PONTE VEDRA BEACH, FLA. — Patients with critical carotid stenosis were more likely to have a stroke following carotid artery stenting than were those without critical stenosis in a study with 350 patients.
But this doesn't mean that stenting is not a good option for these patients. Although endarterectomy is also a “viable option” for patients with critical carotid stenosis, “these patients would be challenging for endarterectomy as well” because they are at high risk for stroke after any carotid intervention, David S. Lee, M.D., said at the annual meeting of the Society for Cardiovascular Angiography and Interventions.
In the study, critical carotid stenosis was defined as a stenosis of at least 90% that also required balloon predilation before it was possible to pass an embolic-protection device through the affected coronary artery. The need for predilation “was a marker for complex lesions and complex vessel morphology,” said Dr. Lee, a cardiologist at the Cleveland Clinic Foundation.
The study involved the 350 patients in a registry of those who underwent carotid stenting with an embolic protection device during August 1999-October 2003 at the Cleveland Clinic, of whom 21 required balloon predilation of their affected coronary artery to allow passage of an embolic protection device. All 350 patients began treatment with both aspirin and a thienopyridine (either clopidogrel or ticlopidine) at least 24 hours before their carotid procedure, and with unfractionated heparin during procedure. After the procedure, aspirin and thienopyridine treatment was continued for at least 4 weeks.
The study's primary end point was the incidence of stroke within 30 days of stenting. Two strokes occurred among the 21 patients with critical carotid stenosis (9.5%), and seven occurred among the other 329 patients (2.1%), a significant difference. The two strokes in the patients with critical carotid stenosis were not secondary to the balloon predilation procedures, Dr. Lee said.