Our Single-Centre Experience of Carotid Artery Stenting in High-Risk Patients over a 10-year period

INTRODUCTION: Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are means of carotid revascularisation in patients with carotid artery stenosis. Recent large randomised control trials (RCTs) have compared these two methods of carotid revascularisation, with conflicting results. We review the outcomes of all patients who have undergone CAS at a single centre. We also contrast the clinical features and outcomes of patients with symptomatic versus asymptomatic carotid artery disease. METHODS: We maintained a database of all patients undergoing CAS over a 10-year period. Patient demographic information was collected, as well as intra-procedural details, complications occurring within 30 days of the procedure and clinical follow-up. RESULTS: 203 patients underwent CAS over 10 years. After exclusions, 199 patients (M:F, 134:65) were included. Our patient population consisted largely of those unsuitable for surgery and therefore comprised a higher-risk group when compared to the patient population in the RCTs. There were more symptomatic patients (n=123, 61.8%) than asymptomatic patients (n=76, 38.2%). The 30-day major adverse event (MAE) rate was 8.5 % (n=17), including stroke (n=6, 3.2 %), myocardial infarction (MI) (n=2, 1.0 %) and death (n=9, 4.5 %). There was no statistical difference between MAEs in the symptomatic (n=11, 8.9 %) compared to the asymptomatic group (n=6, 7.9 %). CONCLUSIONS: The outcomes of CAS performed at our centre in an unrestricted high-risk group of patients compare favourably with those of recent RCTs. Despite a higher incidence of ischaemic heart disease (IHD) in patients with asymptomatic disease, outcomes were similar to those of symptomatic patients. Our data suggests that CAS is a safe and dependable method of carotid revascularisation when offered as an alternative to CEA or if patients are unsuitable for CEA.

引言：颈动脉支架置入术（CAS）和颈动脉内膜切除术（CEA）是颈动脉狭窄患者颈动脉血运重建的方法。近期的大型随机对照试验（RCT）对这两种颈动脉血运重建方法进行了比较，但结果相互矛盾。我们回顾了在一个中心接受CAS的所有患者的结果。我们还对比了有症状和无症状颈动脉疾病患者的临床特征和结果。 方法：我们建立了一个10年间所有接受CAS患者的数据库。收集了患者的人口统计学信息，以及手术过程中的详细情况、术后30天内发生的并发症和临床随访情况。 结果：10年间有203名患者接受了CAS。排除后，纳入199名患者（男∶女，134∶65）。我们的患者群体主要是那些不适合手术的患者，因此与RCT中的患者群体相比，是一个风险更高的群体。有症状的患者（n = 123，61.8%）比无症状患者（n = 76，38.2%）多。30天主要不良事件（MAE）发生率为8.5%（n = 17），包括卒中（n = 6，3.2%）、心肌梗死（MI）（n = 2，1.0%）和死亡（n = 9，4.5%）。有症状组（n = 11，8.9%）与无症状组（n = 6，7.9%）的MAE之间无统计学差异。 结论：在我们中心对无限制的高危患者群体进行的CAS结果与近期的RCT结果相比具有优势。尽管无症状疾病患者缺血性心脏病（IHD）的发病率较高，但结果与有症状患者相似。我们的数据表明，当作为CEA的替代方法或患者不适合CEA时，CAS是一种安全可靠的颈动脉血运重建方法。