Evaluation of perioperative radiological, clinical and postop early period results of carotid artery stenting

Objective: Carotid artery stenosis is becoming increasingly common due to factors such as sedentary lifestyle, obesity, smoking, increased lifespan, higher incidence of comorbid diseases, and improved accessibility of imaging methods. The optimal treatment approach for carotid artery stenosis in symptomatic and asymptomatic patients remains uncertain, and detailed multicenter studies are needed. The objective of our study is to retrospectively analyze the perioperative radiological, clinical, and early postoperative outcomes of carotid artery stenting performed at our hospital, and to evaluate and present information from the literature. Materials and Methods: The study included 115 patients who underwent carotid artery stenting for atherosclerotic extracranial internal carotid artery stenosis between January 2020 and May 2023 at Harran University Faculty of Medicine Research and Practice Hospital. This retrospective study collected demographic information (age, gender, comorbid diseases), use of antiplatelet medication during diagnosis, symptomatic or asymptomatic status, emergency or elective procedure, history of acute ischemic infarction in the 5 days preceding the procedure, location and degree of stenosis measured by tomography and ultrasound, characteristics of the stenotic plaque (including ulceration and presence of thrombus), stenosis rate in the contralateral internal carotid artery extracranial segment of 50% or higher, stenosis rate in the ipsilateral and contralateral distal intracranial segment of the internal carotid artery of 50% or higher, use of predilation and postdilation during the procedure, length and diameter of the stent used, use of distal embolism protection device, occurrence of asystole and bradycardia during the procedure, technical complications related to the procedure, periprocedural extracranial complications, stroke incidence due to the procedure, procedure-related deaths, development of hyperperfusion bleeding, procedure-related local vascular access site complications, need for intensive care lasting more than 48 hours, incidence of periprocedural myocardial infarction, post-procedure residual stenosis rates, and length of postoperative hospitalization. Results: The study included 47 (40.9%) women and 68 (59.1%) men who underwent carotid artery stenting, with a mean age of 69.87±9.17 years. The mean age was 70.47±8.56 for female patients and 69.46±9.61 for male patients. Of the patients who underwent carotid artery stenting, 96 (83.5%) were symptomatic, and 19 (16.5%) were asymptomatic. A total of 108 (93.9%) patients had comorbidities, with hypertension being the most common (n=85, 73.9%; p<0.01). Elective stenting was performed in 96 (83.5%) patients, while emergency stenting was performed in 19 (16.5%) patients. Asystole occurred in 8 (6.9%) patients, and bradycardia occurred in 12 (10.4%) patients. The incidence of periprocedural stroke was 4 (3.5%), periprocedural myocardial infarction was 1 (0.9%), and the incidence of acute infarction in the 5 days before the procedure was 19 (16.5%). Periprocedural extracranial complications occurred in 1 (0.9%) patient, and 6 (5.2%) patients required intensive care for more than 48 hours. Three (2.6%) patients experienced hyperperfusion bleeding after carotid artery stenting. Predilation was performed in 16 (13.9%) patients, postdilation in 112 (97.4%) patients, and a distal embolism protection device was used in 113 (98.3%) patients. When comparing the data of the 19 patients who underwent emergency carotid artery stenting with the 96 patients who underwent elective carotid artery stenting, significant differences were found in ulcerated plaque (p<0.001), acute infarction in the preceding 5 days (p<0.001), stenting on a dissection ground (p<0.001), thrombus level in the internal carotid artery (p<0.001), asystole/bradycardia (p<0.001), and hospital stay (p=0.033). There were no significant differences between patients who underwent emergency and elective carotid artery stenting regarding periprocedural stroke (p=0.519), myocardial infarction (p=0.946), extracranial complications (p=0.835), and death (p=0.190). The intraoperative control DSA examination showed a residual stenosis rate of 22.13% after completion of the carotid artery stenting procedure. Conclusion: In our center, carotid artery stenting, performed in both emergency and elective cases, demonstrated patency rates and early complication rates similar to those reported in the literature for carotid artery stenosis. Future studies with larger patient populations and long-term follow-ups are needed to compare the long-term treatment outcomes and complications between emergency and elective carotid artery stenting. Key words: Carotid Artery, Stenting, Stenosis, Emergency, Elective