Long-term outcomes of carotid stenting in a single neurovascular center: up to 12-year retrospective analysis with a focus on the influence of comorbidities

• Published in: Neuroradiology 2024, Vol.66 (1), p.117-127
• Main Authors: Hajiyev, K., Cimpoca, A., Ernemann, U., Bäzner, H., Henkes, H., von Gottberg, P.
• Format: Article
• Language: English
• Subjects: Asymptomatic; Carotid arteries; Carotid artery; Cerebral infarction; Comorbidity; Death; Diabetes; Diabetes mellitus; Durability; Exercise; Health risks; Imaging; Interventional Neuroradiology; Ischemia; Medicine; Medicine & Public Health; Mortality; Myocardial infarction; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Patients; Physical activity; Radiology; Risk reduction; Stenosis; Stroke; Survival
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-023-03248-0

Background The aim of this study was to evaluate long-term outcomes in patients who underwent carotid artery stenting (CAS) for symptomatic or asymptomatic high-grade stenosis. Methods A total of 1158 patients (asymptomatic, n  = 636; symptomatic, n  = 522) underwent CAS at our center between 2009 and 2020. A total of 560 patients or contacts (asymptomatic, n  = 316; symptomatic, n  = 244) were interviewed by telephone to evaluate long-term outcomes with a mean follow-up of 5 years. Mortality from all causes, myocardial infarction, and stroke, as well as comorbidities influencing their occurrence, including overall survival and stroke-free survival, were examined. Results The overall survival rate for all-cause mortality was 91.6% at 1 year, 77.1% at 5 years, and 55.7% at 10 years. A total of 39 (6.9%) patients had an ischemic stroke during long-term follow-up. The stroke-free survival rates at 1 year, 5 years, and 10 years were 97.9%, 92.7%, and 86.6%, respectively. Stroke-free survival and overall survival did not differ significantly between the symptomatic and asymptomatic groups (overall survival, p  = 0.304; stroke-free survival, p  = 0.336). Regular physical activity reduced the risk of stroke and death and was associated with better long-term clinical outcomes. Age at treatment and diabetes mellitus were statistically significantly associated with death during follow-up. Conclusion Long-term follow-up data confirmed the effectiveness and durability of CAS as a therapy option for both symptomatic and asymptomatic patients. In patient selection for CAS, special consideration should be paid to patient age, ability to engage in physical activity, and diabetes mellitus.