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Varbella F, Cerrato E, Rolfo C, Quadri G, Franzè A, Ferrari F, Mariani F, Giacobbe F, Lo Savio L, Giay Pron P, Amarù S, Tomassini F. Characteristics and outcomes of elderly patients undergoing carotid stenting: Experience of a high-volume interventional cardiology center. Catheter Cardiovasc Interv 2022; 99:853-859. [PMID: 35235693 DOI: 10.1002/ccd.30002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 09/28/2021] [Accepted: 10/17/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Carotid artery stenting (CAS) is an attractive option in order to treat carotid artery stenosis. However, its safety in elderly patients is questioned. Aim of this single-center retrospective study was to assess data of elderly patients undergoing CAS, and to compare them with those of the younger (< 75 years). METHODS We collected data of 580 consecutive patients undergoing CAS between December 2007 and June 2020 and compared clinical and procedural characteristics as well as in-hospital major adverse events (MACCE) and long-term mortality between patients < 75 years and patients ≥ 75 years old. RESULTS There were 272 patients (46.9%) with age ≥ 75 years and 308 patients (53.1%) with age < 75 years. The median follow-up was 48 months (range 2-144). There was no significant difference about in-hospital MACCE between the two groups (4.7% in the older vs. 3.5% in the younger group, p = 0.9), but a higher rate of cerebral hemorrhage occurred in the older group (1.8% vs. = 0.3%, p = 0.07), even if not significant. Long-term mortality was significantly higher in the older group (27.9 vs. 20.1%, p = 0.027). Multivariate predictors of 12-months mortality were neurologic symptoms within 6 months (OR: 4.83; 95% CI: 2.04-11.42; p ≤ 0.001), smoking status (OR: 2.84; 95% CI: 1.17-6.86; p = 0.02) and age ≥ 75 years (OR: 2.78; 95% CI: 1.14-6.76; p = 0.024). CONCLUSIONS In elderly patients, CAS can be carried out efficaciously with acceptable procedural risks, if performed by expert operators and after a correct selection by a multidisciplinary team.
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Affiliation(s)
- Ferdinando Varbella
- Interventional Cardiology Unit, Infermi Hospital, Rivoli, Italy.,San Luigi Gonzaga Hospital, Orbassano, Italy.,Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Enrico Cerrato
- Interventional Cardiology Unit, Infermi Hospital, Rivoli, Italy.,San Luigi Gonzaga Hospital, Orbassano, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Cristina Rolfo
- Interventional Cardiology Unit, Infermi Hospital, Rivoli, Italy.,San Luigi Gonzaga Hospital, Orbassano, Italy.,Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Giorgio Quadri
- Interventional Cardiology Unit, Infermi Hospital, Rivoli, Italy.,San Luigi Gonzaga Hospital, Orbassano, Italy.,Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Alfonso Franzè
- Interventional Cardiology Unit, Infermi Hospital, Rivoli, Italy.,San Luigi Gonzaga Hospital, Orbassano, Italy.,Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Fabio Ferrari
- Interventional Cardiology Unit, Infermi Hospital, Rivoli, Italy.,San Luigi Gonzaga Hospital, Orbassano, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Fabio Mariani
- Interventional Cardiology Unit, Infermi Hospital, Rivoli, Italy.,San Luigi Gonzaga Hospital, Orbassano, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Federico Giacobbe
- Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Luca Lo Savio
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | | | | | - Francesco Tomassini
- Interventional Cardiology Unit, Infermi Hospital, Rivoli, Italy.,San Luigi Gonzaga Hospital, Orbassano, Italy.,Department of Cardiology, Infermi Hospital, Rivoli, Italy
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Thirty-Day Outcome of Carotid Artery Stenting in Elderly Patients: A Single-Center Experience. World Neurosurg 2020; 138:e311-e316. [PMID: 32112939 DOI: 10.1016/j.wneu.2020.02.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The safety of carotid artery stenting (CAS) in elderly patients is controversial. The aims of this study were to evaluate 30-day outcomes after CAS in elderly patients (≥70 years old) and to investigate risk factors for postoperative incidence of major adverse clinical events (MACE) to improve CAS safety based on clinical evidence in this specific subgroup of patients. METHODS The data set included patients who underwent CAS between 2001 and 2017 at Xuanwu Hospital, Capital Medical University. The primary outcome variable was 30-day postoperative incidence of the following MACE: death, myocardial infarction, and ipsilateral stroke. Univariate and multivariate analyses were performed to identify high-risk patients and procedural characteristics associated with MACE. RESULTS A total of 1029 elderly patients who underwent CAS for carotid artery stenosis were identified and analyzed. The incidence of postoperative MACE was 3.01% (n = 31 cases [5 deaths, 24 strokes, and 2 myocardial infarctions]). After multivariate analysis, independent predictors of MACE included a family history of stroke (odds ratio [OR] = 3.817; 95% confidence interval [CI], 1.227-11.876; P = 0.021), symptomatic status (OR = 2.650; 95% CI, 1.210-5.806; P = 0.015), and modified Rankin Scale score ≥3 (OR = 4.594; 95% CI, 1.708-12.352; P = 0.003). Hyperlipidemia was not an independent risk factor (OR = 1.597; 95% CI, 0.745-3.425; P = 0.229). CONCLUSIONS At our center, CAS was safely performed in elderly patients. A family history of stroke, symptomatic status, and modified Rankin Scale score ≥3 indicating a neurologic deficit increased the risk of 30-day postoperative MACE.
