1%) in-stent restenosis; in these patients, the previous endovascular procedure had been performed at a median of 20.4 months before (range: 15.8–23.4 months). In remaining patients CAS was considered for high surgical risk, because of patients’ comorbidities or difficult anatomy. Symptoms had occurred in 205 patients (35.2%). Most of CAS were performed in males (409 patients, 70.3%). Patients’ median age was 73.6 years (range 49.4–99.7 years), while 102 (17.5%) were aged more than 80. Carotid stenosis were right-sided in 277 (47.6%) cases. In 505 patients CAS was performed using EPD. Five hundred and forty-nine stents were used (428 closed-cells, 101 open-cells and 20 hybrid stents). Results: The procedure was successfully ended in 573 patients (98.4%): in six selective catheterization of vessels was not possible, and three required an immediate conversion to surgery for acute stent thrombosis. At 30-day results we observed three deaths (0.5%), one of them following a severe stroke, four ipsilateral invalidant strokes (0.7%), three minor strokes (0.5%), five TIA (0.9%) and one MI (0.2%). At a median follow-up of 90.3 months (range 1–136 months), 46.3+5.4% of patients were free from any adverse event, 55.6+5.8% were alive, 97+0.9% were free from any neurological event and 91+4.3% were free from restenosis. Conclusions: CAS has emerged as a therapeutic alternative to endarterectomy for high-risk patients, with good early and long-term results. As arranging a (RCTs) for CAS is difficult, multicenter prospective registries and single-centres experience are essential to validate the technique, however, they have some limitations. In our experience CAS is both a safe and effective procedure, with good long-term results.