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Stroke
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my personal edition > stroke > news
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DGDispatch
Carotid Stenting Appears Safe, Effective In Preventing Strokes: Presented at RSNA
By Ed Susman
CHICAGO, IL -- December 1, 2004 -- Retrospective study results appear to show that carotid artery angioplasty and stenting to prevent strokes has similar safety and efficacy as surgical carotid endarterectomy.
In a comparison with historical data, the stenting procedure resulted in about a 3% neurological complication rate and a 4% restenosis rate, said Gianluca Piccoli, MD, an interventional radiologist at the Santa Maria della Misericordia Hospital, Udine, Italy, in his presentation at the Radiological Society of North America 90th Scientific Assembly and Annual Meeting.
"In our retrospective study, we treated 222 patients who had a total of 228 lesions that were corrected using carotid angioplasty with stent implacement," Dr. Piccoli said. "Our findings demonstrate that carotid angioplasty is a safe procedure and the results are the same [as those] of surgical ones reported in literature."
Dr. Piccoli reported on 178 patients in the series with at least 6 months follow-up. Three patients died -- two of non-related disease and one from a fatal contralateral stroke. Two other strokes, which were considered to be minor in nature, also occurred. About 65% of patients were symptomatic; the others, although asymptomatic, had appreciable blockage in imaging studies.
"This study adds to the body of evidence that carotid stenting at this institution can be performed safely and with acceptable results," said Michael Brant-Zawadski, MD, medical director of radiology, Hoag Memorial Hospital, Newport Beach, California, United States. Dr. Brant-Zawadski moderated the RSNA-sponsored press briefing at which Dr. Piccoli presented his data.
Dr. Brant-Zawadski cautioned that the new information is unlikely to settle the controversy over who should perform the procedures nor whether the less invasive, catheter-based procedure is superior in efficacy and benefits when compared with open operations. The controversy may be resolved, he said, by an ongoing study that randomizes candidates to either the minimally invasive angioplasty and stent implacement or open surgery.
Dr. Piccoli said that all the procedures in the current series were performed using an umbrella-like filter upstream of the lesion to collect clot debris that might cause additional damage in smaller blood vessels in the brain.
He said the stents used in the carotid arteries are similar to those used in coronary arteries, but are somewhat larger. He did not use drug-eluting stents because, he said, the low rate of restenosis (4%) makes those more expensive stents less necessary in the carotid arteries. Dr. Piccoli said that in his institutions decisions on whether to stent or to perform open surgery is made by an interdisciplinary team of doctors, including surgeons, neurologists and radiologists.
Dr. Brant-Zawadski applauded the multidisciplinary approach to the procedure. "Whomever does these procedures -- whether the surgeon or an interventional radiologist or a cardiologist -- it is imperative to think of the patients," he said. "I want to have a doctor present who knows how to deal with problems if they occur, especially someone familiar with brain vascular anatomy who can correct something that occurs elsewhere in the brain."
[Presentation title: "Protected Carotid Artery Angioplasty and Stenting: Acute and Long-term Outcomes in 180 Patients." Abstract SSK03-05]
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