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Garriboli L, Pruner G, Miccoli T, Recchia A, Tamellini P, Jannello AM. Carotid Artery Stenting Without Embolic Protection Device: A Single-Center Experience. J Endovasc Ther 2018; 26:121-127. [PMID: 30514133 DOI: 10.1177/1526602818816656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of carotid artery stenting (CAS) performed without an embolic protection device (EPD) in a selected group of asymptomatic patients with primary internal carotid artery (ICA) stenosis or restenosis after carotid endarterectomy (CEA). MATERIALS AND METHODS Between May 2015 and May 2018, 77 patients (mean age 77 years; 60 men) underwent CAS without any embolic protection device. Forty-seven (61%) patients had primary ICA stenosis and were excluded from CEA because of high surgical risk; the other 30 (39%) patients had post-CEA restenosis (n=26) or a distal ICA flap after eversion CEA (n=4). The mean ICA stenosis was 82%. All procedures were performed from a femoral artery access. Pre- and/or postdilation were used in 64 patients. The primary outcome was the incidence of major complications (death, stroke, or myocardial infarction) during the procedure and within 30 days; the secondary outcome was the incidence of restenosis in follow-up. RESULTS No relevant bradycardia was encountered during CAS. The combined rate of stroke, death, or myocardial infarction at 30 days was 1.3%. The single stroke patient recovered fully after 2 months. Over a follow-up that ranged to 3 years (mean 24±18 months), no further neurological events were recorded. One (1.3%) patient had a >70% restenosis after 6 months; the lesion was dilated, successfully restoring the lumen contour. CONCLUSION In our series, endovascular treatment of carotid stenosis without the use of protection devices in patients with primary stenosis or postsurgical restenosis can achieve satisfactory safety and efficacy outcomes. The choice of performing CAS without using EPDs should follow a tailored approach based on the appropriate patient anatomy and specific clinical parameters to minimize neurological complications.
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Affiliation(s)
- Luca Garriboli
- 1 Department of Vascular and Endovascular Surgery, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | - Gianguido Pruner
- 1 Department of Vascular and Endovascular Surgery, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | - Tommaso Miccoli
- 1 Department of Vascular and Endovascular Surgery, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | - Andrea Recchia
- 1 Department of Vascular and Endovascular Surgery, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | - Paolo Tamellini
- 1 Department of Vascular and Endovascular Surgery, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | - Antonio Maria Jannello
- 1 Department of Vascular and Endovascular Surgery, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
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Hopf-Jensen S, Marques L, Preiß M, Müller-Hülsbeck S. Initial Clinical Experience With the Micromesh Roadsaver Carotid Artery Stent for the Treatment of Patients With Symptomatic Carotid Artery Disease. J Endovasc Ther 2015; 22:220-5. [PMID: 25809366 DOI: 10.1177/1526602815576337] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To assess the effectiveness, technical aspects, handling, and safety of the micromesh Roadsaver Carotid Artery Stent in the treatment of atherosclerotic carotid artery stenosis and tandem lesions in ischemic stroke patients. Methods: Seven patients (5 men; mean age 75±11.4 years, range 53–86) suffering from symptomatic internal carotid artery (ICA) stenosis (mean 76% diameter reduction) were treated with the dual layer closed-cell stent without embolic protection. Postdilation was performed in 6 of 7 patients. Two patients were treated in the context of ischemic stroke and concurrent middle cerebral artery occlusion. Mean National Institutes of Health Stroke Scale score at admission was 12.8±5. Results: All devices were deployed satisfactorily. One wall-adherent thromboembolus in a proximal ICA was covered with the Roadsaver stent in a tandem lesion setting. The modified Rankin Scale (mRS) declined from 3.7±0.7 to 2.4±0.8 in hospital, showing an improvement in clinical symptoms. No complications were detected during or after the procedure. The 30-day mRS was 1.7±1.1. At 6 months, ultrasound examination demonstrated patency of stents and the external carotid arteries. Conclusion: The Roadsaver double layer micromesh stent seems to be safe and effective in the treatment of extracranial ICA stenosis and in the context of tandem lesions in ischemic stroke. Further studies with larger populations are warranted.
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Affiliation(s)
- Silke Hopf-Jensen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Germany
| | - Leonardo Marques
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Germany
| | - Michael Preiß
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Germany
| | - Stefan Müller-Hülsbeck
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Germany
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