Carotid Stenting for Severe, Symptomatic and High-Surgical-Risk Stenosis, a Clinical Series

Background: A significant number of randomized trials with long term follow up has been modifying the role of carotid stenting for symptomatic as well as asymptomatic carotid stenosis.

Method: In this retrospective study a series of high-surgical-risk symptomatic carotid stenosis managed with carotid stenting performed under standard protocol of general anaesthesia with distal filter protection and closed cell self-expanding nitinol stent was reviewed. Inclusion criteria were symptomatic carotid stenosis>70%, clinically significant cardiac disease, severe pulmonary disease, contralateral carotid occlusion, contralateral laryngeal nerve palsy, recurrent stenosis after carotid endarterectomy, previous radical neck surgery or radiotherapy to the neck. Follow up ultrasound was done at 6 and 24 months.

Results: 40 cases aged 50 to 85 years fulfilled the inclusion criteria. There were no stroke, myocardia infarct or death perioperatively or within 30 days. There was one unsuccessful intervention due to tight 99% stenosis precluding passage of filter wire. There was one asymptomatic recurrent stenosis>50% detected at two years in a case with prior radiation.

Conclusion: Carotid stenting with distal filter protection is safe and effective for severe, symptomatic and high-surgical-risk carotid stenosis.