Abstract
Purpose According to evidence from randomized trials and current guidelines, elective carotid
artery stenting (CAS) is still considered second-line therapy compared with carotid
endarterectomy (CEA). However, the publication of randomized comparative trials for
patients with symptomatic stenoses occurred well over 10 years ago. In view of problems
regarding German quality assurance when differentiating elective from emergency interventions
and low case numbers for CAS indications, it seemed reasonable to present neurologically
controlled CAS results and to investigate whether elective CAS consistently fulfills
the strict quality criteria and what differences exist with respect to emergency CAS
interventions in acute ischemic stroke.
Materials and Methods Between 01/2012 and 07/2022, 141 elective CAS procedures were performed to treat
patients with symptomatic (n = 123) and asymptomatic (n = 18) stenoses. Protection
by a filter system was achieved in 134 of these elective procedures (95 %). During
the same period, 158 patients underwent carotid stenting for acute stroke. Complication
rates were determined using neurologically controlled data. CAS-related complications
(stent thrombosis, stent-associated vascular damage, thromboembolism, and symptomatic
hemorrhage) were extracted from emergency interventions, and clinical outcome (NIHSS
progression) was determined during the inpatient stay.
Results The rate of stroke and death determined during the inpatient stay for elective symptomatic
patients was 0.8 %. Early treatment within the first 7 days after the index event,
age > 70 years, and operator experience were not significant risk factors for the
occurrence of complications. No complications were observed after CAS of asymptomatic
stenoses. The procedure-related complication rate for emergency procedures was 7.8 %,
which was significantly higher than after elective CAS, as expected (p < 0.006).
Conclusion Even with limited indications and limited case numbers, compliance with the strict
quality criteria of the current S3 Guideline 2022 for elective CAS interventions is
possible for both symptomatic and asymptomatic stenoses in an experienced center.
Emergency CAS interventions have significantly higher complication rates under other
conditions and must be considered separately with regard to quality assurance.
Key Points:
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Elective carotid stenting fulfills the strict quality criteria of the current S3 guideline
2022.
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Emergency carotid stenting has significantly higher complication rates than elective
procedures.
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Elective and emergency carotid stenting cannot be meaningfully compared.
Citation Format
Key words
vascular - angiography - QA/QC - carotid artery stenosis - carotid artery stenting
- quality criteria
