What is the clinical evidence from this study?

Study design: Cohort. Population: Carotid artery stenosis in high-risk patients (n=170). Intervention: Carotid artery stenting. Primary outcome: 30-day stroke rate.

What question did this study set out to answer?

To assess the procedural safety, clinical efficacy, and restenosis rates of carotid artery stenting in patients facing high surgical risk for traditional carotid endarterectomy.

September 26, 2026Journal of the American College of CardiologyOpen Access

Safety and efficacy of elective carotid artery stenting in high-risk patients

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Key result

Elective CAS in high-risk patients yields a ~3% 30-day stroke rate with zero mortality.

n=170

Why the study?

Carotid endarterectomy has limitations and carotid artery stenting may be a reasonable alternative, particularly in high-risk patients.

Population

170 consecutive high-risk patients undergoing elective carotid artery stenting in 192 carotid arteries

Design

Prospective cohort study

Follow-up

30 days and mean 19 +/- 11 months

Authors

FSFayaz A. ShawlMuslim Community Center Medical Clinic WKWaleed KadroSociety of Interventional Radiology MDMichaël DomanskiHeart Failure & Transplant

Discussion

Member takes

Implication

Supports stenting feasibility in high-risk patients ineligible for endarterectomy; leaves open comparative efficacy versus surgery in randomized trials.

Key Points

To assess the procedural safety, clinical efficacy, and restenosis rates of carotid artery stenting in patients facing high surgical risk for traditional carotid endarterectomy.
Prospective evaluation of 170 consecutive patients undergoing carotid artery stenting across 192 carotid arteries, with 76% (129/170) meeting criteria that would exclude them from major endarterectomy trials.
The cohort had a mean age of 73 ± 8 years (95% CI, 57–89; 25% aged ≥80 years) and received independent neurological evaluations before and after the procedure; 73 patients underwent concurrent coronary interventions.
Procedural success was achieved in 99% of cases, significantly reducing carotid stenosis from a mean of 78 ± 10% (95% CI, 58–98%) pre-procedure to 2 ± 3% (95% CI, -4–8%) post-procedure.
The overall 30-day stroke rate was 2.9% per patient (1 major stroke, 4 minor strokes) and 2.6% per treated artery, with 0 myocardial infarctions and 0 deaths.
Over a mean follow-up of 19 ± 11 months, asymptomatic restenosis occurred in 2% (3/170) of patients, with no late major strokes or neurological deaths.

Study Design

Type

Cohort (n=170)

Structured PICO

Population

170 consecutive high-risk patients with carotid artery stenosis undergoing elective carotid artery stenting, followed for a mean of 19 months.

Exposure

Elective carotid artery stenting (CAS)

Outcome

Procedural success, 30-day stroke, myocardial infarction, and death, as well as restenosis at follow-uphard clinical

Elective carotid artery stenting is feasible and associated with low rates of periprocedural complications and restenosis in high-risk patients who are often ineligible for carotid endarterectomy.

Cite This Study

Shawl et al. (2000) conducted a cohort in Carotid artery stenosis in high-risk patients (n=170). Carotid artery stenting was evaluated on 30-day stroke rate. Elective carotid artery stenting in high-risk patients achieved a 99% procedural success rate with a 30-day stroke rate of 2.9% and no myocardial infarctions or deaths.

synapsesocial.com/papers/6ab78d551990c5312f751a61 https://doi.org/10.1016/s0735-1097(00)00618-5

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Implication

Supports stenting feasibility in high-risk patients ineligible for endarterectomy; leaves open comparative efficacy versus surgery in randomized trials.

Safety and efficacy of elective carotid artery stenting in high-risk patients

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Safety and efficacy of elective carotid artery stenting in high-risk patients

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

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