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Published online before print November 18, 2008, 10.1148/radiol.2493080057

(Radiology 2009;250:178.)

A more recent version of this article appeared on January 1, 2009
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© RSNA, 2008

Neuroradiology

Safety of Unprotected Carotid Artery Stent Placement in Symptomatic and Asymptomatic Patients: A Retrospective Analysis of 30-day Combined Adverse Outcomes1

Franco Perona, MD, Giorgio Castellazzi, MD, Luca Valvassori, MD, Edoardo Boccardi, MD, Laura de Girolamo, PhD, Gian Paolo Cornalba, MD, and Krishna Kandarpa, MD, PhD

1 From the Departments of Radiology (F.P., G.C.) and Research (L.d.G.), I.R.C.C.S. Galeazzi Orthopaedic Institute, Via Riccardo Galeazzi 4, 20161 Milan, Italy; Department of Neuroradiology, Ospedale Niguarda, Milan, Italy (L.V., E.B.); Department of Diagnostic and Interventional Radiology, University of Milan, School of Medicine, San Paolo Hospital, Milan, Italy (G.P.C.); and Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (K.K.). From the 2006 RSNA Annual Meeting. Received January 9, 2008; revision requested February 29; revision received June 3; accepted June 17; final version accepted July 3. Address correspondence to F.P. (e-mail: franco.perona{at}yahoo.it).

Purpose: To retrospectively evaluate the outcome of carotid artery stent placement (CAS) without the use of embolic protection devices (EPDs) in a large cohort of patients.

Materials and Methods: Institutional review board approval and informed consent from all patients were obtained. Preprocedure color Doppler ultrasonography (US), magnetic resonance (MR) imaging, or computed tomography (CT) were used to evaluate stenosis severity (70% or greater). Clinical findings and combined 30-day complication rates in 400 patients (289 men, 111 women; mean age, 73 years ± 8 [standard deviation]) who underwent unprotected CAS for asymptomatic (n = 156; 39%) or symptomatic (n = 244, 61%) stenoses were analyzed. Follow-up at 30 days included neurologic evaluation and color Doppler US.

Results: Self-expanding stents were successfully deployed in 397 of 400 (99.25%) patients. Among the 397 patients, nine (2.27%) major complications (all in patients with prior symptoms) had occurred at 30 days, including three (0.76%) major (all in patients who had stopped antiplatelet prophylaxis) and six (1.5%) minor strokes—three intraprocedural and three delayed. Minor complications included 16 (4%) transient ischemic attacks, four in asymptomatic and 12 in symptomatic patients. The 30-day combined adverse outcomes (transient ischemic attack, ipsilateral stroke, death) were significantly correlated with prior presence of symptoms (symptomatic, 8.6%; asymptomatic, 2.6%; P < .03).

Conclusion: Stent placement without EPD was performed with a high technical success rate. For asymptomatic patients, the combined 30-day adverse-outcomes rate was within the limits recommended by the American Heart Association for carotid endarterectomy and compared favorably with results reported for CAS with EPD. When a transient ischemic attack is excluded, the 30-day combined death and stroke rate among patients with prior symptoms also compared favorably with published results.

© RSNA, 2008