BACKGROUND: Stroke represents the third leading cause of death in developed countries and the leading cause of disability in the elderly. Because asymptomatic, surgically high-risk patients have been systematically excluded from randomized trials of carotid endarterectomy and medical therapy, the management of this group of patients is still controversial. A single-centre, single-operator registry was analyzed to evaluate feasibility and safety of carotid artery stenting (CAS) with distal protection devices in consecutive, asymptomatic, surgically high-risk patients who were scheduled for endovascular treatment of significant carotid stenoses. METHODS: A total of 122 consecutive, surgically high-risk, asymptomatic patients (150 carotid arteries, 59% men, mean [± SD] age 69±9 years) with severe carotid stenosis and one or more high-risk features for carotid endarterectomy were scheduled for CAS. All procedures were performed in a single centre by a single operator. All patients were prospectively asked to undergo a clinical 30-day follow-up. RESULTS: A total of 154 stents were implanted in 150 carotid arteries. The primary success rate was 98.7%. The rates of stenosis before and after direct CAS were 81%±9% and 10%±13%, respectively. The median of fluoroscopic time of direct CAS was 6 min (range 2.5 min to 31.5 min). At 30 days, data were available in all patients. The combined 30-day mortality and stroke rate was 1.3%. CONCLUSIONS: Short-term outcomes of CAS in asymptomatic, surgically high-risk patients treated by a single operator suggest a low periprocedural complication rate.

Cardiovascular Center University Hospital Motol 1st Medical School Prague Czech Republic Prague Czech Republic

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Atherosclerotic Plaque Composition Is Still an Almost Unrecognized Factor of Risk Stratification in Patients with Carotid Artery Disease