CardioVascular and Interventional Radiology

, Volume 36, Issue 5, pp 1221–1231 | Cite as

United Kingdom Carotid Artery Stent Registry: Short- and Long-Term Outcomes

Clinical Investigation

Abstract

Background

Carotid artery stenting (CAS) has evolved to treat carotid artery disease with the intention of prevent stroke. The British Society of Interventional Radiologists developed a voluntary registry to monitor the practice of this novel procedure. We present the data from the United Kingdom (UK) CAS registry for short and long-term outcomes for symptomatic and asymptomatic carotid disease.

Methods

The UK CAS registry collected data from 1998 to 2010 from 31 hospitals across the UK for 1,154 patients. All interventions were enrolled in the registry for both asymptomatic and symptomatic patients. Initial entry forms were completed for each patient entered with data including indications, demographic data, CAS data (including stents and protection device details) and 30-day outcomes. Complications were documented. Follow-up data were collected at yearly intervals.

Results

Nine hundred fifty-three (83 %) symptomatic and 201 (17 %) asymptomatic patients were enrolled into the registry. The 30-day all stroke and death rates for symptomatic patients were 5.5 and 2.2 % for those with asymptomatic disease. The 30-day mortality rate was 1.7 % for symptomatic and 0.6 % for asymptomatic patients. For symptomatic patients undergoing CAS, the 7-year all-cause mortality rate was 22.2 % and for asymptomatic patients 18.1 %. The 7-year all-cause mortality and disabling stroke rates were 25.3 and 19.4 %, respectively.

Conclusion

These data indicate that outside of the tight constraints of a randomised trial, CAS provides effective prophylaxis against stroke and death.

Keywords

Carotid artery Arterial intervention Stenting 

Notes

Acknowledgments

A great many thanks to all of the clinicians who contributed data to this registry over many years and continued to provide essential follow-up data. Thanks are also due to A. Counsell, J. Saeed, M. Ireland, and S. Inglis for their help with data collection and data entry. The invaluable help of Dendrite Clinical Systems, including Robin Kinsman and Peter Walton, in setting up the registry and analyzing the data, is acknowledged and thanked.

Conflict of interest

S. Goode, T. Cleveland, and P. A. Gaines were funded by Study Grant Gore. T. Cleveland also holds a consultancy at Boston Scientific.

