Endovascular treatment of symptomatic carotid stenosis using stent placement - Long-term follow-up of patients with a balanced surgical risk/benefit ratio

Background and Purpose-Carotid endarterectomy (CEA) is not necessarily bene ficial in all patients with symptomatic high-grade (greater than or equal t o 70%) internal carotid artery (ICA) stenosis. Independent risk factors mod ulate both the individual stroke risk under medical treatment and the combi ned stroke and death risk after CEA. Endovascular stenting of symptomatic I CA stenosis may be an alternative to CEA in patients with a balanced surgic al risk/benefit ratio. Methods-We included 43 patients (71% men; median age, 67 years) with a rece ntly symptomatic ICA stenosis with greater than or equal to 70% luminal nar rowing in whom the individual sum of medical and surgical risk factors sugg ested a balanced surgical risk/benefit ratio (risk-modeling appraisal deriv ed from the European Carotid Surgery Trial). After stenting of the stenosed ICA with distal balloon protection, the mean +/- SD follow-up, including c linical and ultrasonographic examinations, was 20 +/- 11.8 months, with a m edian number of examinations of 5 per patient. Results-Recanalization of ICA stenoses was technically successful in 40 of 43 procedures (93%). Within the 30-day postinterventional period I death oc curred (2.5%), and the combined stroke and death rate within follow-up was 5%. Except for I asymptomatic ICA occlusion, no restenosis greater than or equal to 70% occurred during follow-up. Conclusions-ICA stenting in symptomatic patients with a balanced surgical r isk/benefit ratio is technically feasible, with a low periprocedural risk o f stroke or death. Furthermore, the risk of future stroke and rate of signi ficant restenosis during long-term follow-up appears to be low, suggesting that ICA stenting may be useful in carotid revascularization and stroke pre vention.