Published in:
01-08-2003 | Clinical Investigations
Extracranial Carotid Artery Stenting in Surgically High-Risk
Patients Using the Carotid Wallstent Endoprosthesis:
Midterm Clinical and Ultrasound Follow-Up Results
Authors:
Geert Maleux, Pauwel Bernaerts, Vincent Thijs, Kim Daenens, Johan Vaninbroukx, Inge Fourneau, André Nevelsteen
Published in:
CardioVascular and Interventional Radiology
|
Issue 4/2003
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Abstract
The purpose of this study was to evaluate the
feasibility, safety and midterm outcome of elective implantation of the
Carotid Wallstent® in patients considered to be at high surgical
risk. In a prospective study, 54 carotid artery stenoses in 51 patients
were stented over a 24-month period. Three patients underwent bilateral
carotid artery stenting. Institutional inclusion criteria for invasive
treatment of carotid occlusive disease (carotid endarterectomy or
carotid artery stenting) are patients presenting with a 70% or more
symptomatic stenosis and those with an 80% or more asymptomatic
stenosis having a life-expectancy of more than 1 year. All patients treated by carotid artery stenting were considered at high risk for carotid
endarterectomy because of a hostile neck (17 patients—31.5%) or
because of severe comorbidities (37 patients—68.5%). No cerebral
protection device was used. Of the 54 lesions, 33 (61.1%) were
symptomatic and 21 (38.8%) were asymptomatic. Follow-up was performed by
physical examination and by duplex ultrasonography at 1 month, 6
months, 1 year and 2 years after the procedure. All 54 lesions could be
stented successfully without periprocedural stroke. Advert events
during follow-up (mean 13.9 ± 5.7 months) were non-stroke-related
death in 6 patients (11.1%), minor stroke in 4 stented hemispheres
(7.4%), transient ipsilateral facial pain in 1 patient (1.8%),
infection of the stented surgical patch in 1 patient (1.8%) and
asymptomatic instent restenosis in 4 patients (7.4%). The percutaneous
implantation of the Carotid Wallstent®, even without cerebral
protection device, appears to be a safe procedure with acceptable
clinical and ultrasonographic follow-up results in patients at high
surgical risk. But some late adverse events such as ipsilateral
recurrence of non-disabling (minor) stroke or instent restenosis still
remain real challenging problems.