(Circulation. 2001;103:532.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Immediate and Late Clinical Outcomes of Carotid Artery Stenting in Patients With Symptomatic and Asymptomatic Carotid Artery Stenosis
A 5-Year Prospective Analysis
Presented in part at the 72nd Scientific Sessions of the American Heart Association, Atlanta, Ga, November 7–10, 1999, and published in abstract form (Circulation. 1999;100[suppl I]:I-674).
From Lenox Hill Heart and Vascular Institute, New York, NY (G.S.R., G.N., S.S.I., J.J.V., N. Al-M.); Division of Cardiovascular Disease, Department of Medicine and Department of Neurology, University of Alabama at Birmingham, Birmingham (M.W.L., C.G.); Cleveland Clinic, Cleveland, Ohio (J.Y.); and Brigham and Women’s Hospital, Boston, Mass (R.E.K.).
Correspondence to Gary S. Roubin, MD, PhD, Director, Endovascular Therapy, Lenox Hill Heart and Vascular Institute, 130 E 77th St, New York, NY 10021. E-mail 110775.2410{at}compuserve.com
Background—Carotid stenting is a less invasive percutaneous procedure than carotid endarterectomy for the treatment of carotid stenosis. Reports suggest that it can be performed with periprocedural complication rates similar to those of carotid endarterectomy. The purpose of this study was to determine short- and long-term outcomes in the largest prospective cohort of carotid stenting patients.
Methods and
Results—This study followed 528 consecutive
patients (604 hemispheres/arteries) undergoing carotid stenting. There
was a 0.6% (n=3) fatal stroke rate and 1% (n=5) nonstroke death rate
at 30 days. The major stroke rate was 1% (n=6), and the minor stroke
rate was 4.8% (n=29). The overall 30-day stroke and death rate was
7.4% (n=43). Over the 5-year study period, the 30-day minor stroke
rate improved from 7.1% (n=7) for the first year to 3.1% (n=5) for
the fifth year (P<0.05 for
trend). The best predictor of 30-day stroke and death was age 
80
years. After the 30-day period, the incidence of fatal and nonfatal
stroke was 3.2% (n=31). On Kaplan-Meier analysis, the 3-year freedom
from ipsilateral or fatal stroke was
92±1%.
Conclusions—Experience from a single group of operators demonstrates that carotid stenting can be performed with an acceptable 30-day complication rate. Late follow-up also demonstrates a low rate of fatal and nonfatal stroke. These results suggest that carotid stenting may be comparable to carotid endarterectomy, and it underscores the clinical equipoise and premise for the National Institute of Health–supported, randomized Carotid Revascularization Endarterectomy Versus Stent Trial comparing carotid stenting with carotid endarterectomy.
Key Words: stents • stenosis • stroke
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