Carotid artery stenting: clinical and procedural implications for near-occlusion stenosis.

Abstract

INTRODUCTION AND OBJECTIVES:

The advisability of implanting a stent in carotid near-occlusion stenosis is a controversial topic. We have assessed procedural and clinical implications of stent implantation for carotid artery disease with near occlusion.

METHODS:

We included 205 patients who underwent carotid artery revascularisation with a stent. The group of patients with near-occlusion stenosis (n=54)was compared to the rest of the population (n=151).

RESULTS:

No differences were found between groups for age, sex, and the percentage of symptomatic patients (three-quarters of the population). Carotid stent revascularisation for near-occlusion stenosis presented a high procedural success rate (96%) similar to that of revascularisation processes for other lesions (98%). Stenting in cases of near-occlusion stenosis required increased use of proximal protection (54% vs. 20.5%, P<.001) and predilation (33% vs. 17%, P=.01). The process to repair near-occlusion stenosis cause increased detachment of plaque, as shown by higher percentages of macroscopic plaque captured by protection devices (18.5% vs. 7%, P=.01) and of perioperative ischaemic brain lesions (47% vs 31%, P = .07). At 30 days of follow-up, the tendency toward adverse neurological events (death, major and minor stroke) was higher in the near-occlusion group (9.2% vs. 3.2%, P=.08).

CONCLUSIONS:

Stent revascularisation for near-occlusion carotid stenosis has a high procedural success rate; however, its higher plaque load was responsible for the increased rate of ischaemic brain lesions and adverse neurovascular events at 30 days post-procedure.

• Authors: R J Ruiz-Salmerón, M A Gamero, C Carrascosa, S Pérez, D de Araujo, F Marcos, S Rodríguez de Leiras, M Vizcaíno, C Caparrós, G Izquierdo
• Journal: Neurologia (Barcelona, Spain) (Neurologia) 2013 Nov-Dec Vol. 28 Issue 9 Pg. 535-42 ISSN: 1578-1968 [Electronic] Spain
• PMID: 23465685 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Brain Ischemia (diagnosis, pathology)
• Carotid Arteries (surgery)
• Carotid Stenosis (surgery)
• Cerebral Revascularization
• Female
• Humans
• Magnetic Resonance Angiography
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Stents