Long-Term Outcomes Following Carotid
Artery Stenting. G New1*,
G S Roubin1, S S Iyer1, N Al-Mubarak1, I
Moussa1, G Yates2, M Liu2, J W Moses, J J
Vitek1, 1Lenox
Hill Heart and Vascular Institute, New York, New York, 2Division
of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham,
Alabama. Background: Carotid stenting is a less invasive percutaneous procedure
for the treatment of carotid artery stenosis. Many previous reports suggest
that carotid stenting can be performed with similar peri-procedural
complication rates compared with carotid endarterectomy. The study represents
the largest prospective cohort of carotid stenting patients evaluated for acute
and late-term outcomes. Methods: Five-hundred and twenty-eight
consecutive patients (604 hemispheres/vessels) undergoing elective CS were
prospectively followed. There was 99.5% late follow-up in people eligible (n =
385, > 12 months, range: 12 to 55 months). Stroke and death rates were
estimated at 30 days and at last follow-up (mean ± SD). Predictors of 30-day and late fatal and non-fatal stroke
were identified. Results: Procedural success rate was 98%
(592/604). There was a 0.6% (n=3) fatal stroke rate and 1% (n=5)
non-neurological death rate at 30 days. Major stroke rate was 1% (n=6) and the
minor stroke rate was 4.8% (n=29). The overall thirty-day stroke and death rate
was 7.4% (n=43). Over the 5 year study period, the 30-day stroke and death rate
improved from 9.3% (n=9) for the first year to 4.3% (n=7) for the 5th year of
the study (p<0.05 for trend). The most significant predictor of 30-day
stroke and death was age >= 80 years, with this group having a stroke and death rate of
16% (n=12) compared with 6% (n=31) for patients < 80
years old (p < 0.01). On long-term follow-up there was an incremental 3.2%
(n=31) incidence of fatal and non-fatal stroke beyond 30 days. Freedom from
fatal and non-fatal stroke at 3 years was 88 ±
2%, and the freedom from ipsilateral non-fatal stroke and all fatal stroke was
92 ±
1%. Conclusion: Experience from a single group of operators demonstrates
that, carotid artery stenting can be performed with a 30-day peri-procedural
complication rate similar to carotid endarterectomy. Late follow-up also
demonstrates similar rates of fatal and non-fatal stroke compared with
endarterectomy.
