Purpose: To report the results of carotid artery stenting (CAS) in patients
considered to have high-risk anatomical characteristics for carotid endart
erectomy.
Methods: CAS was performed in 39 carotid arteries of 37 consecutive patient
s (26 men; mean age 72 +/- 8 years, range 56-88) who met the criteria for h
igh-risk surgical anatomy: previous ipsilateral carotid endarterectomy (20/
39, 51.3%), common carotid bifurcation above the mandibular angle (5/39, 12
.8%), contralateral carotid artery occlusion (15/39, 38.5%), or previous ra
diation therapy to the neck (1/39, 2.6%). Palmaz, Integra, or Wallstents we
re deployed via a percutaneous femoral artery access. Independent neurologi
cal evaluation was performed at specified time points, and a dedicated comm
ittee adjudicated all clinical events.
Results: Procedural success was 100%, with no major in-hospital complicatio
ns. Neurological events were rare. Only 1 (2.6%) transient ischemic attack
occurred prior to discharge; at 30 days, 1 (2.6%) additional minor stroke h
ad been observed, giving a 2.6% cumulative 30-day "death plus any stroke" r
ate. Over a mean 11 +/- 6-month follow-up, 2 (5.4%) patients died of nonneu
rological causes, but there were no strokes.
Conclusions: CAS is a viable endovascular revascularization technique that
can be performed safely and effectively in patients with high-risk anatomy
for carotid endarterectomy.