Cor Vasa 2016, 58(6):e569-e575 | DOI: 10.1016/j.crvasa.2015.09.005

Carotid artery stenting outcomes in high-risk patients receiving best medical therapy: results from a single high-volume interventional cardiology practice

Karlis Trusinskis^a,b,*, Deniss Vasiljevs^b, Evija Knoka^c, Dace Sondore^a, Andis Dombrovskis^a, Indulis Kumsars^a, Karlis Strenge^a, Kristine Bumeistere^a, Gurjoat S. Kareer^c, Andrejs Erglis^a,d

^a Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia

^b Daugavpils Hospital, Daugavpils, Latvia

^c Riga Stradins University, Riga, Latvia

^d University of Latvia, Riga, Latvia

Background: Carotid artery stenting (CAS) is now being widely used in the treatment of carotid artery stenosis. Recent clinical studies have demonstrated low adverse event rates after CAS. This study evaluates the 30-day and 1-year results in patients treated with CAS and receiving intensive medical therapy in a high-volume percutaneous coronary intervention centre.

Methods: A total of 184 patients underwent CAS between January 2011 and December 2013. In addition to antiplatelet therapy, patients received intensive antihypertensive treatment, high intensity statin and heart rate normalization therapy. Patients were stratified according to age and symptomatic status.

Results: Most of the patients (86.4%) had at least one high surgical risk criteria. The procedural success rate was 98.4%. The 30-day and 1-year incidence of stroke was 4.1% and 4.5%. At 30 days the combined rate of stroke/cardiovascular (CV) death/myocardial infarction (MI) was 5.8% and 10.9% in 1 year. The 30-day incidence of stroke/CV death in asymptomatic and symptomatic patients was 5.4% and 4.2%. Age ≥80 years increased the risk of stroke/CV death/MI at 1 year (OR 4.41; 95% CI 1.06-18.36; p = 0.04).

Conclusions: The study demonstrated acceptable clinical outcome results in patients with high medical comorbidities treated with CAS and intensive medical therapy. Adverse event rate in symptomatic patients did not exceed the guideline recommended range while in asymptomatic patients it was increased.

Keywords: Carotid artery disease; Carotid artery stenosis; Carotid artery stenting; Stroke

Received: August 20, 2015; Revised: September 7, 2015; Accepted: September 12, 2015; Published: December 1, 2016  Show citation