Carotid artery stenting: Single center experience and clinical consequences

Abstract

Objective: In this study, we aimed to present the characteristics and short-term clinical outcomes of the patients admitted to our clinic with a diagnosis of carotid artery disease and revascularized by carotid artery stenting (CAS). Methods: The study was retrospective and a single-centered study. Between May 2012 and May 2014 the patients with an indication for carotid artery intervention and accepted CAS procedure were included in the study. Clinical characteristics and procedural data of the patients were obtained by scanning patient files. After discharge, hospital records were scanned and patients were called to learn whether or not patients were alive and that they have suffered a recent stroke. Results: We included 26 patients that meet the inclusion criteria in the study. 69% of patients were female with a mean age of 66 ± 9 years. 73% of patients were symptomatic, 73% had hypertension, 27% had diabetes mellitus, 39% had hyperlipidemia, 69% had coronary artery disease and 31% were active smoker. In all patients, self-expandable stents and distal embolic protection devices were used. 18 left, six right, and two bilateral (in separate sessions) carotid arteries were stented with a total of 26 patients and 28 successful CAS. Due to residual stenosis a second stent was implanted only in one patient. One patient experienced a partial muscle weakening in upper extremity due to an air embolism, which recovered spontaneously in 24 hours. Patients were followed for 11.5 ± 8 (minimum 2-maximum 27, median 10) months. During follow-up, no patients had recurrent stroke and transischemic attack. One patient died after eight months of CAS. Conclusion: CAS is being successfully applied with a very low risk of complications in experienced centers. Short-term clinical results of CAS are quite satisfactory.

Keywords

• stroke, carotid artery stenosis, carotid artery stenting, clinical outcomes

Karotis artere stent yerleştirme: Tek merkez deneyimi ve klinik sonuçları

Abstract

Amaç: Bu çalışmada kliniğimize başvuran, karotis arter hastalığı tanısı almış ve karotis arter stentleme (KAS) ile revaskülarize edilen hastaların özelliklerini ve orta vadeli klinik sonuçlarını sunmayı amaçladık. Yöntemler: Tek merkezli, geriye dönük Mayıs 2012- Mayıs 2014 tarihleri arasında karotis artere müdahale gerekliliği olan ve KAS işlemini kabul eden hastalar çalışmaya dahil edildi. Hastanın klinik özellikleri ve işlem ile ilgili verileri hasta dosyaları taranarak elde edildi. Daha sonra taburculuk sonrası hastanın yaşayıp yaşamadığı ve işlem sonrası yeni inme geçirip geçirmediği hastane kayıtlarından ve/veya telefon ile öğrenildi. Bulgular: Dahil edilme kriterlerini sağlayan 26 hasta çalışmaya alındı. Hastaların %69\'u bayan olup, yaş ortalaması 66±9 yıl saptandı. Hastaların %73\'ü semptomatik olup, %73\'ünde hipertansiyon, %27\'sinde diabetes mellitus, %39\'unda hiperlipidemi, % 69\'unda koroner arter hastalığı ve %31\'inde aktif sigara içiciliği mevcuttu. Bütün hastalarda self ekspandable stent ve distal emboli koruyucu cihaz kullanıldı. İşlem ile ilişkili olarak 18 hastaya sol, 6 hastaya sağ ve 2 hastaya ayrı seanslarda iki taraflı olmak üzere 26 hastaya toplamda 28 başarılı KAS işlemi yapıldı. Sadece 1 hastaya rezidü darlık nedeniyle ikinci stent yerleştirme ihtiyacı oldu. İşlemle ilişkili sadece 1 hastada 24 saate tamamen düzelen hava embolisine bağlı güç kaybı oldu. Hastalar tekrarlayan inme ve ölüm açısından 11,5±8 (en az 2-en çok 27, median 10) ay takip edildi. Takip süresince hiçbir hastada tekrarlayan inme ve trans iskemik atak saptanmadı. Sadece 1 hastada 8 ay sonra ölüm gözlendi. Sonuç: Deneyimli merkezlerde KAS başarılı bir şekilde uygulanmakta olup komplikasyon riski oldukça düşüktür. KAS\'ın orta vadeli klinik sonuçları oldukça yüz güldürücüdür.

