Convenience of carotid artery stenting in management of carotid artery stenosis in surgically high-risk patients: periprocedural results and early outcome

Aim
The aim was to review the value of carotid artery stenting (CAS) in management of carotid artery stenosis in surgically high-risk patients.
Patients and methods
This prospective study was carried out in Vascular Surgery Department at 6 October Insurance Hospital and Mahmoud Mosque Specialized Hospital on 45 patients (33 males and 12 females), with a mean age of 68 years (54–82 years), who had carotid artery stenosis and were at high risk for surgery. Patients were subjected to CAS during the period between December 2015 and March 2019 and followed up for 1 year. Nearly all carotid lesions were in internal carotid artery (41 patients, 91.1%) and only four (8.9%) patients had common carotid artery lesions. Of 45 patients, 39 had symptomatic carotid stenosis whereas 6/45 patients were asymptomatic and were referred from cardiothoracic surgery unit before coronary artery bypass graft. The commonest clinical presentation was stroke (55.6%) followed by transient ischemic attack (TIA) (31.1%).
Results
Technical success was achieved in all patients, and all the procedures were performed using embolic protection devices. Periprocedural (within 30 days) complication included stroke in 6.7% (three patients) and TIA in 8.9% (four patients), with no deaths or MI. Regarding the overall 1-year complications, five (11.1%) patients developed stroke, where two cases had intraoperative stroke after stent deployment whereas the other cases occurred during 6th–12th month follow-up. One patient developed cerebral hemorrhage and eight (17.8%) cases developed TIA. Acute MI occurred in five (11.1%) patients. A total of six (13.3%) cases had intraoperative bradycardia. Death occurred in three (6.7%) patients.
Conclusion
Management of carotid stenosis in surgically high risk patients is debatable. The main task is prevention of stroke. CAS is an effective and convenient procedure for management of carotid artery stenosis in surgically high-risk patients. Whatever the used technique, proper patient selection and preprocedural planning are necessary in achieving success.