Carotid artery stenting in surgically unfit patients with symptomatic carotid artery stenosis: Does it worth?

Abstract

Background: Carotid endarterectomy (CEA) is the gold standard for the treatment of patients with severe carotid stenosis (CS). However, carotid artery stenting (CAS) has emerged as an alternative to CEA in surgically unfit patients. The present study aimed to assess the role of CAS with an embolic protection device (EPD) in the management of symptomatic CS in patients who were deemed unfit surgically for CEA. Patients and Methods: This is a retrospective study that encompassed the analysis of patients who presented with symptomatic CS and were treated with CAS using EPD. The patients’ clinical data, procedure details, and procedure outcomes were obtained from the medical files and analyzed. Results: This study included 40 patients. During the immediate postprocedural period, one case (2.5%) showed stroke due to early stent occlusion. The late adverse events were stent occlusion that occurred in 3 patients (7.5%), TIA (n=2; 5%), myocardial infarction (n=3; 7.5%), and stroke (n=2; 5%). The primary patency rate during the follow-up period was 89.5%, and the secondary patency rate was 94.8%. The presence of diabetes and the stenosis length were significant predictors of stent occlusion. The delayed mortality rate was 7.5%. The predictors of patients’ mortality were the presence of diabetes mellitus, stent occlusion, and the occurrence of myocardial infarction (MI). Conclusion: The one-year primary and secondary patency rates were encouraging at 89.5% and 97.4%. Diabetes and stenosis length were identified as significant predictors of stent occlusion. Mortality was predicted by diabetes, stent occlusion, and MI.