Outcomes Of Carotid Artery Stenting In Patients With Unstable Carotid Plaque And Patients With Carotid Occlusive Disease

Abstract

Background: Carotid atherosclerotic plaques exist as two distinct types, a majority is those that remain quiescent, and a smaller proportion is unstable and vulnerable to disruption. Increasing degrees of stenosis, however, have not been consistently accompanied by a correspondingly increased risk for stroke in asymptomatic patients. Not all plaques with unstable histologic features cause symptoms.

Aim: To report the follow-up of patients with unstable and stable carotid plaque in two different study groups after carotid stenting with embolic protection device.

Methods: This prospective interventional study included 20 patients with nine significant unstable plaque lesions and eleven stable plaques. All patients underwent carotid stenting with embolic protection device. Investigations included carotid duplex ultrasound, CTA and MRI to study the content of the plaque. The intervention was performed under local anesthesia in all patients. Follow-up included the neurological assessment and review of any post-procedure complication. Imaging follow-up included duplex ultrasound at 3 months post-procedure then every 6 months.

Results: Statistically significant relation between degree of stenosis (50-69 % or > 70 % stenosis) and age was observed. Statistically significant relation between occurrence of death and age. Neither comorbidities (DM, HTN, Hyperthyroid, Smoker and IHD) nor the diagnosis (Asymptomatic, Stroke and TIA) were statistically related to death (P>0.05). Meanwhile, there was a significant relation between the unstable plaque and the occurrence of death (p=0.038). There was non-statistically significant relation between occurrence of death among the studied cases and postoperative femoral hematoma or the brain edema that lasted less than 24 hours (P>0.05). However, there was statistically significant relation between occurrence of death among the studied cases and postoperative Ischemic stroke and Hemorrhagic stroke.

Conclusion: The findings of this study demonstrate favorable outcomes with carotid artery stent under filter protection, and carotid artery stenting is a safe alternative to carotid endarterectomy (CEA).