Carotid artery stenting in clinical practice results from the Carotid Artery Stenting (CAS)-registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK) |
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| Authors: | Zahn R Roth E Ischinger T Mark B Hochadel M Zeymer U Haerten K Hauptmann K E von Leitner E-R Schramm A Kasper W Senges J |
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| Institution: | (1) Herzzentrum Ludwigshafen, Kardiologie, Bremserstraße 79, 67063 Ludwigshafen, Germany;(2) Med. Klinik 1—Kardiologie, Stadtkrankenhaus, Gabriel von Seidlstr. 31, 67550 Worms, Germany;(3) Kardiologie—Städtisches Klinikum, Englschalkinger Str. 77, 81925 München-Bogenhausen, Germany;(4) Med. Abt. 1—Kardiologie, Marien-Hospital, Pastor Janssen Str. 8–38, 46483 Wesel, Germany;(5) Kardiologie, Krankenhaus der Barmherzigen Brüder, Nordallee 1, 54292 Trier, Germany;(6) Med. Klinik II—Kardiologie, Städt. Krankenhaus Siloah, Roesebeckstr. 15, 30449 Hannover, Germany;(7) Klinik für Innere Medizin und Kardiologie, Marienhospital, Johannisfreiheit 2–4, 49074 Osnabrück, Germany;(8) Med. Klinik 1—Kardiologie, St.-Josefs-Krankenhaus, Solmsstr. 15, 65189 Wiesbaden, Germany |
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| Abstract: | Summary
Background
Carotid artery stenting (CAS) for symptomatic and asymptomatic carotid stenosis seems to be on the doorstep of more widespread use. However, its feasibility and safety in clinical practice at a broad spectrum of hospitals needs to be determined.
Methods
We analyzed data of the prospective multi-centre Carotid Artery Stenting (CAS) Registry of the German Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK).
Results
From 7/1996 to 5/2004 1888 patients from 28 hospitals were included in the CAS Registry. The median hospital stay from CAS until hospital discharge was 3 days (quartiles: 2–6 days). Median patients age was 70 years (quartiles: 64–76 years) with 72.1% males. CAS for symptomatic stenosis was performed in 55% of cases. Patients treated with CAS suffered from coronary artery disease in 66.5%, had arterial hypertension in 91.7%, hyperlipidemia in 86.3% and 34.2% were diabetics. The intended CAS procedure was completed in 98.1% of cases. A stent was implanted in 97.3% of completed cases. The median intervention time was 43 min (quartiles: 30–60 min). During the hospital stay death rate was 0.3% (5/1888) and the rate of ipsilateral stroke 3.2% (58/1840). A contralateral ischemic event occurred in 1.4% (26/ 1840) of patients. The combined rate of all death or strokes was 3.8% (70/1841). Between 1996 and 2004 there was a steady increase in the use of protection devices during CAS (0% in 1996 and 97.9% in 2004; p for trend <0.0001). There was also an increase in the proportion of patients treated for asymptomatic stenoses (p for trend <0.0001). We observed a decrease of the combined endpoint of death or stroke from 6.3% in 1996 to 1.9% in 2004 (p for trend=0.021).
Conclusion
The multi-centre ALKK CAS Registry data confirm the feasibility and shot-term safety of CAS even in daily clinical practice. There was a rapid penetration of the use of embolic protection devices, an increase in treatment of asymptomatic carotid stenoses and a decrease in acute complication rates from 1996 to 2004.For the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK) |
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| Keywords: | Carotid arteries carotid artery stenting protection devices angioplasty |
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