Impact of coronary artery disease presence on the long-term follow-up of carotid artery stenting

Abstract

Background: Carotid artery stenting (CAS) has become an alternative for carotid endarterectomy in the treatment of carotid artery atherosclerosis, due to limited injury and comparable periprocedural risk. The impact of coronary artery disease (CAD) on long-term follow-up after CAS needs to be reconsidered due to the intensifcation of aggressive pharmacotherapy in CAD in recent years. Aim: To assess the impact of CAD presence on the long-term follow-up of patients after CAS. Methods: Data of 130 symptomatic and asymptomatic patients undergoing CAS with cerebral protection systems from December 2002 to December 2010 were divided into two groups: those with and those without CAD. Major adverse cardio- and cerebrovascular events (MACCE) during follow-up were defned as the combination of death (cardiac and non-cardiac), myocardial infarction (MI) and stroke or transient ischaemic attack (TIA). Long-term outcomes of patients were stratifed based on the history of CAD. Results: The mean age of patients was 66 ± 9 years, and the majority of patients were male (80.2%). Long-term follow-up data were available in 86.2% of patients. During mean follow-up of 71.9 ± 31.7 months the all-cause mortality rate was 19.3%. The rates of MI, stroke/TIA, and MACCE were 16.7%, 12.3%, and 36.3%, respectively. The frequency of MACCE during long-term follow-up was higher in patients with CAD vs. without CAD (40.8% vs. 6.7%, p = 0.01), and the mortality rate in the two groups was 22.2% vs. 0%, (p = 0.07), respectively. Conclusions: Patients with symptomatic or asymptomatic carotid stenosis are high-risk individuals. The presence of CAD increases the risk of MACCE in such patients during long-term follow-up.