Abstract
BACKGROUND: Stroke represents the third leading cause of death in developed countries and the
leading cause of disability in the elderly. Because asymptomatic, surgically high-risk
patients have been systematically excluded from randomized trials of carotid endarterec-
tomy and medical therapy, the management of this group of patients is still controversial.
A single-centre, single-operator registry was analyzed to evaluate feasibility and
safety of carotid artery stenting (CAS) with distal protection devices in consecutive,
asymptomatic, surgically high-risk patients who were scheduled for endovascular treatment
of significant carotid stenoses.
METHODS: A total of 122 consecutive, surgically high-risk, asymptomatic patients (150 carotid
arteries, 59% men, mean [± SD] age 69±9 years) with severe carotid stenosis and one
or more high-risk features for carotid endarterectomy were scheduled for CAS. All
procedures were performed in a single centre by a single operator. All patients were
prospectively asked to undergo a clinical 30-day follow-up.
RESULTS: A total of 154 stents were implanted in 150 carotid arteries. The primary success
rate was 98.7%. The rates of stenosis before and after direct CAS were 81%±9% and
10%±13%, respectively. The median of fluoroscopic time of direct CAS was 6 min (range
2.5 min to 31.5 min). At 30 days, data were available in all patients. The combined
30-day mortality and stroke rate was 1.3%.
CONCLUSIONS: Short-term outcomes of CAS in asymptomatic, surgically high-risk patients treated
by a single operator suggest a low periprocedural complication rate.
