Multidisciplinary approach to carotid stenting.

Abstract:

BACKGROUND:Stroke neurologists, vascular surgeons, interventional neuroradiologists and interventional cardiologists have embraced carotid angioplasty and stenting (CAS) because of potential advantages over carotid endarterectomy (CEA). At Austin Health, a multidisciplinary neuro-interventional group was formed to standardise indications and facilitate training. The aims of this study were to describe our organisational model and to determine whether 30-day complications and early outcomes were similar to those of major trials. METHODS:A clinical protocol was developed to ensure optimal management. CAS was performed on patients with high medical risk for CEA, with technically difficult anatomy for CEA, or who were randomised to CAS in a trial. RESULTS:From October 2003 to May 2008, 47 patients (34 male, mean age 71.5) underwent CAS of 50 carotid arteries. Forty-three cases had ipsilateral carotid territory symptoms within the previous 12 months. The main indications for CAS were high risk for CEA (n= 17) and randomised to CAS (n= 21). Interventionists were proctored in 27 cases. The procedural success rate was 94% with two cases abandoned because of anatomical problems and one because of on-table angina. Hypotension requiring vasopressor therapy occurred in 12 cases (24%). The duration of follow up was one to 44 months (mean 6.8 months). The 30-day rate of peri-procedural stroke or death was 6% and the one-year rate of peri-procedural stroke or death or subsequent ipsilateral stroke was 10.6%. Restenosis occurred in 13% (all asymptomatic). CONCLUSION:A multidisciplinary approach is a useful strategy for initiating and sustaining a CAS programme.

journal_name

Intern Med J

authors

Mak CS,Chambers BR,Clark DJ,Molan M,Brooks M,Roberts N,Fell G,Roberts AK,New G,Donnan GA

doi

10.1111/j.1445-5994.2010.02285.x

subject

Has Abstract

pub_date

2011-11-01 00:00:00

pages

789-94

issue

11

eissn

1444-0903

issn

1445-5994

pii

IMJ2285

journal_volume

41

pub_type

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