Safety and efficacy of carotid stenting in individuals with concomitant severe carotid and aortic stenosis

AIMS: Carotid artery stenting (CAS) prior to open-heart surgery may be a useful approach to minimise the risk of neurologic events in patients undergoing aortic valve replacement (AVR). METHODS AND RESULTS: All patients referred for carotid intervention at our institution between 1998 and 2005 with concomitant severe aortic stenosis (AS) (aortic valve area <1.0 cm2) were included. Data were obtained prospectively and confirmed by chart review. The primary endpoint was all-cause mortality at 30-days after CAS or AVR. Secondary endpoints included incidence of stroke, transient ischaemic attack (TIA), and myocardial infarction (MI) at 30-days after CAS or AVR. Patients were followed-up at 30-days, six months, and annually thereafter. Of the 829 patients who underwent CAS, 52 had severe AS. Carotid stenting in 28 (54%) of the patients was attempted using embolic protection devices. Three patients (6%) died <30 days after carotid stenting, and two (4%) died >30 days after carotid stenting but prior to aortic valve replacement. At one year after CAS, a total of nine patients had died. There were a total of 19 deaths (37%) over a median follow-up of 3.8 years. One patient (2%) suffered a TIA during carotid stenting; at 30-days and 1-year there were no strokes in the CAS group. There were no MI's. AVR was performed in 29 patients (56%), and at 30-days and 1-year there were no strokes or deaths noted in those patients. CONCLUSIONS: In patients with severe AS, CAS can be accomplished effectively and with a low rate of stroke, MI, and death.