Results of Carotid Artery Stenting in a Belgian “Real-World” Practice

Objective: Carotid artery stenting (CAS) is a valuable solution for the
treatment of carotid artery stenosis in a population of patients at high
risk for carotid endarterectomy (CEA). This high-risk population includes
patients with recurrent stenosis after CEA, high/low lesion, contralateral
laryngeal nerve palsy, previous radical neck surgery, cervical radiation
therapy, and tracheostomy. In the European Society for Vascular Surgery
guidelines, however, the authors were concerned about the death and
stroke rates of CAS in “real-world” practice. Because Belgium is a small
country with a broad offer of medical care and there is no reimbursement
for CAS, only small numbers of patients can be treated per vascular
surgeon.
Methods: In our service, 47 CAS procedures were performed from
January 2006 to May 2018, of which we excluded 2 procedures because
they were performed for aneurysmatic disease. We analyzed 45 CAS procedures
for carotid artery stenosis in 40 patients. Characteristics of the
patients, indication for treatment and choice of treatment, minor stroke
rate, major stroke rate, and death rate were analyzed retrospectively.
Results: Of these patients, 8 of 45 (18%) had a symptomatic carotid artery
stenosis and 37 of 45 (82%) had an asymptomatic stenosis; 24 of 45
(53%) were treated with CAS because of recurrent stenosis after CEA,
and 13 of 45 (29%) were treated because of a hostile neck with (12/13) or
without (1/13) radiotherapy. A total minor stroke rate of 3 of 45 (6.6%)
was recorded, but no major stroke (0%) or death (0%). Of the 37 patients
who were asymptomatic at the start, 1 suffered a minor stroke (1/37
[2.7%]) perioperatively.
Conclusions: In our real-world practice, reasonable results were obtained
concerning minor periprocedural stroke rates. The higher minor
stroke rates in CAS procedures are according to other literature. With
no periprocedural major stroke or death, a good result was obtained.
Even in the specific Belgian situation, acceptable results can be obtained
with a CAS procedure in a high-risk population for CEA.