OBJECTIVE: Endovascular treatment - carotid artery stenting (CAS) - has been recommended as the current option in the treatment of carotid artery disease in high risk patients for carotid endarterectomy surgery (CEA). This study reports our experience at Instituto de Cirurgia Vascular e Endovascular de São Paulo with regard to CAS in high risk patients. MATERIAL AND METHOD: A retrospective descriptive study was performed based on the analysis of 113 medical charts of patients (84 males and 29 females) submitted to 130 CAS from March 2000 to June 2004. Mean age was 74 years (range, 51-86 years). Asymptomatic patients (55%) presented stenosis > 75%, whereas in symptomatic patients (45%) stenosis was > 70%. Indication for CAS included: high risk for CEA (45%), recurrent stenosis post-CEA (15%), contralateral internal carotid artery stenosis (14%), contralateral carotid occlusion (12%), high cervical bifurcation (6%), post-radiation stenosis (5%), anatomically limited access (3%). The lesions were located at: carotid bifurcation (46%), internal carotid artery (32%), common carotid artery origin (9%), brachiocephalic trunk (8%), and common carotid artery (5%). RESULT: Seven neurological events were observed (five cases of cerebral vascular accident and two patients who had a transitory ischemic attack). Death rate was 0%. Overall complication rate (cerebral vascular accident, transitory ischemic attack, death) was 5.3%. CONCLUSION: CAS has proved to be a procedure with a low complication rate. Therefore, it is a safe and efficient option in high risk patients for CEA.
Carotid artery; stenosis; angioplasty; high surgical risk
