Data di Pubblicazione:
2011
Citazione:
Ten years outcomes of carotid artery stenting (CAS): a monocentric experience in 582 patients / D. Mazzaccaro, A.M. Settembrini, G. Malacrida, M.T. Occhiuto, S. Stegher, M. Caldana, D.G. Tealdi, G. Nano. ((Intervento presentato al 60. convegno ESCVS International Congress tenutosi a Mosca nel 2011.
Abstract:
Objective: Even if carotid endarterectomy (CEA) still remains the gold standard
treatment for carotid artery stenosis, carotid artery stenting (CAS) has
emerged as a therapeutic alternative for high-risk patients, with good early and long-term results. Arranging a randomized clinical trial (RCT) which
compares CAS to CEA is a hard matter, as different standards of care exist
for CAS. Multicenter prospective registries and single-centres experience are
thus essential to validate the technique, however they all have some limitations.
We report early and long-term results of our experience in CAS.
Methods: From January 1999 to June 2010, 1612 patients were admitted to our
department for a significant carotid stenosis. Of them, 582 patients (36.1%)
were proposed for CAS according to our ‘intention to treat’. Indications for
CAS included 88 patients (15.1%) who had restenosis after endarterectomy
and 12 patients who presented (2.1%) in-stent restenosis; in these patients,
the previous endovascular procedure had been performed at a median of
20.4 months before (range: 15.8–23.4 months). In remaining patients CAS
was considered for high surgical risk, because of patients’ comorbidities or
difficult anatomy. Symptoms had occurred in 205 patients (35.2%). Most of
CAS were performed in males (409 patients, 70.3%). Patients’ median age was
73.6 years (range 49.4–99.7 years), while 102 (17.5%) were aged more than
80. Carotid stenosis were right-sided in 277 (47.6%) cases. In 505 patients CAS
was performed using EPD. Five hundred and forty-nine stents were used (428
closed-cells, 101 open-cells and 20 hybrid stents).
Results: The procedure was successfully ended in 573 patients (98.4%): in
six selective catheterization of vessels was not possible, and three required
an immediate conversion to surgery for acute stent thrombosis. At 30-day
results we observed three deaths (0.5%), one of them following a severe
stroke, four ipsilateral invalidant strokes (0.7%), three minor strokes (0.5%),
five TIA (0.9%) and one MI (0.2%). At a median follow-up of 90.3 months
(range 1–136 months), 46.3+5.4% of patients were free from any adverse
event, 55.6+5.8% were alive, 97+0.9% were free from any neurological event
and 91+4.3% were free from restenosis.
Conclusions: CAS has emerged as a therapeutic alternative to endarterectomy
for high-risk patients, with good early and long-term results. As
arranging a (RCTs) for CAS is difficult, multicenter prospective registries and
single-centres experience are essential to validate the technique, however,
they have some limitations. In our experience CAS is both a safe and effective
procedure, with good long-term results.
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
D. Mazzaccaro, A.M. Settembrini, G. Malacrida, M.T. Occhiuto, S. Stegher, M. Caldana, D.G. Tealdi, G. Nano
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