Eight-year experience with carotid artery stenting for correction of symptomatic and asymptomatic post-endarterectomy defects

Enrico Maria Marone, Giovanni Coppi, Yamume Tshomba, Roberto Chiesa

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Carotid endarterectomy (CEA) has been shown to be superior to medical therapy alone in the prevention of stroke only if it can be safely performed (ie, with a complication rate less than 3% in asymptomatic patients and less than 6% in symptomatic patients). Technical defects are the most common cause of neurological complications after CEA, and their correction has traditionally been performed through standard surgical techniques. Methods From 1999, we started to treat intimal flaps, dissection, or partial thrombosis after CEA with carotid artery stenting (CAS). A retrospective analysis of the operating room registry and of the registry of our Interventional Cardiology laboratory was conducted in order to identify all the patients that underwent stenting of the internal carotid artery after CEA between January 2001 and June 2009. Results During the time period considered, 5012 CEA were performed at our institution and a total of 34 patients (34/5012; 0.6%) were found to have received carotid stenting after CEA, both for symptomatic and asymptomatic defects. Immediate technical success was obtained in all patients. One major cerebrovascular adverse event (1/34; 3%) in the immediate perioperative period was recorded. At a mean follow-up of 18.6 months (range, 3-84 months; median, 12 months), we did not observe any neurological symptoms related to the treated carotid artery, nor hemodynamic in-stent restenosis. Long-term follow-up (ie, equal or greater than 4 years) was available for five patients: all patients remained event-free during the entire period. Conclusions Our study adds to the assumption that CAS in post-CEA symptomatic and asymptomatic patients is safe and technically feasible, and represents a valid and quick alternative to standard surgical revision. Even if in a small group of patients, long-term results seem promising.

Original languageEnglish
Pages (from-to)1511-1517
Number of pages7
JournalJournal of Vascular Surgery
Volume52
Issue number6
DOIs
Publication statusPublished - Dec 2010

Fingerprint

Endarterectomy
Carotid Arteries
Carotid Endarterectomy
Registries
Tunica Intima
Perioperative Period
Internal Carotid Artery
Operating Rooms
Cardiology
Reoperation
Stents
Dissection
Thrombosis
Hemodynamics
Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Eight-year experience with carotid artery stenting for correction of symptomatic and asymptomatic post-endarterectomy defects. / Marone, Enrico Maria; Coppi, Giovanni; Tshomba, Yamume; Chiesa, Roberto.

In: Journal of Vascular Surgery, Vol. 52, No. 6, 12.2010, p. 1511-1517.

Research output: Contribution to journalArticle

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abstract = "Background Carotid endarterectomy (CEA) has been shown to be superior to medical therapy alone in the prevention of stroke only if it can be safely performed (ie, with a complication rate less than 3{\%} in asymptomatic patients and less than 6{\%} in symptomatic patients). Technical defects are the most common cause of neurological complications after CEA, and their correction has traditionally been performed through standard surgical techniques. Methods From 1999, we started to treat intimal flaps, dissection, or partial thrombosis after CEA with carotid artery stenting (CAS). A retrospective analysis of the operating room registry and of the registry of our Interventional Cardiology laboratory was conducted in order to identify all the patients that underwent stenting of the internal carotid artery after CEA between January 2001 and June 2009. Results During the time period considered, 5012 CEA were performed at our institution and a total of 34 patients (34/5012; 0.6{\%}) were found to have received carotid stenting after CEA, both for symptomatic and asymptomatic defects. Immediate technical success was obtained in all patients. One major cerebrovascular adverse event (1/34; 3{\%}) in the immediate perioperative period was recorded. At a mean follow-up of 18.6 months (range, 3-84 months; median, 12 months), we did not observe any neurological symptoms related to the treated carotid artery, nor hemodynamic in-stent restenosis. Long-term follow-up (ie, equal or greater than 4 years) was available for five patients: all patients remained event-free during the entire period. Conclusions Our study adds to the assumption that CAS in post-CEA symptomatic and asymptomatic patients is safe and technically feasible, and represents a valid and quick alternative to standard surgical revision. Even if in a small group of patients, long-term results seem promising.",
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