Effect of Morphological Types of Carotid Lesion on Long-Term Outcomes of Carotid Artery Stenting

Abstract: Background: Over 2/3 rd of strokes are caused by carotid artery disease (CAD). Be it symptomatic or asymptomatic patients, the role of carotid artery stenting (CAS) in carotid artery disease is well established. Data on the effect of morphology on the CAS outcomes are limited. In addition, there are limited Indian data on the long-term outcomes of this procedure. This study attempted to address this data deficiency. Objective: To determine the effect of the morphological types of carotid artery lesions like soft stenosis, soft plaque, and ulcerative and total obstruction on the long-term follow-up of patients who underwent CAS. Materials and Methods: This was a single-center retrospective study conducted at a tertiary care facility. In total, 116 patients underwent CAS between 2000 and 2017. The mean follow-up period was 4.5 years. Stenosis was quantified using the North American Symptomatic Carotid Endarterectomy Trial. Long-term outcomes such as all-cause mortality and stroke (Major and Minor) were recorded. Results: Among the 116 patients with CAS, 31.03% (36) were asymptomatic and 68.97% (80) were symptomatic. The various symptoms included motor weakness in 50 (43.1%) patients, loss of consciousness in 8 (6.9%), amaurosis in 9 (7.7%), giddiness in 6 (5.2%), dysarthria in 5 (4.3%), and headache in 2 (1.7%). Post CAS, the first 30 days mortality was 0.86% (one death), and stroke was 1.72% (two major strokes). A total of 53 (45.7%) patients had soft stenosis, 57 (49.13%) had ulcerated plaques, 5 (4.31%) had soft plaques, and 1 (0.86%) had total occlusion. Long-term follow-up (69% follow-up) showed a mortality rate of 17.5% (14 deaths) and stroke of 5% (4 major strokes). Conclusions: CAS is an effective treatment modality for symptomatic and asymptomatic CAD. Almost all the stroke patients had ulcerated plaque and soft stenosis with worst outcomes compared to soft plaque/total occlusion. The long-term all-cause mortality and incidence of major stroke were comparable to those of carotid endarterectomy.