There are no data outside controlled studies, neither are there long term outcomes, on carotid artery stenting. This study was designed to assess the long term effectiveness of carotid stenting to prevent strokes in a large number of real life patients.
This registry included prospective data with a strict follow up protocol on 901 patients undergoing carotid stenting between the years 1999 and 2015 in one center.
Population mean age was 71±9 years and symptomatic stenosis was found in 262 patients (29.1%).
The population also had a high rate of comorbidities. In fact, 289 patients (32.1%) should have been excluded as per CREST protocol (Carotid Revascularization Endarterectomy Versus Stent Trial).
Median follow up was 5.5 years (range 2.6 – 7.9 years) and it was completed in 93% of patients.
Primary end point (combination of death, stroke, acute myocardial infarction) at 30 days plus ipsilateral stroke beyond 30 days was 6.9% (9.9% in symptomatic vs. 5.7% in asymptomatic patients; p=0.03).
Events rate resulted higher in patients excluded from the CREST trial compared to those with less comorbidities that could have been included (11.4% vs. 4.9%; p=0.001).
Conclusion
Carotid artery stenting is effective at long term to prevent stroke in experienced centers. A high percentage of patients that would have been excluded from randomized studies undergoes carotid stenting in the daily practice. These patients have a significantly higher rate of cardiac and cerebrovascular events.
Original Title: Long-Term Outcomes of Carotid Artery Stenting in Clinical Practice.
Reference: Mudra H et al. Circ Cardiovasc Interv. 2016 Sep;9(9).
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