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.
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References
FJ Veith M Amor T Ohki et al. (2001) ArticleTitleCurrent status of carotid bifurcation angioplasty and stenting based on a consensus of opinion leaders. J Vasc Surg 33 S111–116 Occurrence Handle10.1067/mva.2001.111665 Occurrence Handle1:STN:280:DC%2BD3M7lslyntw%3D%3D Occurrence Handle11174821
JJ Vitek GS Roubin G New et al. (2001) ArticleTitleCarotid angioplasty with stenting in post-carotid endarterectomy restenosis. J Invasive Cardiol 13 123–125 Occurrence Handle1:STN:280:DC%2BD3M3gsV2ruw%3D%3D Occurrence Handle11176022
G New GS Roubin SS Iyer et al. (2000) ArticleTitleSafety, efficacy and durability of carotid artery stenting for restenosis following carotid artery endarterectomy: A multicenter study. J Endovasc Ther 7 354–352
G Lanzino RA Mericle DK Lopes et al. (1998) ArticleTitlePercutaneous transluminal angioplasty and stent placement for recurrent carotid artery stenosis. J Neurosurg 90 688–694
P Alric P Branchereau JP Berthet et al. (2002) ArticleTitleCarotid artery stenting for stenosis following revascularization or cervical irradiation. J Endovasc Ther 9 14–19 Occurrence Handle11958319
E Houdart C Mounayer R Chapot et al. (2001) ArticleTitleCarotid stenting for radiation-induced stenoses: A report of 7 cases. Stroke 32 118–121 Occurrence Handle1:STN:280:DC%2BD3M%2FpsV2msQ%3D%3D Occurrence Handle11136925
N Al-Mubarak GS Roubin SS Iyer et al. (2000) ArticleTitleCarotid stenting for severe radiation-induced extracranial carotid artery occlusive disease. J Endovasc Ther 7 36–40 Occurrence Handle1:STN:280:DC%2BD3c3jtlGguw%3D%3D Occurrence Handle10772747
J Waigand CM Gross J Krämer et al. (1998) ArticleTitleElective stenting of carotid artery stenosis in patients with severe coronary artery disease. Eur Heart J 19 1365–1370 Occurrence Handle10.1053/euhj.1998.1048 Occurrence Handle1:STN:280:DyaK1M%2Fgs1Onug%3D%3D Occurrence Handle9792262
D Paniagua M Howell N Strickman et al. (2001) ArticleTitleOutcomes following extracranial carotid artery stenting in high-risk patients. J Invasive Cardiol 13 375–381 Occurrence Handle1:STN:280:DC%2BD3MzktFOqsA%3D%3D Occurrence Handle11385152
GP Teitelbaum MA Lefkowitz SL Giannotta (1998) ArticleTitleCarotid angioplasty and stenting in high-risk patients. Surg Neurol 50 300–312 Occurrence Handle10.1016/S0090-3019(98)00038-X Occurrence Handle1:STN:280:DyaK1M%2Fjt1eruw%3D%3D Occurrence Handle9817451
A Mathur GS Roubin CR Gomez et al. (1998) ArticleTitleElective carotid artery stenting in the presence of a contralateral occlusion. Am J Cardiol 81 1315–1317 Occurrence Handle10.1016/S0002-9149(98)00161-1 Occurrence Handle1:STN:280:DyaK1c3ptlOgsg%3D%3D Occurrence Handle9631969
RA Mericle SH Kim G Lanzino et al. (1999) ArticleTitleCarotid artery angioplasty and use of stents in high-risk patients with contralateral occlusions. J Neurosurg 90 1031–1036 Occurrence Handle1:STN:280:DyaK1M3nslOmsw%3D%3D Occurrence Handle10350248
InstitutionalAuthorNameNorth American Symptomatic Carotid Endartectomy Trial Collaborators (1991) ArticleTitleBeneficial effect of carotid endartectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325 445–453 Occurrence Handle1852179
Stat Soft, Inc. (2002) Electronic Statistics Textbook. Tulsa. Web: http://www.Statsoft.com/textbook/stathome.html
