Carotid artery stenting in ischaemic stroke prevention: initial results from the National Programme of Prevention and Treatment of Cardiovascular Diseases POLKARD

摘要

Introduction: Stroke is the third most common cause of death and the leading cause of disability in adults. Atherosclerotic carotid stenosis is responsible for 15–20% of all ischaemic strokes. Endarterectomy is currently the only approved treatment for primary and secondary prevention of ischaemic stroke due to carotid stenosis. Percutaneous carotid angioplasty and stenting is a novel method requiring further evaluation of efficacy and treatment compared to endarterectomy. Methods: The National Programme for Prevention and Treatment of Cardiovascular Diseases POLKARD aims to introduce and monitor new treatment modalities and control healthcare quality. Carotid artery stenting procedures were funded by the programme from 2003 to 2005 in centres selected in competition. In the years 2004–2005 a register was conducted in order to monitor safety and efficacy. The procedures were performed in patients with a 50 to 99% stenosis. Results: 420 procedures were performed, of which 411 were reported. All reported procedures were included in this analysis. 71.8% of patients in the study group were male and the mean age was 65 years. 42.8% had an ischaemic stroke preceding the procedure, 31.9% had a TIA (transient ischaemic attack). 28.7% of patients were asymptomatic. Complications during the first 30 days following the procedure included ischaemic stroke in 6.8% of patients, intracerebral haemorrhage in 0.7%, TIA in 3.6% and myocardial infarction in 3.2%. The overall rate of severe complications was 10.0%. Conclusions: Carotid angioplasty and stenting seems to have a similar periprocedural rate as endarterectomy. Long-term observation and further studies comparing it with endarterectomy are needed to fully state its utility in primary and secondary prevention of stroke.