CAROTID ARTERY STENTING: AFIC-NIHD REGISTRY STUDY

Abstract

Objective: To report management, procedural outcome, short and long term results of carotid artery stenting in patients with significant carotid artery stenosis.

Study Design: Descriptive observational study.

Place and Duration of Study: Adult cardiology departments of Armed forces institute of cardiology / National institute of heart diseases (AFIC/NIHD) from January 2005 to December 2013.

Patients and Methods: We studied 168 patients from Jan 2005 to Dec 2013 who underwent carotid artery stenting with significant coronary stenosis. Significant lesion was defined as 70% stenosis as documented by non-invasive imaging or 50% as documented by catheter angiography in symptomatic patients and 70% as documented by validated Doppler ultrasound or at least 60-70% by catheter angiography in asymptomatic
patients. A 7 or 8F multipurpose guiding catheter was used to cannulate internal carotid artery depending upon type of deployment. We used either right coronary Judkin or JB diagnostic with railroad technique. The lesion was crossed with an appropriate sized distal protection device which was then deployed in the internal carotid artery at least 2.5 cm distal to the lesion. Predilatation was done in critical narrowing cases followed
by placement of self-expanding tapering carotid stent across the lesion. Direct stenting was done only when the lesion was considered suitable. Post dilatation was done subsequently to ensure that not more than 20% of residual stenosis was left. Mean age of patients was 65 ± 8.4 years. Majority of patients were males (78.9%). Embolic protection device was used in all cases.

Results: The procedural success rate was 97.03%.The 30 day event rate of primary end points-death, stroke or myocardial infarction was 4.16%. Two patients (1.19%) died after discharge. Stroke occurred in 5 patients (2.97%), in three ipsilateral to the stenting and in two contralateral. One patient developed stroke during the procedure, two after the procedure but before discharge and two after discharge but within 30 days.

Conclusion: Carotid artery stenting is a safe procedure for significant carotid artery stenosis as an alternative to carotid endarterectomy with low complication rate.