CAROTID STENTING - A VIABLE ALTERNATIVE TO SURGERY? B. Gunalingam*, P. Roy, D. Baron
and D.W. Muller. Cardiology Department, St Vincent's
Hospital, Darlinghurst, NSW. Carotid
stenting is emerging as an alternative to carotid endarterectomy for carotid
occlusive disease. Between 12/97 and
1299, 29pts (22M,7F) with age 68.9 ± 10.3 yrs (45 - 92 yrs) underwent 32
carotid (n=31) or vertebral (n=1) procedures, with 3(10%) having bilateral
extra-cranial stents. All but 1 pt were unsuitable for surgery according to
NASCET criteria. Diabetes was present
in 11 pts (38%), coronary artery disease in 27 pts (93%), with 3 vessel
coronary artery disease in 19 (66%); 6 (21%) patients had a history of previous
CABG. Bilateral carotid disease was
present in 20 pts (69%), with 3 (10%) having occluded contra-lateral internal
carotid arteries. Three pts had had
a previous carotid endarterectomy on
the ipsilateral side (10%), 2 pts (7%) had high bifurcation lesions and 4 (14%)
patients had previous neck radiotherapy. RESULTS: Of the 32 interventions one (3%) was complicated by an
intra-procedural CVA due to balloon rupture. 3 pts (10%) suffered brief periods
of hypotension (SBP < 60mmHg). The median length of stay was 1 day; 43% of pts were
discharged within 24 hrs. Long term follow up was available to 6 months in 21 pts
and 12 months in 9 pts. One pt suffered 2 minor TIAs (3%) and 3 pts
(10%) suffered CVAs (2 minor and 1 major), of which only 1 CVA (3%) was
directly attributable to the
stent. There were 2 deaths, 1 due to
cardiac causes. CONCLUSION: In this high risk group of pts, carotid stenting appears
to be a satisfactory alternative to carotid endarterectomy.
