Australia & New Zealand Society of Vascular Surgeons

Introduction Carotid Artery Stenting (CAS) has been recommended as an alternative to carotid endarterectomy (CEA) by some clinicians. However recently published clinical trials have reported 30-day stroke and death rates of 10-12%. This prompted a review of our experience with CAS in high-risk patients to document our results and guide further use of CAS. Methods From September 1996 to present, we have performed 105 CAS procedures in 63 (60%) men and 42 (40%) women, mean age 70 years (range 45-93). Indications for CAS included restenosis after prior CEA in 74 cases (67%), primary lesions in high-risk patients in 38 cases (28%) and carotid stenosis with prior ipsilateral radiation therapy in 8 cases (7%). Asymptomatic stenoses >80% were managed in 62 patients (61%), while symptomatic lesions were treated in 39 patients (39%). Results Technical success of CAS occurred in all cases. Mean severity of stenosis prior to CAS was 87 + 6 and 9 + 4% after CAS. Two deaths (1.9%, 1 reperfusion/intra-cerebral hemorrhage and 1 myocardial infarction 10-days after discharge) and one stroke (0.9%) were observed (30-day stroke and death 2.8%). Two transient neurological events occurred (1.9%). No cranial nerve deficits were noted. No neurological complications have been observed in the last 27 cases (26%). Conclusions A 30-day stroke and death rate of 2.8% in our experience demonstrates acceptability of CAS as an alternative to reoperation or primary CEA in high-risk patients. We recommend further clinical investigation of CAS and participation in clinical trials by vascular surgeons.