Extracranial Carotid Artery Stenting in Surgically High-RiskPatients Using the Carotid Wallstent Endoprosthesis:Midterm Clinical and Ultrasound Follow-Up Results

The purpose of this study was to evaluate thefeasibility, safety and midterm outcome of elective implantation of theCarotid Wallstent® in patients considered to be at high surgicalrisk. In a prospective study, 54 carotid artery stenoses in 51 patientswere stented over a 24-month period. Three patients underwent bilateralcarotid artery stenting. Institutional inclusion criteria for invasivetreatment of carotid occlusive disease (carotid endarterectomy orcarotid artery stenting) are patients presenting with a 70% or moresymptomatic stenosis and those with an 80% or more asymptomaticstenosis having a life-expectancy of more than 1 year. All patients treated by carotid artery stenting were considered at high risk for carotidendarterectomy because of a hostile neck (17 patients—31.5%) orbecause of severe comorbidities (37 patients—68.5%). No cerebralprotection device was used. Of the 54 lesions, 33 (61.1%) weresymptomatic and 21 (38.8%) were asymptomatic. Follow-up was performed byphysical examination and by duplex ultrasonography at 1 month, 6months, 1 year and 2 years after the procedure. All 54 lesions could bestented successfully without periprocedural stroke. Advert eventsduring follow-up (mean 13.9 ± 5.7 months) were non-stroke-relateddeath in 6 patients (11.1%), minor stroke in 4 stented hemispheres(7.4%), transient ipsilateral facial pain in 1 patient (1.8%),infection of the stented surgical patch in 1 patient (1.8%) andasymptomatic instent restenosis in 4 patients (7.4%). The percutaneousimplantation of the Carotid Wallstent®, even without cerebralprotection device, appears to be a safe procedure with acceptableclinical and ultrasonographic follow-up results in patients at highsurgical risk. But some late adverse events such as ipsilateralrecurrence of non-disabling (minor) stroke or instent restenosis stillremain real challenging problems.