Carotid Stent Explant Indications And Outcomes
Coulter N. Small, BS, Tyler S. Thompson, BS, Salvatore T. Scali, MD, Scott A. Berceli, MD, PhD, Michol A. Cooper, MD, PhD, Martin R. Back, MD, Dean J. Arnaoutakis, MD, MBA, Gilbert R. Upchurch, Jr., MD, Thomas S. Huber, MD, PhD, Samir K. Shah, MD, MPH.
University of Florida, Gainesville, FL, USA.
OBJECTIVES: Carotid artery stenting is an alternative to carotid endarterectomy, especially in patients deemed to have significant anatomic or medical risk for the latter. As stenting has become more common - particularly with increasing transcarotid arterial revascularization - stent explant may become more frequent as well. There is scant literature, however, on indications for and outcomes of carotid stent (CAS) explant. We sought to determine indications and outcomes of CAS explant at our institution.
METHODS: We queried a prospectively maintained institutional vascular surgery database as well as hospital records to identify patients undergoing CAS explant from 2010 to 2020. 11 patients were identified, but three were lacking operative data. We extracted demographic, comorbidity, procedural, and outcomes data for the remaining eight patients.
RESULTS: Mean age was 68 years; 5 patients were male. All patients had at least one atherosclerotic factor, with hypertension being the most common(87.5%). Six(75.0%) patients had recurrent stenosis as the indication for explant. Six(75.0%) presented symptomatically (Table 1). Four(50.0%) cases of restenosis had been refractory to angioplasty. There were two(25.0%) instances of CAS explant due to infection. One patient had a history of radiation and radical neck dissection and underwent carotid endarterectomy with CAS as a temporizing measure for rupture. Based on the six available implant times, median time to explant from CAS was 53 months. Six(75.0%) patients were repaired with carotid artery bypass (three with PTFE, three with femoral vein) (Table 1); two(25.0%) had vein patch angioplasty. There was a mean hospital length of stay of 4.5 days. There was no 30-day mortality, stroke, or postoperative wound infections.
CONCLUSIONS: Carotid stent explant was performed principally for recurrent stent stenosis. Most patients had neurologically symptomatic presentations. The carotid artery was reconstructed with carotid bypass in most cases. Our series had 0% 30-day mortality, stroke, and postoperative wound infection suggesting that CAS explant may be performed safely. Our series is small but represents the largest single institution series to date. This procedure may become increasingly common in the coming years with the more frequent use of CAS; additional data is needed to rigorously understand outcomes.
|Variable||n (%) or mean (range)|
|Neurological Presentation||4 (50%)|
|Infectious Presentation||2 (25.0%)|
|Length of Hospital Stay||Mean 4.5 (1-16)|
|PTFE Bypass||3 (37.5%)|
|Femoral Vein Bypass||3 (37.5%)|
|Vein Patch||2 (25.0%)|
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