Perioperative Complications After Carotid Artery Stenting: A Contemporary Experience From the University at Buffalo Neuroendovascular Surgery Team
Neurosurgery - Current Issue
BACKGROUND:Technological advances have resulted in diminishing perioperative complications reported during carotid artery stenting (CAS) trials. Because trial experience lags behind technological advances, an understanding of the incidence of perioperative complications after CAS remains in flux. OBJECTIVE:In this single-arm, observational study, a contemporary experience of CAS at a high-volume academic training center for neuroendovascular surgeons was reviewed to assess perioperative morbidity. METHODS:A prospectively maintained database of all neuroendovascular procedures was queried for all CAS procedures performed for stenotic atherosclerotic disease between 2009 and 2011. Each case was assessed for major perioperative (30 day) adverse events, including new acute ischemic stroke, postoperative symptomatic intracranial hemorrhage, myocardial infarction (MI), and mortality. RESULTS:A total of 474 patients were identified. Perioperative adverse events were noted in 13 patients (2.7%). These included 4 ischemic strokes, 4 intracranial hemorrhages, 3 MIs, and 5 deaths. Most perioperative events occurred in symptomatic patients (10 of 239 symptomatic patients with events, 4.2% event incidence), whereas these events occurred rarely in asymptomatic patients (3 of 235 asymptomatic patients with events, 1.3% event incidence). CONCLUSION:In this retrospective analysis of consecutive patients treated with CAS, the perioperative incidence of stroke (0.9%), MI (0.6%), and death (1.1%) was favorable. ABBREVIATIONS:CAS, carotid artery stentingCEA, carotid endarterectomyCREST, Carotid Revascularization Endarterectomy versus Stenting TrialMI, myocardial infarctionNASCET, North American Symptomatic Carotid Endarterectomy TrialNIHSS, National Institutes of Health Stroke scaleOriginal Article: http://journals.lww.com/neurosurgery/Fulltext/2013/10000/Perioperative_Complications_After_Carotid_Artery.24.aspx
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