(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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M. Schillinger, M. Exner, W. Mlekusch, H. Rumpold, R. Ahmadi, S. Sabeti, W. Lang, O. Wagner, and E. Minar Acute-Phase Response after Stent Implantation in the Carotid Artery: Association with 6-month In-Stent Restenosis Radiology, May 1, 2003; 227(2): 516 - 521. [Abstract] [Full Text] [PDF]
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S. Taylor, F. Alcocer, and W. D. Jordan Jr Controversies in Carotid Stenting Vascular and Endovascular Surgery, March 1, 2003; 37(2): 79 - 87. [Abstract] [PDF]
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A. Kastrup, K. Groschel, H. Krapf, B. R. Brehm, J. Dichgans, and J. B. Schulz Early Outcome of Carotid Angioplasty and Stenting With and Without Cerebral Protection Devices: A Systematic Review of the Literature Stroke, March 1, 2003; 34(3): 813 - 819. [Abstract] [Full Text] [PDF]
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 C. Kremer, M. Mosso, D. Georgiadis, E. Stockli, D. Benninger, M. Arnold, and R.W. Baumgartner Carotid dissection with permanent and transient occlusion or severe stenosis: Long-term outcome Neurology, January 28, 2003; 60(2): 271 - 275. [Abstract] [Full Text] [PDF]
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Z. Kaposzta, A. Clifton, J. Molloy, J. F. Martin, and H. S. Markus S-Nitrosoglutathione Reduces Asymptomatic Embolization After Carotid Angioplasty Circulation, December 10, 2002; 106(24): 3057 - 3062. [Abstract] [Full Text] [PDF]
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P. Faries, N. J. Morrissey, V. Teodorescu, E. C. Gravereaux, J. A. Burks JR, A. Carroccio, K. C. Kent, L. H. Hollier, and M. L. Marin Recent Advances in Peripheral Angioplasty and Stenting Angiology, November 1, 2002; 53(6): 617 - 626. [Abstract] [PDF]
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E.J. Cunningham, R. Bond, Z. Mehta, M.R. Mayberg, C.P. Warlow, and P.M. Rothwell Long-Term Durability of Carotid Endarterectomy for Symptomatic Stenosis and Risk Factors for Late Postoperative Stroke Stroke, November 1, 2002; 33(11): 2658 - 2663. [Abstract] [Full Text] [PDF]
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G Stankovic, F Liistro, S Moshiri, C Briguori, N Corvaja, G Gimelli, A Chieffo, M Montorfano, L Finci, V Spanos, et al. Carotid artery stenting in the first 100 consecutive patients: results and follow up Heart, October 1, 2002; 88(4): 381 - 386. [Abstract] [Full Text] [PDF]
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T. G. Brott Angioplasty and Stenting Should Be Performed Only in the Setting of a Clinical Trial Stroke, October 1, 2002; 33(10): 2519 - 2520. [Full Text] [PDF]
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G. S. Roubin Angioplasty and Stenting Should Not Be Restricted to Clinical Trials Stroke, October 1, 2002; 33(10): 2520 - 2522. [Full Text] [PDF]
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M. Schluter, T. Tubler, D. G. Mathey, and J. Schofer Feasibility and efficacy of balloon-based neuroprotection during carotid artery stenting in a single-center setting J. Am. Coll. Cardiol., September 4, 2002; 40(5): 890 - 895. [Abstract] [Full Text] [PDF]
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A. M. Abou-Zamzam Jr, G. L. Moneta, G. J. Landry, R. A. Yeager, J. M. Edwards, D. B. McConnell, L. M. Taylor Jr, and J. M. Porter Carotid Surgery Following Previous Carotid Endarterectomy Is Safe and Effective Vascular and Endovascular Surgery, July 1, 2002; 36(4): 263 - 270. [Abstract] [PDF]
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J. L. Kaufman, W.A.J. Hoefnagels, G. S. Roubin, G. New, and R. L. Sacco Extracranial Carotid Stenosis N. Engl. J. Med., May 16, 2002; 346(20): 1590 - 1591. [Full Text] [PDF]
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 J. A. Beckman, M. A. Creager, and P. Libby Diabetes and Atherosclerosis: Epidemiology, Pathophysiology, and Management JAMA, May 15, 2002; 287(19): 2570 - 2581. [Abstract] [Full Text] [PDF]
