Carotid revascularisation using angioplasty and stent in 134 consecutive cases in a reference hospital: a risky technique?

• Published in: Neurología (Barcelona, Spain) Spain), 2010-10, Vol.25 (8), p.485-490
• Main Authors: Parrilla, G, Zamarro, J, Espinosa de Rueda, M, Lüttich, A, Garrote, M, Morales, A, Escribano, B, Lucas, C, Martínez García, F, Hernández-Clares, R, López, J, Villegas, I, Tortosa, T, Moreno, A
• Format: Article
• Language: Spanish
• Subjects: Aged; Angioplasty - adverse effects; Angioplasty - methods; Carotid Stenosis - surgery; Endarterectomy, Carotid - methods; Female; Hospitals; Humans; Male; Postoperative Complications; Risk Factors; Spain; Stents - adverse effects; Stroke - prevention & control; Treatment Outcome; Vascular Surgical Procedures - adverse effects
• ISSN: 0213-4853
• DOI: 10.1016/j.nrl.2010.07.003

Carotid revascularisation (CR) using angioplasty and stent (ASC) is an effective procedure in the prevention of ischaemic stroke, but with a controversial morbidity and mortality in the different studies conducted in this field. The results of the ASCs performed in the Virgen de la Arrixaca University Hospital (Murcia) between January 2006 and April 2009 were analysed (epidemiology, indication, grade of residual stenosis and procedure complications). All patients subjected to ASC were pre-selected and followed up by neurologists, and they followed a strict medical protocol for performing the procedure. All ASCs were performed by a team consisting of two surgeons, an anaesthetist and a nurse. A total of 134 ASC were performed. The mean age of our patients was 72.7 years, with the large majority (75%) being male. The most prevalent diseases were, high blood pressure (81%), smoking (66.4%), and diabetes (38.1%). The most common indications for CR were symptomatic carotid stenosis with a level of stenosis of 75-99%, either in the left (33.6%) or right (32.1%), followed by asymptomatic stenosis combined with risk factors (11.2% in the left side and 10.4% in the right side). A level of stenosis less than 30% was achieved in 132 of the 134 ASC (98.5%). performed. Five patients (3.7%) had complications associated with the procedure, of which four were different clinical presentations of a re-perfusion syndrome and one an asymptomatic thrombosis of the stent. ASC is a complex technique that must be performed by appropriately trained specialists. The performing a minimum number of procedures per year and an admission protocol controlled by Neurology are essential conditions for a low rate of complications. Under these conditions, the morbidity and mortality of the technique is no higher than that of endarterectomy.