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Carotid Stenting in Asymptomatic Carotid Stenosis: The Calgary Experience

  • N. Shobha (a1), M. A. Almekhlafi (a1), A. Pandya (a1), P. L. Couillard (a1), W. F. Morrish (a1), J. H. Wong (a1) (a2) and M. D. Hill (a1) (a3) (a2) (a4)...

Abstract

Background:

Although carotid endarterectomy is considered the ‘gold standard’ for standard risk symptomatic patients, the treatment of choice for asymptomatic patients remains controversial. Carotid stenting has demonstrated real-world outcomes consistent with established guidelines for carotid endarterectomy in asymptomatic high-surgical risk patients in recent prospective multicenter trials. We describe our experience with asymptomatic patients who underwent carotid stenting at our center in a routine clinical setting.

Methods:

This is a retrospective, longitudinal cohort study of patients who underwent carotid angioplasty and stenting at the Foothills Medical Center, Calgary, Canada between 1997 and 2007. The qualifying events were categorized as symptomatic and asymptomatic. The procedures were performed by four experienced neurointerventionists. The primary outcome was stroke or death at 30-day follow- up.

Results:

243 patients underwent 255 carotid stenting procedures. Their ages ranged from 50 to 83 years; the mean age was 72.0 ± 9.3 years; 67(26.3%) were women. Forty one patients (16.1%) were asymptomatic; 214 patients (83.9%) were symptomatic. The patients in the asymptomatic group were significantly younger - 66.0 ± 8.8 years compared to patients in the symptomatic group 73.2 ± 8.9 years (p<0.0001). Intraprocedurally one minor stroke (2.4%) occurred in the asymptomatic group. At 30-day follow-up, no deaths or further strokes were noted in the asymptomatic group; while eight deaths, six major and seven minor strokes occurred in the symptomatic group (p=0.22).

Conclusion:

Carotid stenting appears to be a safe procedure in asymptomatic patients with severe carotid stenosis in routine clinical settings as witnessed in this single center study.

RÉSUMÉ: Contexte:

Bien que l’endartérectomie carotidienne soit considérée comme la méthode de référence chez les patients symptomatiques à risque usuel, le traitement de choix chez les patients asymptomatiques demeure un sujet de controverse. Les résultats de la mise en place d’une endoprothèse carotidienne en pratique courante sont conformes aux lignes directrices établies pour l’endartérectomie carotidienne chez les patients asymptomatiques dont le risque chirurgical est élevé, qui ont participé à des essais multicentres prospectifs récents. Nous décrivons notre expérience chez des patients asymptomatiques qui ont subi une implantation d’endoprothèse de la carotide à notre centre hospitalier dans un contexte clinique de routine.

Méthodes:

Il s’agit d’une étude longitudinale rétrospective de cohorte de patients qui ont subi une angioplastie carotidienne avec implantation d’endoprothèse au Foothill Medical Center, à Calgary, au Canada, entre 1997 et 2007. Les événements qui motivaient l’intervention ont été classés selon la présence ou l’absence de symptomes. Quatre neurointerventionnistes expérimentés ont réalisé les interventions. L’issue primaire était l’accident vasculaire cérébral ou le décès au cours des trente premiers jours de suivi.

Résultats:

Deux cent quarante-trois patients ont subi 255 implantations d’endoprothèses. Les patients étaient àgés de 50 à 83 ans, avaient un àge moyen de 72,0 ± 9,3 ans, et 67 (26,3%) étaient des femmes. Quarante et un patients (16,1%) étaient asymptomatiques et 214 (83,9%) étaient symptomatiques. Les patients du groupe asymptomatique, dont l’àge moyen était de 66,0 ± 8,8 ans, étaient significativement plus jeunes par rapport aux patients du groupe symptomatique dont l’àge moyen était de 73,2 ± 8,9 ans (p < 0,0001). Un patient asymptomatique (2,4%) a subi un AVC mineur pendant l’intervention. Au moment du suivi 30 jours après l’intervention, aucun décès ou autre AVC n’a été observé dans le groupe de patients asymptomatiques alors que 8 décès, 6 AVC majeurs et 7 AVC mineurs sont survenus chez les patients du groupe symptomatique (p = 0,22).

Conclusion:

L’implantation d’une endoprothèse au niveau de la carotide semble une intervention sure chez les patients asymptomatiques qui sont porteurs d’une sténose sévère de la carotide dans un contexte de soins de routine, comme le témoigne cette étude réalisée dans un seul centre.

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Copyright

Corresponding author

University of Calgary, Dept Clinical Neurosciences&Hotchkiss Brain Institute, Rm 1242A, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta, T2N 2T9, Canada.

References

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Carotid Stenting in Asymptomatic Carotid Stenosis: The Calgary Experience

  • N. Shobha (a1), M. A. Almekhlafi (a1), A. Pandya (a1), P. L. Couillard (a1), W. F. Morrish (a1), J. H. Wong (a1) (a2) and M. D. Hill (a1) (a3) (a2) (a4)...

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