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      Long-Term Results of Elective Stenting for Severe Carotid Artery Stenosis in Taiwan

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          Abstract

          Stenting for severe carotid stenosis has been proposed as an alternative for patients with high surgical risk for endarterectomy, but its effectiveness and safety has never been evaluated in large case series in a pure Asian population. One hundred and eighteen ethnic Chinese patients (mean age 72.8 years) with 129 severely narrowed carotid arteries were stented electively using self-expanding stents. The mean pre-treatment diameter stenosis was 85% and final residual diameter stenosis 14%. The peri-procedural stroke and death rate was 4.2%. One (0.8%) late ischemic stroke and 2 (1.7%) deaths occurred during a mean follow-up of 16.3 months, and the restenosis rate was 3.1%. Carotid stenting, therefore, can be done safely and effectively in Chinese patients.

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          Most cited references 5

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          The role of carotid screening before coronary artery bypass.

          Five hundred thirty-nine patients with no symptoms of cerebral ischemia undergoing coronary artery bypass were preoperatively evaluated for presence of carotid stenosis by noninvasive methods (duplex scanning and ocular pneumoplethysmography-Gee). Overall prevalence of carotid stenosis greater than 75% was higher (8.7%) than that generally reported. Age greater than 60 years was significantly related to presence of carotid stenosis greater than 75% (11.3% vs 3.8%, p = 0.003). Risk factors such as hypercholesterolemia, hypertension, diabetes mellitus, and smoking were not predictive for carotid stenosis, postoperative stroke, or death. Carotid stenosis greater than 75% (odds ratio 9.87, p less than 0.005) and coronary artery bypass redo (odds ratio 5.26, p less than 0.05) were both independent predictors of stroke risk. Patients were divided into four groups: group 1, minimal or mild degree of carotid stenosis (less than 50%), not submitted to prophylactic carotid endarterectomy (432 patients, 80.1%); group 2, moderate degree of stenosis (50% to 75%), no prophylactic carotid endarterectomy (60 patients, 11.2%); group 3, severe carotid stenosis; (greater than 75%), submitted to prophylactic carotid endarterectomy (19 patients, 3.5%), group 4, severe carotid stenosis (greater than 75%) no prophylactic carotid endarterectomy (28 patients, 5.2%). Patients in group 4 had significantly higher stroke rate (14.3%) compared to the other three groups (1.1%) (p = 0.0019). The finding of carotid stenosis greater than 75% in patients over 60 years of age was associated with occurrence of stroke in 15% of cases. Carotid screening is helpful to determine patients at increased risk of stroke and should be performed in patients greater than 60 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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            Current global status of carotid artery stent placement.

            Our purpose was to review the current status of carotid artery stent placement throughout the world. Surveys were sent to major interventional centers in Europe, North and South America, and Asia. Information from peer-reviewed journals was also included and supplemented the survey. The survey asked various questions regarding the patients enrolled, procedure techniques, and results of carotid stenting, including complications and restenosis. Of the centers which were sent surveys, 24 responded. The total number of endovascular carotid stent procedures that have been performed worldwide to date included 2,048 cases, with a technical success of 98.6%. Complications that occurred during carotid stent placement or within a 30-day period following placement were recorded. Overall, there were 63 minor strokes, with a rate of occurrence of 3.08%. The total number of major strokes was 27, for a rate of 1.32%. There were 28 deaths within a 30-day postprocedure period, resulting in a mortality rate of 1.37%. Restenosis rates of carotid stenting have been 4.80% at 6 mo. Endovascular stent treatment of carotid artery atherosclerotic disease is growing as an alternative to vascular surgery, especially for patients that are at high risk for standard carotid endarterectomy. The periprocedural risks for major and minor strokes and death are generally acceptable at this early stage of development.
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              Surgical staging for simultaneous coronary and carotid disease: a study including prospective randomization.

              Simultaneous carotid disease was documented in 275 (2.8%) of 9714 patients scheduled for coronary artery bypass (CAB), including 80 (29%) who had had previous neurologic events and 195 with severe (greater than or equal to 70% diameter), asymptomatic carotid stenosis. Preliminary carotid endarterectomy (CE) was feasible before CAB in only 24 patients with stable cardiac disease (group I). Another 129 patients with unstable disease (group II) had unilateral, asymptomatic carotid lesions and were prospectively randomized to receive either combined operations (IIA; n = 71) or CAB followed by delayed CE (IIB; n = 58). The remaining 122 patients (group III) had symptomatic or bilateral carotid stenosis and were managed on a selective basis without randomization. The operative mortality rate ranged from 4.2% to 5.2%, and the early stroke rates were 4.2% in group I, 7.8% in group II, and 11% in group III. Postoperative strokes occurred after CAB in nine (4.7%) of the 193 patients protected by preliminary or simultaneous CE, compared with six (7.4%) of the 81 who received only delayed CE. Nevertheless, the composite stroke risk for "reverse-staged" procedures in group IIB (14%) exceeded that for combined operations (2.8%) in group IIA (p = 0.045). The stroke rate was 11% (7/61) when delayed CE was performed within 2 weeks after CAB compared with 2.2% (1/46) with longer staging intervals.
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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2002
                April 2002
                25 April 2002
                : 97
                : 2
                : 89-93
                Affiliations
                aCardiovascular Division, Department of Internal Medicine, and bDepartment of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC
                Article
                57678 Cardiology 2002;97:89–93
                10.1159/000057678
                11978955
                © 2002 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, Tables: 3, References: 19, Pages: 5
                Categories
                Cardiac Catheterization and Interventional Cardiology

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