Keywords

• İnme, karotis arter darlığı, karotis arter stentleme, klinik sonuç

References

1. Miniño AM, Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2008. Natl Vital Stat Rep 2011;59:1–126
2. Roger VL, Go AS, Lloyd-Jones DM, et al. American Heart Association Statistics Committee and Stroke Statistics Sub- committee. Heart disease and stroke statistics—2012 up- date: A report from the American Heart Association. Circu- lation 2012;125:2–220.
3. Dumont TM, Rughani AI. National trends in carotid artery revascularization surgery. J Neurosurg 2012;116:1251- 1257.
4. Brott TG, Hobson RW, Howard G, et al. Stenting vs endar- terectomy for treatment of carotid-artery stenosis. N Engl J Med 2010;363:11-23.
5. Gurm HS, Yadav JS, Fayad P, et al. Long-term results of ca- rotid stenting versus endarterectomy in high-risk patients. N Engl J Med 2008;358:1572-1579.
6. Aykan AÇ, Gül İ, Gökdeniz T, et al. Semptomu olan yüksek riskli hastalarda karotis arter stentleme: Tek merkez dene- yimi. Koşuyolu Heart J 2014;17:91-94.
7. Ertem AG, Akdemir R, Kılıç H, Yeter E. Karotis artere stent yerleştirmenin orta dönem klinik sonuçları: Tek merkez ça- lışması. Sakarya Med J 2013;3:65-71.
8. Public Health Agency of Canada. Tracking Heart Disease and Stroke in Canada. Stroke Highlights 2011. Available at: http://www.phac-aspc.gc.ca/cd-mc/cvd-mcv/sh-fs-2011/ index-eng.php. Accessed October 27, 2013.

9. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics 2013 update: a report from the American Heart Association. Circulation 2013;127:e6-245.
10. Kim LK, Yang DC, Swaminathan RV, et al. Comparison of Trends and Outcomes of Carotid Artery Stenting and Endarterectomy in the United States, 2001 to 2010. Circ Cardiovasc Interv 2014 August.
11. Kerber CW, Cromwell LD, Loehden OL. Catheter dilata- tion of proximal carotid stenosis during distal bifurcation endarterectomy. AJNR Am J Neuroradiol 1980;1:348-349.
12. Naylor AR, Bolia A, Abbott RJ, et al. Randomized study of carotid angioplasty and stenting versus carotid endarterec- tomy: a stopped trial. J Vasc Surg. 1998;28:326-334.
13. Jordan WD Jr, Schroeder PT, Fisher WS, McDowell HA. A comparison of angioplasty with stenting versus endarterec- tomy for the treatment of carotid artery stenosis. Ann Vasc Surg 1997;11:2-8.
14. Ringleb PA, Allenberg J, Bruckmann H, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a random- ized non-inferiority trial. Lancet 2006;368:1239–1247.
15. Gray WA, Hopkins LN, Yadav S, et al. Protected carotid stenting in high-surgical-risk patients: the ARCHeR results. J Vasc Surg 2006;44:258-268.
16. White CJ, Iyer SS, Hopkins LN, Katzen BT, Russell ME. Carotid stenting with distal protection in high surgical risk patients: the BEACH Trial 30 day results. Catheter Cardio- vasc Interv 2006;67:503-512.
17. Matsumura JS, Gray W, Chaturvedi S, et al. Results of carotid artery stenting with distal embolic protection with improved systems: Protected Carotid Artery Stenting in Patients at High Risk for Carotid Endarterectomy (PRO- TECT) trial. J Vasc Surg 2012;55:968-976.
18. Ansel GM, Hopkins LN, Jaff MR, et al. Safety and effec- tiveness of the INVATEC MO.MA proximal cerebral pro- tection device during carotid artery stenting: results from the ARMOUR pivotal trial. Catheter Cardiovasc Interv 2010;76:1-8.
19. Canadian Stroke Network/Heart and Stroke Foundation of Canada. Canadian Stroke Best Practices and Standards Working Group. Canadian Best Practice Recommenda- tions for Stroke Care. Fourth Edition. September 2012. Available at: http://www.strokebestpractices.ca/wpcon- tent/uploads/2012/10/20120BPR_Ch2_Prevention_Final- Version_20Sept-2012F-12.pdf. Accessed October 27, 2013.
20. Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke As- sociation. Stroke 2011;42:227-276.
21. Saw J. Review Carotid Artery Stenting for Stroke Preven- tion. Can J Cardiol 2014:30:22-34.
22. Zahn R, Mark B, Niedermaier N, et al. Embolic protection devices for carotid artery stenting: better results than stent- ing without protection? Eur Heart J 2004;25:1550-1558.