References

  1. 1.
    Bockenheimer SA, Mathias K (1983) Percutaneous transluminal angioplasty in arteriosclerotic internal carotid artery stenosis. AJNR Am J Neuroradiol 4(3):791–792PubMedGoogle Scholar
  2. 2.
    Courtheoux P, Theron J, Tournade A et al (1987) Percutaneous endoluminal angioplasty of post endarterectomy carotid stenoses. Neuroradiology 29(2):186–189PubMedCrossRefGoogle Scholar
  3. 3.
    NICE (2006) Carotid artery stent placement for carotid stenosisGoogle Scholar
  4. 4.
    Goode SD, Cleveland TJ, Gaines PA (2011) First BSIR carotid stent registry reportGoogle Scholar
  5. 5.
    Johnston SC, Rothwell PM, Nguyen-Huynh MN et al (2007) Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 369(9558):283–292PubMedCrossRefGoogle Scholar
  6. 6.
    NICE (2011) IPG389 carotid artery stent placement for symptomatic extracranial carotid stenosisGoogle Scholar
  7. 7.
    Naylor AR, Mehta Z, Rothwell PM et al (2002) Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature. Eur J Vasc Endovasc Surg 23(4):283–294PubMedCrossRefGoogle Scholar
  8. 8.
    Brott TG, Hobson RW 2nd, Howard G et al (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363(1):11–23PubMedCrossRefGoogle Scholar
  9. 9.
    Ederle J, Dobson J, Featherstone RL et al (2010) Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 375(9719):985–997PubMedCrossRefGoogle Scholar
  10. 10.
    Moore WS, Barnett HJ, Beebe HG et al (1995) Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association. Circulation 91(2):566–579PubMedCrossRefGoogle Scholar
  11. 11.
    Brown MM, Rogers J, Bland JM (2001) Endovascular versus surgical treatment in patients with carotid stenosis in the carotid and vertebral artery transluminal angioplasty study (CAVATAS): a randomised trial. Lancet 357(9270):1729–1737CrossRefGoogle Scholar
  12. 12.
    Anderson HV, Rosenfield KA, White CJ et al (2010) Clinical features and outcomes of carotid artery stenting by clinical expert consensus criteria: a report from the CARE registry. Catheter Cardiovasc Interv 75(4):519–525PubMedGoogle Scholar
  13. 13.
    Eckstein HH, Ringleb P, Allenberg JR et al (2008) Results of the stent-protected angioplasty versus carotid endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol 7(10):893–902PubMedCrossRefGoogle Scholar
  14. 14.
    Keldahl ML, Park MS, Garcia-Toca M et al (2012) Does a contralateral carotid occlusion adversely impact carotid artery stenting outcomes? Ann Vasc Surg 26(1):40–45PubMedGoogle Scholar
  15. 15.
    Bonati LH, Dobson J, Algra A et al (2010) Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patient data. Lancet 376(9746):1062–1073PubMedCrossRefGoogle Scholar
  16. 16.
    Mas JL, Chatellier G, Beyssen B et al (2006) Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med 355(16):1660–1671PubMedCrossRefGoogle Scholar
  17. 17.
    Reimers B, Schluter M, Castriota F et al (2004) Routine use of cerebral protection during carotid artery stenting: results of a multicenter registry of 753 patients. Am J Med 116(4):217–222PubMedCrossRefGoogle Scholar
  18. 18.
    Yadav JS, Wholey MH, Kuntz RE et al (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351(15):1493–1501PubMedCrossRefGoogle Scholar
  19. 19.
    Barbato JE, Dillavou E, Horowitz MB et al (2008) A randomized trial of carotid artery stenting with and without cerebral protection. J Vasc Surg 47(4):760–765PubMedCrossRefGoogle Scholar
  20. 20.
    Macdonald S, Evans DH, Griffiths PD et al (2010) Filter-protected versus unprotected carotid artery stenting: a randomised trial. Cerebrovasc Dis 29(3):282–289PubMedCrossRefGoogle Scholar
  21. 21.
    Rapp JH, Zhu L, Hollenbeck K et al (2009) Distal filtration versus flow reversal: an ex vivo assessment of the choices for carotid embolic protection. J Vasc Surg 49(5):1181–1188PubMedCrossRefGoogle Scholar
  22. 22.
    Massop D, Dave R, Metzger C et al (2009) Stenting and angioplasty with protection in patients at high-risk for endarterectomy: SAPPHIRE worldwide registry first 2,001 patients. Catheter Cardiovasc Interv 73(2):129–136PubMedCrossRefGoogle Scholar
  23. 23.
    Gurm HS, Yadav JS, Fayad P et al (2008) Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med 358(15):1572–1579PubMedCrossRefGoogle Scholar
  24. 24.
    Ederle J, Bonati LH, Dobson J et al (2009) Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the carotid and vertebral artery transluminal angioplasty study (CAVATAS): long-term follow-up of a randomised trial. Lancet Neurol 8(10):898–907PubMedCrossRefGoogle Scholar
  25. 25.
    Mas JL, Trinquart L, Leys D et al (2008) Endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol 7(10):885–892PubMedCrossRefGoogle Scholar
