SCOTTSDALE, ARIZ. — The results of carotid stenting appear to be similar to endarterectomy results for at least 5 years after the procedure, based on a cohort study of 2,172 patients treated at four European centers.
In the cohort of patients 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, Dr. Patrick Peeters said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.
Several different, self-expanding stents were used in the series, as chosen by 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.
The restenosis rates were 1% at 1 year, 2% at 3 years, and 3% at 5 years (139 patients); restenosis was considered to be 50% narrowing as imaged with ultrasound, noted Dr. Peeters, head of the department of cardiovascular and thoracic surgery at Imelda Hospital, Bonheiden, Belgium.
Previous studies 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 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.
Although stenting did not make a significant difference in the stroke/death rate, compared with ballooning only, it did in the restenosis rate. Restenosis at 5 years was 3% in the stented patients but 15% in the ballooned-only patients.
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) versus 17% for those not predilated. There was no difference in stroke and death in the series between patients who were symptomatic or asymptomatic.