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Safety and efficacy of elective carotid artery stenting in high-risk patients

Fayaz Shawl, MD, FACC^a, Waleed Kadro, MD, FACC^a, Michael J. Domanski, MD, FACC^a, Fernando L. Lapetina, MD^a, Aleem A. Iqbal, MD^*, Kathy G. Dougherty, CRTT, RCVT^a, David D. Weisher, MD^*, Jaime F. Marquez, MD and S. Tariq Shahab, MD, FACC^a

^a Department of Interventional Cardiology, Washington Adventist Hospital, Takoma Park, Maryland, USA
^* Department of Neurology, Washington Adventist Hospital, Takoma Park, Maryland, USA
Department of Vascular Surgery, Washington Adventist Hospital, Takoma Park, Maryland, USA

View larger version (100K): [in a new window]   Figure 1 An 82-year-old woman with a previous anterior MI (LVEF 25%) presented with unstable angina due to a critical left circumflex coronary artery stenosis. After a successful coronary intervention, carotid angiography showed critical, tandem (arrows) right carotid lesions (A) with an occluded contralateral internal carotid artery. Two (15-mm) Johnson & Johnson biliary stents were placed, with the proximal stent covering the distal common carotid artery (B), with excellent angiographic results. Intracerebral angiography showed excellent collateral filling (C) from the right carotid to the left anterior cerebral and middle cerebral arteries. (D) Follow-up duplex ultrasound at six months showed a widely patent stent. RT ICA = right internal carotid artery.

View larger version (19K): [in a new window]   Figure 2 Cumulative frequency distribution for minimal lumen diameter before, immediately after and six months after the procedure.

View larger version (12K): [in a new window]   Figure 3 National Institutes of Health (NIH) stroke scale at baseline, 24 h after carotid artery stenting and at follow-up.

View larger version (11K): [in a new window]   Figure 4 Kaplan-Meier actuarial curves demonstrating survival free from 1) myocardial infarction; 2) any stroke; 3) death; and 4) all events, with event-free survival rates of 98.1%, 95.1%, 93.6% and 88.2%, respectively, at a mean follow-up of 19 ± 11 months. At 12 months of follow-up, the rates were 98.3%, 95.1%, 95.1% and 89.6%, respectively.