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W. A. Gray, H. J. White Jr, D. M. Barrett, G. Chandran, R. Turner, and M. Reisman Carotid Stenting and Endarterectomy: A Clinical and Cost Comparison of Revascularization Strategies Stroke, April 1, 2002; 33(4): 1063 - 1070. [Abstract] [Full Text] [PDF]
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F. Masuhr and M. Busch Ambulatory Carotid Stenting in Patients With Asymptomatic Carotid Artery Stenosis Stroke, April 1, 2002; 33(4): 1168 - 1169. [Full Text] [PDF]
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N. Al-Mubarak, A. Colombo, P. A. Gaines, S. S. Iyer, N. Corvaja, T. J. Cleveland, S. Macdonald, C. Brennan, and J. J. Vitek Multicenter evaluation of carotid artery stenting with a filter protection system J. Am. Coll. Cardiol., March 6, 2002; 39(5): 841 - 846. [Abstract] [Full Text] [PDF]
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R. Hofmann, K. Kerschner, C. Steinwender, A. Kypta, D. Bibl, and F. Leisch Abciximab Bolus Injection Does Not Reduce Cerebral Ischemic Complications of Elective Carotid Artery Stenting: A Randomized Study Stroke, March 1, 2002; 33(3): 725 - 727. [Abstract] [Full Text] [PDF]
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A. Angelini, B. Reimers, M. D. Barbera, S. Sacca, G. Pasquetto, C. Cernetti, M. Valente, P. Pascotto, and G. Thiene Cerebral Protection During Carotid Artery Stenting: Collection and Histopathologic Analysis of Embolized Debris Stroke, February 1, 2002; 33(2): 456 - 461. [Abstract] [Full Text] [PDF]
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T. Tubler, M. Schluter, O. Dirsch, H. Sievert, I. Bosenberg, E. Grube, J. Waigand, and J. Schofer Balloon-Protected Carotid Artery Stenting: Relationship of Periprocedural Neurological Complications With the Size of Particulate Debris Circulation, December 4, 2001; 104(23): 2791 - 2796. [Abstract] [Full Text] [PDF]
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E. Ballotta, G. S. Roubin, G. New, S. S. Iyer, J. J. Vitek, N. Al-Mubarak, M. W. Liu, J. Yadav, C. Gomez, and R. E. Kuntz Immediate and Late Clinical Outcomes of Carotid Artery Stenting in Patients With Symptomatic and Asymptomatic Carotid Artery Stenosis: A 5-Year Prospective Analysis Response Circulation, November 27, 2001; 104 (22): e121 - e122. [Full Text] [PDF]
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C. J. White Another nail in the coffin of carotid endarterectomy J. Am. Coll. Cardiol., November 15, 2001; 38(6): 1596 - 1597. [Full Text] [PDF]
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N. Al-Mubarak, G. S. Roubin, J. J. Vitek, S. S. Iyer, G. New, and M. B. Leon Effect of the Distal-Balloon Protection System on Microembolization During Carotid Stenting Circulation, October 23, 2001; 104(17): 1999 - 2002. [Abstract] [Full Text] [PDF]
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 C. J White Non-surgical treatment of patients with peripheral vascular disease Br. Med. Bull., October 1, 2001; 59(1): 173 - 192. [Abstract] [Full Text] [PDF]
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N. Al-Mubarak, G. S. Roubin, J. J. Vitek, G. New, S. S. Iyer, and D. Pelz Procedural Safety and Short-Term Outcome of Ambulatory Carotid Stenting Editorial Comment Stroke, October 1, 2001; 32(10): 2305 - 2309. [Abstract] [Full Text] [PDF]
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D. O. Williams Carotid Filters : New Additions to the Interventionist's Toolbox Circulation, July 3, 2001; 104(1): 2 - 3. [Full Text] [PDF]
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B. Reimers, N. Corvaja, S. Moshiri, S. Sacca, R. Albiero, C. Di Mario, P. Pascotto, and A. Colombo Cerebral Protection With Filter Devices During Carotid Artery Stenting Circulation, July 3, 2001; 104(1): 12 - 15. [Abstract] [Full Text] [PDF]
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