Introduction: Carotid endarterectomy (CEA) has become established as the preferred approach to the management of critical carotid stenosis. Carotid angioplasty with stenting (CAS) has recently arisen as an alternative in the treatment of carotid occlusive disease. This report describes our experience with carotid angioplasty applied to an unselected patient population suffering from high-grade carotid occlusive disease.
Methods: All patients suffering from carotid stenosis (> 50% symptomatic or > 80% asymptomatic) were offered CAS or CEA. The first 39 patients who underwent attempted CAS over this last year are reported here. CAS was performed with the SMART PRECISE or ACCULINK stents. All procedures were performed with cerebral protection.
Results: The planned procedure success rate was 97% and the major adverse event (MAE) rate was 2.6% in 38 patients who underwent successful CAS. This included a minor stroke and a subendocardial myocardial infarction in the same individual. Both events were attributed to sustained postprocedural hypotension probably induced by increased carotid sinus activity.
Conclusion: CAS can be accomplished with a MAE rate comparable to CEA and will likely become the dominant alternative to CEA for the management of carotid stenosis. In the setting of equivalent morbidity, it appears likely that a nonsurgical option will be preferred by patients.