CAS Supported by Long-Term Data From Single-Center Experience

March 22, 2010—An 8-year institutional review of early and late outcomes of CAS was published by Mark K. Eskandari, MD, et al online ahead of print in the Journal of Vascular Surgery, which can be accessed at www.jvascsurg.org (2010;51:1145–1151).

The investigators from Northwestern University's Division of Vascular Surgery concluded that vascular surgeons performing CAS with embolic protection can achieve good early and late outcomes that are comparable to CEA benchmarks. Late stent failures (stroke, restenosis, and/or stent fatigue), while uncommon, are a recognized delayed problem.

As detailed in the Journal of Vascular Surgery, the investigators reported a single-center, retrospective review of 388 carotid bifurcation lesions treated with CAS using cerebral embolic protection from May 2001 until July 2009. Data analysis includes demographics, procedural records, duplex examinations, arteriograms, and twoview plain radiographs over a mean follow-up time of 23 months (interquartile range, 10.9–35.4).

According to the investigators, at the time of treatment, the mean age of the entire cohort (76% men and 24% women) was 71 years, 13% were ≥ 80 years of age, and 31% had a history of either CEA and/or external beam neck irradiation (XRT). The mean carotid stenosis was 80%, and asymptomatic lesions represent 69% of the group. Overall 30-day rates of death, stroke, and myocardial infarction were 0.5%, 1.8%, and 0.8%, respectively. The combined death/stroke rate at 30 days was 2.3%. The 30-day major/minor stroke rates for analyzed subgroups were statistically significant only for XRT/recurrent stenosis versus de novo lesions, 0% and 2.6% (P = .03) but not for asymptomatic versus symptomatic patients, 1.9% and 1.7% (P = .91) and age < 80 versus ≥ 80 years, 2% and 1.8% (P = .52), respectively.

At long-term follow-up, the rates of freedom from all strokes at 12, 24, 36, and 48 months were 99.2%, 97.6%, 96.7%, and 96.7%, respectively. At late follow-up, the restenosis rate was 3.5%. Restenosis rates for recurrent stenosis/XRT versus de novo lesions were 2.7% and 3.4% (P = .39). Among the restenotic lesions were two associated type 3 stent fractures in de novo lesions, both of which were closed-cell stents. Additionally, two other type 1 fractures were identified, yielding a stent fracture rate of 5.5%. The late death rate for the entire group was 16.8%, with one stent-related death secondary to ipsilateral stroke at 20 months (0.3% death rate), the investigators stated.