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Faggioli G. L. 1, Ferri M. 1, Gargiulo M. 1, Freyrie A. 1, Fratesi F. 1, Manzoli L. 2, Stella A. 1
1 Department of Vascular Surgery Policlinico S. Orsola, University of Bologna, Italy
2 Section of Epidemiology and Public Health University G. D’Annunzio of Chieti, Italy
Aim. Treatment of carotid stenosis by carotid stenting (CAS) is gaining popularity over standard carotid endarterectomy (CEA). However, no definitive conclusions on CAS efficacy have been drawn, especially on low risk patients. This study was aimed at evaluating CAS efficacy in patients with no morphological selection criteria and to examine potential determinants of CAS efficacy.
Methods. From December 2004 to July 2005, 214 patients with symptomatic >50% or asymptomatic carotid stenosis >80% were selected for CAS if they had creatinine <2.0 mg/dL, tolerance to aspirin and clopidogrel, absence of significant cardiac arrhythmias, bilateral iliac occlusion and coagulative disorders. Supraortic trunks and brain vascular state were evaluated using angio magnetic resonance imaging; duplex scanning was used for plaque characterization. No exclusion criteria were set according to plaque morphology or carotid anatomy. The outcomes of CAS efficacy were the rate of technical success and neurological complications, whose relationship with selected demographic and clinical factors was analysed using logistic regression.
Results. Overall, technical success was achieved in 87.4% of the patients. The main reason for technical failure was tortuosity of vessels proximal to carotid stenosis. Perioperative mortality was 0%; 7% of the patients had temporary perioperative neurological complications. At bivariate and multivariate analysis, neither technical failure nor complications were significantly associated with gender, preoperative neurological symptoms, plaque morphology, grade of stenosis, contralateral stenosis or occlusion, and type of protection device and stent. The presence of aortic arch anomaly and type III arch were significantly associated with both technical failure and complications. Older age was significantly associated with an increased risk of technical failure only.
Conclusion. CAS can been performed with low complication rates o a broad category of patients. While several anatomical characteristics do not influence results, the anatomy of the aortic arch is an independent predictor of CAS failure and neurological complications.