Carotid Stenting in Patients with Symptomatic Coronary Artery Disease: A Preferred Approach.

endarterectomy (CEA) is superior to medical therapy in patients with severe carotid artery stenosis. Surgical endarterectomy, however, has several limitations. In the North American Symptomatic Carotid Endarterectomy Trial (NASCET), the risk of stroke or death was 5.8% overall. In high risk patients with significant coronary artery disease, morbidity and mortality as high as 18% has been reported. Cranial nerve palsies occur in 8% to 27% of patients. Furthermore, although inadequately studied, restenosis after endarterectomy appears to occur in 8% to 19% of p a t i e n t s – 9 , 1 1 , 1 2 and scarring from the initial operation makes repeat endarterectomy difficult. Percutaneous techniques have the potential for being safer, less traumatic, more cost effective, and usable in patients at high surgical risk. An advantage compared with CEA is that they are not limited to the cervical portion of the carotid artery. Percutaneous balloon angioplasty of the carotid arteries was first performed in the early 1980s, 3 – 1 8 but concern about potential risks of embolization to the central nervous system has slowed developement. Ongoing technical refinements, powerful new anti-platelet agents, and the addition of stent implantation have made the percutaneous approach an attractive alternative to conventional endarterectomy. As the technique of stent supported carotid angioplasty (SSCA) has evolved, the target population has expanded and new strategies are being formulated to reduce the risk of neurological complications. Multicenter experience in 2,048 patients 9 – 2 7 was recently reported. The peri-procedural risks for major and minor strokes and death are acceptable for the early stage of development, with a minor stroke occurance rate of 4.8%, major stroke occurance rate of 1.32%, and a 30 day post-procedure mortality rate of 1.37%. 8 This review discusses current indications, institutional protocol and procedural results, in-hospital and follow-up evaluation of the first 124 consecutive patients treated at Washington Adventist Hospital.