Carotid artery stenting in patients with acute coronary syndrome: a possible primary therapy for symptomatic carotid stenosis

Journal article

PURPOSE: To report the results of carotid artery stenting (CAS) in symptomatic patients (stroke/transient ischemic attack) after recent percutaneous transluminal coronary angioplasty (PTCA) for acute coronary syndrome (ACS). METHODS: Between January 2009 and July 2011, 28 consecutive patients (18 women; mean age 66 years, range 42-82) underwent protected CAS for symptomatic carotid stenosis following recent PTCA that included bare or drug-eluting stents requiring uninterrupted dual antiplatelet therapy. Primary technical success, neurological complications, major adverse cardiovascular events, and death were evaluated at 30 days and over midterm follow-up. RESULTS: Technical success was 96%; 1 patient suffered a nonfatal major stroke (3.5% 30-day stroke rate) during the procedure. During a median 21.6-month follow-up, 4 (14%) patients died of myocardial infarction (all diabetic smokers with ejection fractions <40%), but there were no new neurological events. Estimated survival was 89.3% at 2 years. Further coronary interventions were performed in 2 diabetic patients with a body mass index >34 kg/m(2). CONCLUSION: This preliminary experience demonstrated that CAS is a reasonable, safe, and effective treatment for patients with symptomatic carotid artery stenosis who were recently treated with coronary stents requiring uninterrupted dual antiplatelet therapy.

Authors: Casana, R; Halliday, A; Bianchi, P; Fresa, E; Silani, V

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Sage Publications
• Journal: Journal of endovascular therapy
• Volume: 20
• Issue: 4
• Pages: 546-551
• Publication date: 2013-08-01
• DOI: 10.1583/13-4244.1
• EISSN: 1545-1550
• ISSN: 1526-6028
• Language: English
• Keywords: Postoperative Complications; Cerebral protection; Male; Aged; Humans; Coronary artery disease; Angioplasty, Balloon, Coronary; Aged, 80 and over; Stroke; Stents; Middle Aged; Acute Coronary Syndrome; Percutaneous coronary intervention; Myocardial infarction; Female; Adult; Carotid Stenosis; Carotid artery stenting; Coronary angioplasty