Background: We review a single centre’s experience of the endovascular treatment of carotid artery disease, present the 30-day and 1-year complication rates and assess whether changes in technique are associated with a change in clinical outcome. Methods: Patients who underwent carotid angioplasty with or without stenting for symptomatic ≧70% carotid artery stenosis secondary to atherosclerosis were included. 333 procedures were performed, i.e. angioplasty alone (86), stent without cerebral protection (150) and stent with cerebral protection (97). Results: At 30 days, the total major disabling stroke and all death rate was 3.0%. For angioplasty alone, this was 2.3%, for stent without cerebral protection 4.0% and for stent with cerebral protection 2.1%. If non-stroke-related deaths were excluded, it was 2.3, 3.3 and 0%, respectively. After 30 days, the 1-year ipsilateral stroke rate was 0.8%. Conclusions: Carotid artery stenting, in particular with a cerebral protection device, is a safe alternative to carotid endarterectomy for the treatment of symptomatic high-grade carotid artery disease.

1.
CAVATAS investigators: Endovascular versus surgical treatment in patients with carotid stenosis in the carotid and vertebral artery transluminal angioplasty study (CAVATAS): A randomised trial. Lancet 2001;357:1729–1737.
2.
Brooks WH, McClure RR, Jones MR, Coleman TC, Breathitt L: Carotid angioplasty and stenting versus carotid endarterectomy: Randomised trial in a community hospital. J Am Coll Cardiol 2001;38:1589–1595.
3.
Gray WA, White HJ, Barrett DM, Chandran G, Turner R, Reisman M: Carotid stenting and endarterectomy: A clinical and cost comparison of revascularization strategies. Stroke 2002;33:1063–1070.
4.
Brown MM: Carotid angioplasty and stenting: Are they therapeutic alternatives? Cerebrovasc Dis 2001;11(suppl 1):112–118.
5.
Guimaraens L, Sola M, Matali A, Arbeláez A, Delgado M, Soler L, Balaguer E, Castellanos C, Ibánez J, Miquel L, Theron J: Carotid angioplasty with cerebral protection and stenting: Report of 164 patients (194 carotid percutaneous transluminal angioplasties). Cerebrovasc Dis 2002;13:114–119.
6.
Yadav JS, Roubin GS, Iyer S, Vitek J, King P, Jordan WD, Fisher WS: Elective stenting of the extracranial carotid arteries. Circulation 1997;95:376–381.
7.
Angelini A, Reimers B, Barbera MD, Sacca S, Pasquetto G, Cernetti C, Valente M, Pascotto P, Thiene G: Cerebral protection during carotid artery stenting, collection and histopathologic analysis of embolized debris. Stroke 2002;33:456–461.
8.
Martin J, Pache J, Treggiari-Venzi M, Murphy KJ, Gailloud P, Puget E, Pizzolato G, Sugiu K, Guimaraens L, Theron J, Rufenacht DA: Role of the distal balloon protection technique in the prevention of cerebral embolic events during carotid stent placement. Stroke 2001;32:479–484.
9.
Whitlow PL, Lylyk P, Londero H, Mediz OA, Mathias K, Jaeger H, Parodi J, Schonholz C, Milei J: Carotid artery stenting protected with an emboli containment system. Stroke 2002;33:1308–1314.
10.
Albuquerque FC, Teitelbaum GP, Lavine SD, Larsen DW, Giannotta SL: Balloon-protected carotid angioplasty. Neurosurgery 2000;46:918–920.
11.
Henry M, Amor M, Henry I, Klonaris C, Chati Z, Masson I, Kownator S, Luizy F, Hugel M: Carotid stenting with cerebral protection: First clinical experience using the PercuSurge GuardWire system. J Endovasc Surg 1999;6:321–331.
12.
Wholey MH, Wholey M, Mathias K, Roubin GS, Diethrich EB, Henry M, Bailey S, Bergeron P, Dorros G, Eles G, Gaines P, Gomez CR, Gray B, Guimaraens J, Higashida R, Sai Wah Ho D, Katzen B, Kambara A, Kumar V, Laborde JC, Leon M, Lim M, Londero H, Mesa J, Musacchio A, Myla S, Ramee S, Rodriguez A, Rosenfield K, Sakai N, Shawl F, Sievert H, Teitelbaum G, Theron JG, Vaclav P, Vozzi C, Yadav JS, Yoshimura S: Global experience in cervical carotid artery stent placement. Catheter Cardiovasc Interv 2000;50:160–167.
13.
Roubin GS, New G, Iyer SS, Vitek JJ, Al-Mubarak N, Liu MW, Yadav J, Gomez C, Kuntz RE: Immediate and late complications of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis: A five-year prospective anlaysis. Circulation 2001;103:532–537.
14.
