ABSTRACT
Management of carotid bifurcation stenosis is a cornerstone of stroke prevention. Carotid artery stenting [CAS] is now used as an alternative to surgical endarterectomy. To evaluate short term outcome of CAS with the use of cerebral protection devices as well as assess the impact of various adverse anatomical features of the aortic arch and culprit carotid lesion oil difficulty and rate of complication during CAS procedures. The study included consecutive eligible patients with internal carotid artery [ICA] stenosis with >/= 50% in symptomatic stenosis and >/= 70% in asymptomatic stenosis presented to the catheterization labs of Catania and Ragusa hospitals during the period from October 2009 till May 2011. According to the anatomical adverse characteristics, the patients were classified into 4 groups: group I represented the least anatomical complexity while group IV represented the most complex anatomical features. Data of the CAS procedures and intra-procedural complications as well as during the 1st month after the procedures were collected and studied. The study included 104 ICA lesions in 100 consecutive eligible patients. Seventy-one males and twenty-nine females, mean age 71.9 +/- 7.85 years and 21 patients were >/= 80 years old [octogenarians]. Most of the patients had asymptomatic ICA stenosis [76%] while 24% of patients had symptomatic ICA stenosis. Technical success was obtained in 103 procedures [99%], failed one procedure due to complex anatomical features. Combined cerebrovascular events had occurred in 5 patients [1 major stroke, 1 minor stroke and 3 transient ischemic attacks] with estimated rate 4.8%. No cases of amaurosis fugax, myocardial infarction or death had occurred. Symptomatic patients had stroke rate of 4.1% while stroke rate in asymptomatic patients was 1.3%. Adverse events showed significant statistical difference with increased anatomical complexity [P < 0.001]. Cerebrovascular events in symptomatic patients did not show significant statistical difference in comparison to asymptomatic patients [P = 0.064]. CAS procedures in octogenarians [>/=80 years] showed no significant statistical difference with the number of cerebrovascular adverse events [P = 0.285]. CAS is a relatively safe procedure could be done with low incidence of complications when performed by trained operators. Evaluation of the anatomical characteristics has an important impact oil procedural difficulty and complications