Neurological Sciences

, Volume 34, Issue 5, pp 723–728

Periprocedural outcome for patients with carotid stenosis treated with endovascular therapy: a single center evaluation

  • Nicola Giannini
  • Alberto Chiti
  • Gino Gialdini
  • Eva Terni
  • Marta Gennaro
  • Guido Andrea Lazzarotti
  • Michele Puglioli
  • Giovanni Orlandi
Original Article

DOI: 10.1007/s10072-012-1121-y

Cite this article as:
Giannini, N., Chiti, A., Gialdini, G. et al. Neurol Sci (2013) 34: 723. doi:10.1007/s10072-012-1121-y

Abstract

Endovascular procedures are a less invasive revascularization strategies than endoarterectomy for carotid stenosis, but to date Guidelines recommend surgery for a major periprocedural safety. Evidences come from randomized studies where operator’s experience in endovascular group was not considered. We retrospectively evaluated 524 endovascular procedures (carotid angioplasty ± stenting, CAS) performed between 1996 and 2010 on 486 patients (mean age 71.3 ± 7.8 years) with symptomatic or asymptomatic carotid stenosis from a single center. We evaluated efficacy (residual stenosis ≤30 % after postprocedural angiography) and safety [minor (TIAs or myocardial infarcts) and major (stroke or death) complications in the first 30 days] of procedures and correlated them with the increasing experience of the operator. CAS was successful in 504/524 cases (96.2 %); unsuccessful procedures occurred more frequently in case of angioplasty alone rather than angioplasty and stenting (13/61, 21.3 % vs. 7/463, 1.5 %, OR 17.64, 95 % CI 6.69–46.06). 17/524 (3.2 %) CAS met the combined safety endpoint: stroke in 2.4 % and death in 0.8 %; the rate of disabling stroke/death was 1.6 %. Center experience was inversely related to the rate of stroke/death (R2 = 0.9375), passing from 5.0 % after 100 CAS to 2.8 % after 500 CAS; for disabling stroke/death (R2 = 0.9386), the rate was 4 % after 100 CAS and 1.6 % after 500 CAS. CAS is an effective and safe revascularization procedure in both symptomatic and asymptomatic patients, if effected in experienced centers. The use of carotid artery stenting than angioplasty alone and emboli protection devices can much more improve the previous considerations.

Keywords

Angioplasty and stentingAsymptomatic carotid stenosisCarotid stenosisNeuroradiologyStentingStents

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Nicola Giannini
    • 1
  • Alberto Chiti
    • 1
  • Gino Gialdini
    • 1
  • Eva Terni
    • 1
  • Marta Gennaro
    • 1
  • Guido Andrea Lazzarotti
    • 2
  • Michele Puglioli
    • 2
  • Giovanni Orlandi
    • 1
  1. 1.Department of Neuroscience, Clinic of NeurologyUniversity of PisaPisaItaly
  2. 2.Clinic of NeuroradiologyUniversity of PisaPisaItaly