Rothwell PM, Slattery J, Warlow CP: A systematic comparison of the risks of stroke and death due to carotid endarterectomy for symptomatic and asymptomatic stenosis. Stroke 1996;27:266–269.
15.
North American Symptomatic Carotid Endarterectomy Trial Collaborators (NASCET): Beneficial effect of carotid endarterectomy on symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445–453.
16.
Macierewicz J, Armon MP, Cleveland TJ, Gaines P, Beard JB: Carotid endarterectomy combined with proximal stenting for multilevel disease. Eur J Vasc Endovasc Surg 2000;20:572–575.
17.
Bamford JM, Sandercock PAG, Warlow CPW, Slattery J: Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1989;20:828.
18.
Gardner SB, Winter PD, Gardner MJ: Confidence Interval Analysis. London, British Medical Journal, 1989.
19.
Intercollegiate Working Party for Stroke: National Clinical Guidelines for Stroke. London, RCP, 2002.
20.
European Carotid Surgery Trialists Collaborative Group: Randomised trial of endarterectomy for recently symptomatic carotid stenosis: Final results of the MRC European carotid surgery trial (ECST). Lancet 1998;351:1379–1387.
21.
Rothwell P, Warlow C: Is audit self-reliable? Lancet 1995;346:1623.
22.
Chaturvedi S, Hachinski V: Does the neurologist add value to the carotid endarterectomy patient? Neurology 1998;50:610–613.
23.
Serruys PW, De Jaegere P, Kiemeneij F, Macaya C, Rutsch W, Heyndrickx G, Emanuelsson H, Marco J, Legrand V, Materne P, Belardi J, Sigwart U, Colombo A, Goy JJ, Van Den Heuvel P, Delcan J, Morel M: A comparison of balloon-expandable stent implantation with balloon angioplasty in patients with coronary artery disease: Benestent study group. N Engl J Med 1994;331:489–495.
24.
Stent Restenosis Study Investigators: A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994;331:496–501.
25.
Theron JG, Payelle GC, Coskun O, Huet HF, Guimaraens L: Carotid artery stenosis: Treatment with protected balloon angioplasty and stent placement. Radiology 1996;201:627–636.
26.
Orlandi G, Fanucchi S, Fioretti C, Acerbi G, Puglioli M, Padolecchia R, Sartucci F, Murri L: Characteristics of cerebral microembolism during carotid stenting and angioplasty alone. Arch Neurol 2001;58:1410–1413.
27.
Crawley F, Stygall J, Lunn S, Harrison M, Brown M, Newman S: Comparison of microembolism detected by transcranial Doppler and neuropsychological sequelae of carotid surgery and percutaneous transluminal angioplasty. Stroke 2000;31:1329–1334.
28.
Cina CS, Clase CM, Haynes RB: Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev 2000;(2):CD001081.
29.
Beebe HG, Archie JP, Baker WH, Barnes RW, Becker GJ, Bernstein EF, Brener B, Clagett GP, Clowes AW, Cooke JP, Creager MA, Cronenwett JL, Dake M, DeWeese JA, Fogarty TJ, Freischlag JA, Goldstone J, Greenfield LJ, Hertzer NR, Hobson RW, Joyce JW, Katzen BT, Logerfo FW, Mohr JP, Moore WS, Najafi H, Ricotta JJ, Riles TS, Ring EJ, Robertson J, Rutherford RB, Sos T, Stanley JC, Strandness DE, Sumner DS, Toole J, Towne JB, Veith FJ, Whittemore AD, Yao JST, Zarins CK: Concern about safety of carotid angioplasty. Stroke 1996;27:197–198.
30.
Bettmann MA, Katzen BT, Whisnant J, Brant-Zawadzki M, Broderick JP, Furlan AJ, Hershey LA, Howard V, Kuntz R, Loftus CM, Pearce W, Roberts A, Roubin G: Carotid stenting and angioplasty: A statement for healthcare professionals from the Councils on Cardiovascular Radiology, Stroke, Cardiovascular Surgery, Epidemiology and Prevention, and Clinical Cardiology, American Heart Association. J Vasc Interv Radiol 1998;91:3–5.
31.
Crawley F, Clifton A, Buckenham T, Loosemore T, Taylor RS, Brown MM: Comparison of haemodynamic cerebral ischaemia and microembolic signals detected during carotid endarterectomy and carotid angioplasty. Stroke 1997;28:2460–2464.
32.
Das MB, Hertzer NR, Ratliff NB, O’Hara PJ, Beven EG: Recurrent carotid stenosis. A five-year series of 65 reoperations. Ann Surg 1985;202:28–35.
33.
Brown MM: International Carotid Stenting Trial (ICSS). Major ongoing trials. Stroke 2002;33:1732.
34.
Hobson RW, Brott T, Ferguson R: CREST: Carotid revascularization endarterectomy versus stent trial. Cardiovasc Surg 1997;5:457–458.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.