Carotid artery stenting is safe and effective for symptomatic patients with acute coronary syndrome

• Published in: Catheterization and cardiovascular interventions 2020-07, Vol.96 (1), p.129-135
• Main Authors: Casana, Renato, Tolva, Valerio Stefano, Odero, Andrea, Malloggi, Chiara, Silani, Vincenzo, Parati, Gianfranco
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - complications; Acute Coronary Syndrome - diagnostic imaging; Acute Coronary Syndrome - mortality; Acute Coronary Syndrome - therapy; Acute coronary syndromes; acute myocardial infarction/STEMI; Aged; Angioplasty; Carotid arteries; Carotid artery; carotid artery disease; Carotid Stenosis - complications; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - mortality; Carotid Stenosis - therapy; Cerebral infarction; coronary artery disease; Death; Diabetes mellitus; Dual Anti-Platelet Therapy; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Endovascular Procedures - mortality; Female; Humans; Male; Metabolic syndrome; Middle Aged; Myocardial infarction; Patients; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - mortality; Recurrence; Restenosis; Retrospective Studies; Risk Assessment; Risk Factors; Stenosis; stenting technique; Stents; Stroke - etiology; Stroke - mortality; Surgery; Time Factors; Treatment Outcome; Ultrasound
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.28445

Background Patients with symptomatic carotid stenosis recently treated with percutaneous transluminal coronary angioplasty (PTCA) for acute coronary syndrome (ACS) are always classified as at high risk for surgery, given that they are required uninterrupted dual antiplatelet therapy. In this regard, carotid artery stenting (CAS) may represent a valid alternative. Objective The purpose of this study is to overview CAS outcomes in symptomatic patients with and without ACS. Methods One hundred fifty‐one consecutive symptomatic patients who underwent CAS between 2010 and 2017 in a single institution were included in this study, of which 66 (43.7%) were identified as having ACS. All patients were followed‐up with carotid duplex ultrasound scan and a neurological assessment of symptoms status at 30‐day postprocedure and at 3, 6, and 12 months, with annual follow‐up after that for 3 years. Results Among symptomatic ACS patients, common risks factors were active smoking, metabolic syndrome, diabetes, and hypertension. In the short‐term follow‐up, no significant differences were observed among rates of death, stroke, myocardial infarction (MI), and restenosis, between patients with and without ACS. Mean clinical follow‐up was 28.2 (12.3) months. In the long‐term follow‐up, higher rates of death and MI were recorded in patients with ACS (death: 11.4% vs. 5.4%, p = .04; MI: 11.4% vs. 3.6%, p = .02), owing to the complexity of these patients. Conclusions This single‐center study suggested that CAS is a safe and effective treatment for patients with symptomatic carotid artery stenosis, who recently underwent PTCA for ACS, requiring uninterrupted dual antiplatelet therapy.