Percutaneous transluminal carotid artery angioplasty and stenting

Background: Carotid angioplasty with stenting is becoming a more popular treatment option for severe carotid occlusive disease. It is accepted as a less invasive technique than carotid endarterectomy and may provide an alternative for select patients, particularly those with significant comorbidities. Carotid artery stenting has been performed in Bahrain since 2006, but no studies have been conducted to evaluate its safety and effectiveness. This study aims to evaluate the feasibility, safety and efficacy of carotid artery stenting in Bahrain.

Methods: We conducted a retrospective case series to review patients who underwent carotid artery angioplasty with stenting at the Sheikh Mohammed Bin Khalifa Bin Salman Al Khalifa Cardiac Centre in the Bahrain Defense Hospital. We studied the demographic, lesion and procedural characteristics of patients and followed the patients for six months. Procedural success was defined as residual diameter stenosis of less than 30% in stented patients. The end points were death, stroke, myocardial infarction or transient ischaemic attack within 30 days or after six months of treatment.

Results: We performed 57 carotid angioplasty and stenting procedures in 47 patients (32 men and 15 women). The mean stenosis before stenting was 83.7% (σ=11.3%) and after stenting was 4.5% (σ=7%). Procedural success was achieved in 55 (96.5%) of the 57 interventions, with two unsuccessful procedures. The end points occurred in two out of the 57 cases within 30 days and in seven cases at six months. In the 30-day post-procedural period, there was one case of myocardial infarction (1.8%) and one case of transient ischaemic attack (1.8%). At six months of clinical follow-up, two patients (3.7%) had passed away and five (9.3%) myocardial infarctions had occurred. In all cases of myocardial infarction, the patients had a history of coronary artery disease before undergoing the carotid stenting. There were no complications with any of the procedures and the restenosis rate at six months for the lesion was 0%. Procedural failure due to inability to cross the lesion was reported in only one case.

Conclusions: Carotid artery stenting is a feasible, safe and effective treatment of carotid occlusive disease among patients with severe carotid artery stenosis. Long-term follow-up is recommended to determine whether the outcomes of this procedure are sustained.