Carotid artery stenting: Technical considerations

BACKGROUND AND PURPOSE: Carotid endarterectomy (CEA) is one of the most fre quently performed operations in the United States. To offer patients a less invasive means to achieve the same goal, carotid artery stenting (CAS) is investigated as an alternative treatment to CEA, METHODS: Three hundred ninety patients underwent GAS, with 451 vessels trea ted. CAS was performed using a coaxial system with a 7F 90-cm sheath for pr edilation, stent placement, and stent dilation, Pretreatment antiplatelet t herapy was administered, We currently practice same-day admissions and 23-h our discharges. RESULTS: The technical success rate was 98%, The 30-day mortality/morbidity rates mere as follows: death, 1.7% (two [0,5%] neurologic and five [1.2%] systemic] major strokes, 0.9% (two of four were related to the intervention ); minor strokes, 5,5%. Among 25 patients who suffered minor strokes, 14 ac hieved complete recovery. On an annual basis, the incidence of minor stroke declined from 6.8% (1994-1995), to 5.8% (1995-1996), 5.3% (1996-1997), and then 4% (1997-1998), with no major strokes or neurologic deaths occurring during the 1997 to 1998 period. CONCLUSION: CAS is an effective treatment for carotid stenosis, With proper selection of patients and meticulous technique, complication rates compare favorably with those of CEA.