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Influence of anatomical factors on the feasibility and safety of carotid stenting in a series of 154 consecutive procedures

Objective The present study assessed the impact of unfavourable vascular anatomy on the feasibility and safety of carotid angioplasty and stenting (CAS). Methods Between 2000 and 2005, 154 CAS procedures (46% in symptomatics) were performed in 138 consecutive patients (mean age 72 ± 7 years, 63% males), followed for a median period of 16 months by a neurologist performing clinical and duplex scan examination. The impact on outcome of tortuous supra-aortic vessels, tortuous internal carotid artery (ICA), calcified stenosis and contralateral ICA occlusion were assessed. Results The feasibility was 100%. The 1-month rate of death and disabling stroke was 2.6% (1.2% in the asymptomatic group and 4.2% in symptomatic group, P = 0.33). The 1-month rate of any stroke and death was 4.5%. During follow-up, a further seven events occurred (one ipsilateral major stroke, one ipsilateral minor stroke and five deaths). There was no difference in occurrence of any event during follow-up between asymptomatic and symptomatic group (8.4% versus 9.6%, P = 0.78). At least one unfavourable vascular anatomy condition was present in 48% of cases, two conditions in 16% and three in 3%. No statistically significant association was found between unfavourable vascular anatomy and outcome. Intra-stent restenosis was registered by duplex scan in five cases (3.2%); it was associated with occurrence of minor stroke during follow-up (P = 0.032). Conclusions CAS as first choice procedure is feasible, safe and effective, despite hostile vascular anatomy may be encountered in some patients. Unfavourable anatomic conditions appear to have a scarce impact on outcome.