P Bergeron JP Becquemin JM Jausseran et al. (1999) ArticleTitlePercutaneous stenting of the internal carotid artery: The European CAST I Study—Carotid Artery Stent Trial. J Endovasc Surg 6 155–159 Occurrence Handle1:STN:280:DyaK1MvgtVeisA%3D%3D Occurrence Handle10473333
EB Dietrich M Ndiaye DB Reid (1996) ArticleTitleStenting in the carotid artery: Initial experience in 110 patients. J Endovasc Surg 3 42–62 Occurrence Handle1:STN:280:BymA1M7hsFc%3D Occurrence Handle8798126
A Mathur G Dorros SS Iyer et al. (1997) ArticleTitlePalmaz stent compression in patients following carotid artery stenting. Cathet Cardiovasc Diagn 41 137–140 Occurrence Handle1:STN:280:ByiA38jmtFM%3D Occurrence Handle9184284
TA Calvey MJ Gough (1998) ArticleTitleA late complication of internal carotid artery stenting. J Vasc Surg 27 753–755 Occurrence Handle1:STN:280:DyaK1c3jsFKhtg%3D%3D Occurrence Handle9576092
MH Wholey MH Wholey WA Tan et al. (2001) ArticleTitleManagement of neurological complications of carotid artery stenting. J Endovasc Ther 8 341–353 Occurrence Handle1:STN:280:DC%2BD3Mrgt1Krtw%3D%3D Occurrence Handle11552726
WH Brooks RR McClure MR Jones et al. (2001) ArticleTitleCarotid angioplasty and stenting versus carotid endarterectomy: Randomized trial in a community hospital. JACC 38 1589–1595 Occurrence Handle10.1016/S0735-1097(01)01595-9 Occurrence Handle1:STN:280:DC%2BD3Mnlt1CqsQ%3D%3D Occurrence Handle11704367
A D’Audiffret P Desgranges H Kobeiter et al. (2001) ArticleTitleTechnical aspects and current results of carotid stenting. J Vasc Surg 33 1001–1007 Occurrence Handle10.1067/mva.2001.113483 Occurrence Handle1:STN:280:DC%2BD3Mzis1SmsQ%3D%3D Occurrence Handle11331841
R Drescher KD Mathias JH Jaeger et al. (2002) ArticleTitleClinical results of carotid artery stenting with a nitinol self-expanding stent (SMART stent). Eur Radiol 12 2451–2456 Occurrence Handle12271384
D Mukherjee V Kalahasti M Roffi et al. (2001) ArticleTitleSelf-expanding stents for carotid interventions: Comparison of nitinol versus stainless-steel stents. J Invasive Cardiol 13 732–735 Occurrence Handle1:STN:280:DC%2BD3MnjvFyrsA%3D%3D Occurrence Handle11689714
JS Yadav GS Roubin SS Iyer et al. (1997) ArticleTitleElective stenting of the extracranial carotid arteries. Circulation 95 376–381 Occurrence Handle1:STN:280:ByiC287hvFE%3D Occurrence Handle9008452
JC Parodi CJ Schönholz M Ferreira et al. (2002) ArticleTitleParodi antiembolism system in carotid stenting: The first 100 patients (abstract). J Vasc Intervent Radiol 13 S27
EY Chaktoura RW Hobson II J Goldstein et al. (2001) ArticleTitleIn-stent restenosis after carotid angioplasty-stenting: Incidence and management. J Vasc Surg 33 220–226 Occurrence Handle10.1067/mva.2001.111880 Occurrence Handle11174771
InstitutionalAuthorNameACAS-Investigators (1995) ArticleTitleEndarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerotic Study (1995) JAMA 273 1421–1428 Occurrence Handle7723155
Chambers BR, You RX, Donnan GA (2000) Carotid endarterectomy for asymptomatic carotid stenosis. Carotid Database Syst Rev (2) CD 001923
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Maleux, G., Bernaerts, P., Thijs, V. et al. Extracranial Carotid Artery Stenting in Surgically High-Risk Patients Using the Carotid Wallstent Endoprosthesis: Midterm Clinical and Ultrasound Follow-Up Results . CVIR 26, 340–346 (2003). https://doi.org/10.1007/s00270-003-0039-4
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DOI: https://doi.org/10.1007/s00270-003-0039-4