Safety and mid-term outcome of endovascular therapy for internal carotid artery disease: A 15-year experience at a single-centre angiology institution [Sicherheit und mittelfristige Ergebnisse der endovaskul?ren Th erapie der Karotis interna Stenose: 15-j?hrige Erfahrung an einer angiologischen Einrichtung]

摘要

Background: Endovascular therapy of carotid artery disease has emerged as a potential alternative to endarterectomy and its clinical practise dramatically increased in many parts of the world. This study aims to determine the safety and mid-term outcome of carotid artery stenting (CAS) within a 15-year carotid program at a single-centre institution. Patients and methods: We retrospectively analysed all CAS-procedures performed at our institution between 1995 and 2009. Results: During the observation period, a total of 497 CAS procedures were attempted in 460 patients with stenoses of the internal carotid artery of which 187 (37.6%) were symptomatic and 310 (62.4%) were asymptomatic. CAS was successful in 479 (96.4%) cases and success rate significantly increased throughout the study (p < 0.001). The periprocedural complication rate for death, stroke, and transient ischemic attack (TIA) was 0.4%, 1.2%, and 2.6%, respectively, and the cumulative event rate did not differ between symptomatic and asymptomatic patients (4.8% vs. 3.9%; p = 0.62). Age was the only significant predictor for the occurrence of any periprocedural adverse event (OR 2.08 [1.22 - 3.54]; p = 0.007). During a median follow-up of 24 [1; 141] months, the rate of stroke, TIA, and in-stent restenosis was 1.0%, 2.2%, and 2.7%, respectively. Conclusions: Data from this large observation in everyday clinical patients demonstrate that endovascular therapy in carotid artery disease can be performed safely and with midterm outcomes comparable to carotid endarterectomy.