Carotid artery stenting in older patients: is age a risk factor for poor outcome?

PURPOSE

To assess the impact of age on technical success and complications of carotid stenting in a prospective single-center cohort study.

METHODS

One hundred eleven consecutive patients (74 men; median age 70 years) with >or=70% symptomatic (n=33) or >or=90% asymptomatic (n=78) internal carotid artery (ICA) stenosis underwent carotid artery stent implantation. Primary technical success and periprocedural complications were compared in patients aged >75 years (n=28) to patients <75 years (n=83).

RESULTS

Patient groups below and above 75 years compared well with respect to baseline demographic and clinical data. Successful stenting was achieved in 108 (97%) patients. The combined neurological complication rate was 7% (n=8), with 1 (1%) major stroke, 1 (1%) minor stroke, and no 30-day mortality. Technical angiographic complications occurred in 8 (7%) patients. No significant differences between patients >75 years and those <75 years were observed for primary success rates (100% [28/28] versus 96% [80/83]; p=0.8), overall complications (14% [4/28] versus 16% [13/83]; p=1.0), neurological complications (7% [2/28] versus 7% [6/83]; p=1.0), or technical complications (7% [2/28] versus 4% [3/83]; p=0.6).

CONCLUSIONS

Elective carotid stenting can be performed safely in older patients with several comorbidities. Patient age does not seem to be an independent risk factor for poor outcome after endovascular treatment of internal carotid artery stenosis.

Carotid artery stenting: effect of learning curve and intermediate-term morphological outcome

PURPOSE

To assess the impact of learning on the rate of success and complications of carotid stenting in a single-center, one-operator series and prospectively follow a patient cohort with regard to restenosis.

METHODS

In 303 patients (mean age 70 +/- 8.8 years), 320 internal carotid arteries (ICA) were treated with carotid stenting for stenoses > or = 70%. Four groups of 80 consecutive interventions were compared with regard to primary technical success and periprocedural complications. Stent patency in follow-up was assessed using duplex scanning.

RESULTS

Stenting was successful in 298 (93%) arteries. The combined neurological complications (transient ischemic attacks and all strokes) and 30-day death rate was 8.2% (n = 25), but the all stroke and 30-day death rate was 3.0% (n = 9). A significant reduction in the frequency of neurological complications after the initial 80 interventions was observed (p = 0.03), but technical success was not appreciably improved with increasing experience thereafter. Over a median 12 months (interquartile range 6 to 24), cumulative patency rates were 91%, 90%, and 91% at 6, 12, and 36 months, respectively.

CONCLUSIONS

Elective carotid stenting can be performed with excellent technical success, an acceptable frequency of periprocedural complications, and good intermediate-term patency. However, our findings suggest that a larger number of interventions should be performed to overcome the negative effects of the initial learning phase.