Background Carotid artery stenting (CAS) is an established procedure for the treatment of atherosclerotic disease affecting the extracranial internal carotid artery. Recent population-based studies have suggested that long-term survival after CAS may be limited, thereby questioning its efficacy in a real-world scenario.
Methods We retrospectively reviewed outcomes of patients undergoing CAS for asymptomatic or symptomatic carotid stenosis by a neurosurgeon or interventional neuroradiologist at our institution between 2008 and 2018. Patient and disease characteristics were recorded, as was the incidence of peri-procedural and overall ischemia and mortality after CAS. Risk factors for recurrent ischemia and mortality were identified using a Cox proportional hazards model.
Results There were 238 patients who met inclusion criteria. Mean age was 69.7 years and the majority of patients were male (69.7%). Most patients had one or two major comorbidities (52.9%), and 21.4% had more than two major comorbidities. 62.2% underwent CAS for symptomatic carotid stenosis. Fourteen patients (5.9%) experienced new or recurrent ipsilateral ischemia during follow-up, with eight (3.4%) experiencing a stroke with permanent neurologic deficit. 59 patients (24.8%) died during follow-up with a median to time to death of 111.3 months (95% CI: 95.1 – 133.6) on Kaplan-Meier analysis. Increasing age at time of CAS (Unit Risk ratio (1.06, 95% CI 1.02–1.10, p=0.005) and more than two major comorbidities (RR 3.82, 95% CI 1.28–11.49, p=0.02) were independent risk factors for mortality during follow-up.
Conclusion Unlike population-based studies, our results indicate acceptable long-term survival rates after CAS in adequately selected patients.
Disclosures L. Rinaldo: None. A. Bhargav: None. C. Arnold Fiebelkorn: None. G. Lanzino: None.
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