Back to Annual Meeting Posters

INTRODUCTION: Carotid artery angioplasty and stenting (CAS) is currently performed by vascular specialists from many different disciplines including radiology, cardiology, and surgery. A multi-disciplinary approach towards the peri-procedural evaluation and care of patients with carotid stenosis should potentially lead to improved outcomes.
METHODS: A prospectively collected and reviewed cohort study of patients between January 2007 and July 2012, who underwent a multi-disciplinary evaluation of carotid stenosis prior to CAS was performed. Each patient was evaluated by a stroke neurologist, interventional neuroradiologist or cardiologist, and a vascular surgeon. CAS procedures performed without complete evaluation were excluded from study. All patients received duplex ultrasound and a CT or MR angiogram using NASCET criteria for grading of carotid stenosis. All CAS cases were staffed by two experienced interventionalists from two different disciplines and an anesthesia team provided care during each case. Each patient was monitored in a surgical or neurological ICU. The outcome measures included 30-day neurological event, acute myocardial infarction (MI), and death.
RESULTS: A total of 35 patients (12 female, 23 male, average age 71) met study criteria. Of these, 27 patients (78%) had symptomatic carotid stenosis and 8 patients (22%) had asymptomatic high grade carotid stenosis. Carotid endarterectomy was considered either anatomically unsuitable or medically unfavorable in each patient. Two patients experienced prolonged hypotension after CAS and required blood pressure support until discharge. One patient (2.7%) died after congestive heart failure following CAS. No patient suffered neurological event or myocardial infarction after CAS. These outcomes are similar with regards to mortality and favorable in terms of neurological event and MI when compared to recently reported data on completed prospective randomized trials for CAS.
CONCLUSIONS: A multi-disciplinary approach towards CAS may allow for similar peri-procedural outcomes as compared with larger, internationally recognized database registries. Benefits of such an approach include a complete evaluation of each patient and procedure selection based on collaborative input and not practitioner skill-set bias.