Carotid artery stenting in high risk patients--results of first twelve patients at Shifa International Hospital, Islamabad, Pakistan.

OBJECTIVE

Carotid artery stenting (CAS) is emerging as an alternative procedure to carotid endarterectomy. It is mostly performed in patients with high surgical risk. Many centers in Pakistan have started CAS. We present results of 1st twelve patients who underwent carotid artery stenting at Shifa International Hospital, Islamabad.

METHODS

Our carotid intervention team is comprised of a vascular neurologist, interventional cardiologist and interventional radiologist. Based on high risk criteria/patient choice, patients are recruited for CAS. Carotid artery stenting using standard technique with embolic protection device is performed.

RESULTS

Twelve carotid artery stenting procedures were done between August 2006 and March 2008. One patient had TIA before stent deployment and was excluded from final analysis. Of the other 11 patients, ten were males, with mean age of 68.2 +/- 11.3 years (median age 71). Ten were symptomatic; one asymptomatic with complete occlusion of contralateral internal carotid artery. High-risk criteria were present in all: complete contralateral occlusion (2 patients); age greater than 70 years (7 patients); severe coronary artery disease (7 patients) and previous ipsilateral endarterectomy (1 patient). The stenosis ranged between 60-95%. Embolic protection device was used in nine (82%). Five (46%) patients developed hypotension requiring intravenous vasopressors. One of them developed persistent hypotension despite maximum pressor support and died. None developed neurological deterioration, acute renal failure, or haematomas/ pseudoaneurysm formation. One-year follow-up is available on two patients with patent stent and no neurological events.

CONCLUSION

Hypotension is a common and potentially lethal complication of carotid artery stenting. Our results suggest that a multidisciplinary team approach with availability of specialized care can provide results comparable to internationally acceptable outcomes.