ABSTRACT
Introduction: This study aims to analyse the results of carotid stenting in a tertiary referral centre in Singapore. Materials and Methods: Retrospective analysis of all carotid artery stenting (CAS) cases in a single centre from March 1997 to December 2008 was performed. Sixty successful procedures were performed in 61 patients, with bilateral stenting in 1 patient, and 2 failed procedures. The majority were Chinese (78.7%) and males (77.0%), with a high proportion having hypertension (82.0%) and hypercholesterolaemia (78.7%). The majority (91.8%) of patients were high surgical risk candidates, primarily due to cardiac risk factors. Ten patients (16.4%) had prior neck irradiation for nasopharyngeal carcinoma, and 3 patients each (4.9%) had previous endarterectomy and contralateral occlusion. A distal embolic protection device was used in 71.7% of cases. Results: Technical success was 96.8%. The 30-day stroke and death rate was 13.8%, comparable to reported results for this high surgical risk population. Conclusion: CAS is a technically feasible and a relatively safe alternative to endarterectomy to treat extracranial carotid stenosis, especially in patients who are inoperable or at high surgical risk.
The NASCET1,2 and ESCT3,4 randomised controlled trials established benefits of carotid endarterectomy (CEA) over medical therapy in a selected group of patients with symptomatic high grade extracranial carotid artery stenosis. Building on these results, the findings of the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS)5 and SAPPHIRE6 trials demonstrated equipoise between CEA and carotid angioplasty with or without carotid stenting (CAS) in a randomised symptomatic standard risk cohort (CAVATAS), and in a high surgical risk cohort (SAPPHIRE). We conducted an analysis of our carotid stenting cases to analyse the benefits in our local patients, as well as the international patients referred to our service.
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