Extracranial Carotid Artery Stenting: The Puerto Rico Medical Center Endovascular Neurosurgery Service Experience

Abstract

Objective: Extracranial carotid artery stenting (CAS) represents a viable alternative for high-risk surgical patients. The aim of this study was to determine the clinical features and outcome of 25 patients that underwent CAS at the Puerto Rico Medical Center. Methods: A retrospective review of a series of 25 high-risk surgical patients that underwent CAS from June 2005 to January 2010 was performed. Patients were followed-up at clinics with computed tomography angiography and/or digital subtraction angiography. Results: Patient ages ranged from 52 to 88 years. Twenty-one of the patients had severe cervical carotid stenosis (more than 80%). Those with moderate stenosis (from 50% to 80%) were treated when they were symptomatic or when stenosis recurred after carotid endarterectomy. Among the 25 patients, only 2 presented with restenosis (more than 50% luminal diameter). Both had a history of radiation-induced disease, but neither required retreatment. Five patients required post-stenting angioplasty due to a less than 50% improvement in luminal diameter. There was 1 death, and 1 patient presented delayed neurocognitive deterioration. The combined long-term morbidity and mortality in the subgroup with at least two years of follow-up was 8.3%. There were no intracerebral hemorrhages or recurrent strokes/transient ischemic attacks. Conclusion: The restriction of post-stenting angioplasty to only those cases without significant revascularization appears to help reduce restenosis rates while ensuring a gradual increase in intracranial blood flow. The latter may not apply to patients with a prior history of radiotherapy.