  26. 26.
    de Donato G, Setacci C, Deloose K et al (2008) Long-term results of carotid artery stenting. J Vasc Surg 48(6):1431–1440PubMedCrossRefGoogle Scholar
  27. 27.
    Hopkins LN, Myla SV, Grube E et al (2010) Carotid artery revascularisation in high-surgical-risk patients with the NexStent and the FilterWire EX/EZ: 3-year results from the CABERNET trial. Eurointervention 5(8):917–924PubMedCrossRefGoogle Scholar
  28. 28.
    Fairman R, Gray WA, Scicli AP et al (2007) The CAPTURE registry: analysis of strokes resulting from carotid artery stenting in the post approval setting: timing, location, severity, and type. Ann Surg 246(4):551–556 discussion 6–8PubMedCrossRefGoogle Scholar
  29. 29.
    Giacovelli JK, Egorova N, Dayal R et al (2010) Outcomes of carotid stenting compared with endarterectomy are equivalent in asymptomatic patients and inferior in symptomatic patients. J Vasc Surg 52(4):906–913PubMedCrossRefGoogle Scholar
  30. 30.
    Giles KA, Hamdan AD, Pomposelli FB et al (2010) Stroke and death after carotid endarterectomy and carotid artery stenting with and without high risk criteria. J Vasc Surg 52(6):1497–1504PubMedCrossRefGoogle Scholar
  31. 31.
    Gray WA, Chaturvedi S, Verta P (2009) Thirty-day outcomes for carotid artery stenting in 6,320 patients from 2 prospective, multicenter, high-surgical-risk registries. Circ Cardiovasc Interv 2(3):159–166PubMedCrossRefGoogle Scholar
  32. 32.
    Gray WA, Hopkins LN, Yadav S et al (2006) Protected carotid stenting in high-surgical-risk patients: the ARCHeR results. J Vasc Surg 44(2):258–268PubMedCrossRefGoogle Scholar
  33. 33.
    Gray WA, Yadav JS, Verta P et al (2007) The CAPTURE registry: predictors of outcomes in carotid artery stenting with embolic protection for high surgical risk patients in the early post-approval setting. Catheter Cardiovasc Interv 70(7):1025–1033PubMedCrossRefGoogle Scholar
  34. 34.
    Gray WA, Yadav JS, Verta P et al (2007) The CAPTURE registry: results of carotid stenting with embolic protection in the post approval setting. Catheter Cardiovasc Interv 69(3):341–348PubMedCrossRefGoogle Scholar
  35. 35.
    Hopkins LN, Myla S, Grube E et al (2008) Carotid artery revascularization in high surgical risk patients with the NexStent and the Filterwire EX/EZ: 1-year results in the CABERNET trial. Catheter Cardiovasc Interv 71(7):950–960PubMedCrossRefGoogle Scholar
  36. 36.
    Katzen BT, Criado FJ, Ramee SR et al (2007) Carotid artery stenting with emboli protection surveillance study: thirty-day results of the CASES-PMS study. Catheter Cardiovasc Interv 70(2):316–323PubMedCrossRefGoogle Scholar
  37. 37.
    Mehta RH, Zahn R, Hochadel M et al (2007) Comparison of in-hospital outcomes of patients with versus without previous carotid endarterectomy undergoing carotid stenting (from the German ALKK CAS registry). Am J Cardiol 99(9):1288–1293PubMedCrossRefGoogle Scholar
  38. 38.
    Pieniazek P, Musialek P, Kablak-Ziembicka A et al (2008) Carotid artery stenting with patient- and lesion-tailored selection of the neuroprotection system and stent type: early and 5-year results from a prospective academic registry of 535 consecutive procedures (TARGET-CAS). J Endovascular Ther 15(3):249–262CrossRefGoogle Scholar
  39. 39.
    Safian RD, Bacharach JM, Ansel GM et al (2004) Carotid stenting with a new system for distal embolic protection and stenting in high-risk patients: the carotid revascularization with ev3 arterial technology evolution (CREATE) feasibility trial. Catheter Cardiovasc Interv 63(1):1–6PubMedCrossRefGoogle Scholar
  40. 40.
    Theiss W, Hermanek P, Mathias K et al (2004) Pro-CAS: a prospective registry of carotid angioplasty and stenting. Stroke 35(9):2134–2139PubMedCrossRefGoogle Scholar
  41. 41.
    Theiss W, Hermanek P, Mathias K et al (2008) Predictors of death and stroke after carotid angioplasty and stenting: a subgroup analysis of the Pro-CAS data. Stroke 39(8):2325–2330PubMedCrossRefGoogle Scholar
  42. 42.
    White CJ, Iyer SS, Hopkins LN et al (2006) Carotid stenting with distal protection in high surgical risk patients: the BEACH trial 30 day results. Catheter Cardiovasc Interv 67(4):503–512PubMedCrossRefGoogle Scholar
  43. 43.
    Wholey MH, Al-Mubarek N (2003) Updated review of the global carotid artery stent registry. Catheter Cardiovasc Interv 60(2):259–266PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2013

Authors and Affiliations

  1. 1.Sheffield Vascular InstituteNorthern General HospitalSheffieldUK

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