Carotid Artery Stenting in High Risk Patients

Kim, Jun; Park, Seong Wook; Lee, Seung Whan; Lee, Jae Whan; Kim, Young Hak; Lee, Cheol Whan; Hong, Myeong Ki; Kim, Jae Joong; Kwon, Sun Uck; Kim, Jong sung; Park, Seung Jung

Abstract

BACKGROUND AND OBJECTIVES
A carotid endarterectomy (CEA) is known to decrease the risk of a stroke and the mortality in patients with symptomatic severe carotid stenosis. However, CEAs are declined by many patients with cardiac or medical diseases, due to the high perioperative risks. This study was performed to evaluate the early clinical outcomes of carotid artery stenting (CAS) in high risk patients.
SUBJECTS AND METHOD
Between March 2001 an September 2002, 23 patients with severe carotid stenosis underwent a CAS, among them 19 with ineligible NASCET (North American Symptomatic Carotid Endarterectomy Trial) criteria, or high cardiac risks, were included, and analyzed retrospectively.
RESULTS
Eighteen of the 19 patients had NASCET ineligible criteria (unstable angina in 9, severe congestive heart failure in 1, end-stage renal disease in 2, intracranial atherosclerosis in 2 and unstable neurologic examination in 4). Fifteen patients had high risk cardiac diseases (unstable angina in 9, severe congestive heart failure in 1 and severe multi-vessel disease or left main coronary artery disease in 5). Thirteen patients had a history of a stroke. The perioperative risks, according to the Sundt criteria, were grade 3 in 15 and grade 4 in 4 patients. Eleven stenotic lesions of the left, and 8 of the right internal carotid arteries were stented with a 100% procedural success rate. The mean pre- and post-procedural diameters stenosis were 90+/-6% and 8+/-5%, respectively. One major and one minor stroke developed immediately after the CAS, but there were no periprocedural deaths. The other in-hospital complications included: acute renal failure in one patient and an access site hematoma in another patient. However, there was no periprocedural myocardial ischemia, myocardial infarction or aggravation of heart failure. One patient died of an intracranial hemorrhage 3.5 months after the CAS. In the remaining patients there were no recurrences or new strokes.
CONCLUSION
Carotid artery stenting should be considered as the treatment of choice in high-risk patients with severe carotid stenosis.