SCOTTSDALE, ARIZ. — Carotid stenting results appear to be similar to endarterectomy for at least 5 years after the procedure, according to a cohort of 2,172 patients who were treated at four European centers.
In the cohort, which was enrolled prospectively between 1993 and 2004, the rate of ipsilateral major stroke or death from any cause was 4% at 1 year, 10% by 3 years, and 16% by 5 years, among the 138 patients followed for that long, Dr. Patrick Peeters said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.
The restenosis rates were 1% at 1 year, 2% at 3 years, and 3% at 5 years (139 patients), where restenosis was considered to be 50% narrowing imaged with ultrasound.
The results from this series are as good or better than results that have been previously reported for carotid stenting, although many of those procedures were done in the early era, before interventionalists had the experience they have now and before the advent of modern technologies, such as distal protection, noted Dr. Peeters, head of the department of cardiovascular and thoracic surgery at Imelda Hospital, Bonheiden, Belgium.
The previous studies have reported restenosis rates at 1 year ranging from 3% to 8%.
Moreover, although the earliest studies of carotid stenting had major, perioperative complication rates as high as 9%, 99.7% of the cases in this series were technically successful.
The results with stenting also compare well with endarterectomy, he noted. The European Carotid Surgery Trial reported a rate of major stroke or death of 15% at 3 years, very similar to the 13% rate of this series.
A number of different, self-expanding stents were used in the series, chosen by the individual interventionalists at the time of the procedure, with the most common being a closed-cell, cobalt chromium alloy stent, used in 62% of the patients. And 4% of patients received only balloon dilation.
Although stenting did not make a significant difference in the stroke/death rate compared with ballooning only, it did make a significant difference in the restenosis rate.
The rate of restenosis at 5 years was only 3% in the patients who were stented, but it was 15% in the ballooned-only patients.
Moreover, predilatation of the artery before stent placement also made a significant difference, Dr. Peeters said.
Of the stented patients, 30% were predilated. Their stroke and death rate at 5 years was 10% (33 patients) compared with a rate of 17% for those who were not predilated.
“We can't say why,” Dr. Peeters said.
In addition, there was no difference in stroke and death in the series between those patients who were symptomatic or asymptomatic.