מתוך medicontext.co.il
By Anthony J. Brown, MD
WESTPORT, CT (Reuters Health) – Stenting as a way to treat carotid artery stenosis can be performed safely as an outpatient procedure, according to a report published in the October issue of Stroke.
Dr. Nadim Al-Mubarak and colleagues, from Lenox Hill Hospital in New York, assessed the safety and feasibility of ambulatory carotid stenting in 92 patients, 61 to 79 years of age, with carotid artery stenosis.
Twenty-eight percent of the patients had symptomatic disease, 16% had previously undergone carotid endarterectomy, 4% had prior ipsilateral neck irradiation, and 8% had complete blockage of the opposite internal carotid artery, the authors note.
A suture-mediated closure device was used to seal the femoral artery access sites at the end of the procedure in all but 2 instances. With the development of this closure device "we realized that carotid stenting could be performed as an ambulatory procedure," Dr. Al-Mubarak told Reuters Health. "In the current study, all of the patients did very well with no neurologic events or other complications whatsoever," he said.
Dr. Al-Mubarak pointed out that "there is a potential to release embolic debris distally when performing this procedure. However, this risk can be greatly reduced by adequate physician training and appropriate patient and lesion selection. Applying these principles, you should be able to achieve a stroke rate of less than 2%."
Dr. Al-Mubarak commented that "to establish stenting as a viable treatment method, large randomized trials need to be done comparing it with carotid endarterectomy." In fact, "a large National Institutes of Health-sponsored trial comparing these modalities is already underway," he added.
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