Outcome of carotid artery stenting in asymptomatic and asymptomatic carotid artery stenosis patients in Siriraj Hospital.

BACKGROUND: Carotid artery stenosis represents one of the most common etiologies of stroke. One of current treatment modalities available for the treatment of carotid artery stenosis is carotid artery stenting (CAS). CAS is a less invasive revascularization strategy than carotid endarterectomy (CEA) in carotid artery stenosis. OBJECTIVE: To determine outcome of CAS in symptomatic and asymptomatic carotid artery stenosis patients in Siriraj Hospital. MATERIAL AND METHOD: The authors enrolled 82 patients with carotid artery stenosis that underwent carotid artery stenting between January 2006 and January 2010. Baseline characteristics were collected. Comorbid medical conditions (age > or = 80 years, congestive heart failure class III/IV angina pectoris class III/IV left main or > or = 2 vessels coronary artery disease, urgent heart surgery < 30 days, left ventricular ejection fraction < 30%, recent myocardial infarction < 30 days, severe chronic lung disease, severe renal disease) and anatomic features (lesion at second cervicle or higher; lesion below clavicle, prior radical neck surgery or radiation, prior ipsilateral CEA, contralateral laryngeal nerve palsy, tracheostomy) that are associated with increased complications after CEA were analyzed. Primary endpoint of the present study was the cumulative incidence of a major adverse cardiovascular event (MACE) at 30 days (a composite of death, stroke or myocardial infarction within 30 days after the intervention). RESULTS: There were 60 male (73.20%). Majority of age group (60-79 years) was 64 patients (78.0%). Symptomatic patients accounted for 69.5%. Eight patients (9.7%) developed a major cardiovascular event which was observed at 30 days. No correlation existed between either comorbid medical conditions or anatomic features to major cardiovascular event. Univariate and multivariate analysis showed that age > or = 80 years (p = 0.04) and history of transient ischemic attack (TIA) (p = 0.03) increased unfavorable outcomes. CONCLUSION: CAS is the alternative treatment to CEA for carotid artery stenosis. Risk factor for unfavorable outcomes at 30 days were age > or = 80 years and history of TIA.