Carotid Artery Stenting in Symptomatic High Risk Patients: A Single Center Experience

Öz

Introduction: Stroke is one of the leading causes of permanent disability and death. Stroke is generally associated with ischemia and carotid artery stenosis is the reason in nearly one third of the cases. The aim of the present study was to investigate the short and mid term results of carotid artery stenting (KAS) procedures performed in high risk patients due to carotid artery disease who were admitted to cardiology clinic of our institution.Patients and Methods: The study group consisted of 14 consecutive high risk patients in whom KAS was performed in the cardiology clinic of our institution due to atherosclerotic carotid artery disease between October 2011 and October 2013. Procedural success, in-hospital and out-hospital stroke, myocardial infarction and all causes of mortality were evaluated.Results: Angiographic success was achieved in all patients. In-hospital and out-hospital acure coronary syndrome was not observed. One patient developed permanent stroke 24 hours after the procedure. This stroke was related with non-intervened carotid artery. This patient died 32 days after the procedure. Procedure related stroke or death was not occurred in any of the patients.Conclusion: KAS is a safe procedure in high risk patients for appropriately equipped experienced operators.

Anahtar Kelimeler

• Karotis arter, stent; yaş; yüksek risk

Semptomu Olan Yüksek Riskli Hastalarda Karotis Arter Stentleme: Tek Merkez Deneyimi

Öz

Giriş: İnme, kalıcı sakatlık ve ölümün önemli nedenlerinden biridir. İnmelerin çoğu iskemik nedenlere bağlı olup, bu hastaların yaklaşık üçte birinde neden karotis arter hastalığıdır. Biz bu çalışmada, hastanemiz kardiyoloji kliniğine başvuran ve ciddi karotis arter hastalığı nedeniyle karotis artere stent (KAS) işlemi yapılan yüksek riskli hastalarda kısa ve orta dönem sonuçları araştırmayı amaçladık.Hastalar ve Yöntem: Ekim 2011 ve Ekim 2013 tarihleri arasında hastanemiz kardiyoloji kliniğinde aterosklerotik karotis arter darlığı nedeniyle KAS işlemi yapılan ardışık 14 yüksek riskli hasta çalışmaya dahil edildi. İşlem başarısı, hastane içi ve dışı inme, miyokard infarktüsü, tüm nedenlere bağlı ölüm değerlendirildi.Bulgular: Bütün hastalarda tam başarılı anjiyografik sonuç elde edildi. Hiçbir hastada hastane içi ve dışı akut koroner sendrom olmadı. Bir hastada işlemden 24 saat sonra kalıcı inme gelişti. Bu hastada inme, işlem yapılmayan karotis arter kaynaklıydı. Kalıcı inme gelişen bu hasta işlem sonrası 32. günde ex oldu. Hiçbir hastada işlemle ilgili inme ve ölüm olmadı.Sonuç: Yüksek riskli hastalarda deneyimli girişimcilerin ellerinde, uygun donanım ile KAS işlemi güvenle yapılabilir.

Anahtar Kelimeler

• Carotid artery, stent; age; high risk

Kaynakça

1. Ferguson GG, Eliasziw M, Barr HW, Clagett GP, Barnes RW, Wallace MC, et al. The North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients. Stroke 1999;30:1751-8.
2. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA 1995;273:1421-8.
3. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet 2001;357:1729-37.
4. Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, et al. Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004;351:1493-501.
5. Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, et al. Benefit of carotid endarterectomy in pa tients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1998;339:1415-25.
6. Mas JL, Trinquart L, Leys D, Albucher JF, Rousseau H, Viguier A, et al. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol 2008;7:885-92.
7. Bonati LH, Fraedrich G; Carotid Stenting Trialists’ Collaboration. Age modifies the relative risk of stenting versus endarterectomy for symptomatic carotid stenosi. A pooled analysis of EVA-3S, SPACE and ICSS. Eur J Vasc Endovasc Surg 2011;41:153-8.
8. Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010;363:11-23.

9. Sheffet AJ, Roubin G, Howard G, Howard V, Moore W, Meschia JF, et al. Design of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST). Int J Stroke 2010;5:40-6.
10. CARESS Steering Committee. Carotid revascularization using endarterectomy or stenting systems (CARESS): phase I clinical trial. J Endovasc Ther 2003;10:1021-30.