Endovascular treatment of symptomatic carotid stenosis using stent placement - Long-term follow-up of patients with a balanced surgical risk/benefit ratio

Background and Purpose-Carotid endarterectomy (CEA) is not necessarily beneficial in all patients with symptomatic high-grade (greater than or equal to 70%) internal carotid artery (ICA) stenosis. Independent risk factors modulate both the individual stroke risk under medical treatment and the combined stroke and death risk after CEA. Endovascular stenting of symptomatic ICA stenosis may be an alternative to CEA in patients with a balanced surgical risk/benefit ratio. Methods-We included 43 patients (71% men; median age, 67 years) with a recently symptomatic ICA stenosis with greater than or equal to 70% luminal narrowing in whom the individual sum of medical and surgical risk factors suggested a balanced surgical risk/benefit ratio (risk-modeling appraisal derived from the European Carotid Surgery Trial). After stenting of the stenosed ICA with distal balloon protection, the mean +/- SD follow-up, including clinical and ultrasonographic examinations, was 20 +/- 11.8 months, with a median number of examinations of 5 per patient. Results-Recanalization of ICA stenoses was technically successful in 40 of 43 procedures (93%). Within the 30-day postinterventional period I death occurred (2.5%), and the combined stroke and death rate within follow-up was 5%. Except for I asymptomatic ICA occlusion, no restenosis greater than or equal to 70% occurred during follow-up. Conclusions-ICA stenting in symptomatic patients with a balanced surgical risk/benefit ratio is technically feasible, with a low periprocedural risk of stroke or death. Furthermore, the risk of future stroke and rate of significant restenosis during long-term follow-up appears to be low, suggesting that ICA stenting may be useful in carotid revascularization and stroke prevention.