Carotid artery stenting with brain protection devices in cardiovascular high risk patients – 12-month follow-up

摘要

Background: Cardiovascular high risk patients with significant internal carotid artery (ICA) stenosis qualified to bypass surgery should undergo carotid endarterectomy (CEA) or carotid artery stenting (CAS) prior to cardiac surgery. Aim: Safety and efficacy assessment of CAS with neuroprotection in high cardiovascular risk patients prior to CABG during 12-month follow-up. Methods: CAS was performed in 107 consecutive patients – 75 men and 32 women, mean age 69±5 years between 1st Jan 2005 and 30th March 2006. There were 71 (66,36%) symptomatic and 36 (33,64%) asymptomatic patients. All patients had significant atherosclerosis involving coronary arteries, left main disease or multivessel disease and were qualified to bypass surgery. Cardiovascular risk in the studied population was high and carotid endarterectomy was relatively contraindicated. Prior to CAS patients were subjected to Duplex Doppler sonography and multislice computed tomography (MSCT) angiography and/or classical angiography as needed. In all cases neuroprotection devices were used (3 proximal, 104 distal). Patient’s clinical status was evaluated at discharge and on ambulatory basis after 30 days and 12 months. Results: The procedural success rate was 100% and all patients had a carotid stent implanted. In one case two stents were implanted. There was a significant reduction of ICA stenosis from 82,3±13,4% to 9,8±7,5% (p <0,001). During 30-day follow-up two deaths and one major stroke were noted (2,8%). After 12 months two additional incidents of major cerebral stroke (1,86%) occurred. Conclusions: CAS in patients with high cardiovascular risk, qualified to bypass surgery is safe and highly effective in terms of reduction of ICA stenosis. It features an acceptable low risk and may be an acceptable alternative to CEA. The success of CAS in high risk patients is based on accurate neurological and cardiological qualification to that procedure, optimal pharmacotherapy, experienced operators and the use of neuroprotection devices.