[Short- and long-term outcomes of angioplasty and stenting for high-risk extracranial carotid stenosis in carotid endarterectomy]

ABSTRACT

Carotid endarterectomy [CEA] is a standard method for patient with significant carotid stenosis but direct surgical repair via carotid endarterectomy may not be a good option in some patients because of the overall health status that may make the surgery too risky. Carotid angioplasty and stenting [CAS], is a relatively new procedure for the treatment of carotid artery disease in patients who may not be fit enough to undergo surgery. In this investigation, we determined short- and long-term outcomes of stent angioplasty in high-risk patients for whom the risk of perioperative morbidity and mortality is high. We have followed 82 consecutive symptomatic patients with a >/= 50% and asymptomatic patients with a >/= 70%- 80% carotid stenosis within 15.9 months of angioplasty and stenting in Baqiyatallah and Jamaran hospitals from 2008-2010. All the patients were considered poor surgical candidates by experienced surgeons and anesthesiologists upon pre-surgical consultation. This descriptive cross-sectional study was performed on 28 women and 54 men with a mean age of 69.7_9.2 years. The procedure was technically successful in 79 [96.3%] cases. There were 6 [7.3%] deaths, 5 [6.1%] strokes, 4 [4.9%] MIs and 4 [4.9%] TIAs during the follow-up period. The clinical results during the short available follow-up period suggested stent angioplasty to be useful, effective, reliable and safe in the treatment of significant cervical carotid stenosis in high-risk patients. Further analytical investigations with longer follow-up periods for predicting risk factors are recommended