Learning curve during percutaneous treatment of carotid lesions

pp. 287-292

Abstract

Background: Percutaneous transluminal angioplasty (PTA) of the carotid artery with stent implantation is an effective procedure for the prevention of ischemic stroke, although its periprocedural morbimortality remains debated.
Objective: To report the results of a prospective series of patients treated with PTA.
Methods: Descriptive, observational, prospective study using the database of three Hemodynamic centers in Buenos Aires, including all patients who underwent PTA from January 1998 to December 2010. Results of PTA performed by the same operator were analyzed.
Results: Mean age was 69 years; 58% were men, 58.8% smokers, 52% dyslipidemic, 79.1% hypertensive, and 28% diabetic. Prior acute myocardial infarction and coronary surgery were present in 19.4% and 11.6% of patients, respectively. In the initial stage (1998–2004, n=54), 72% of patients were symptomatic and revascularization was performed without cerebral protection. In the recent stage (2004–2010, n=171), only 17.5% were symptomatic and cerebral protection was used systematically. Angiographic success was similar in both stages (96% vs. 97%), while clinical success was higher in the recent stage (96.1% vs. 87%, p=0.016). No cardiac complications occurred. Death or intrahospital stroke occurred in 4% overall—4.3% in symptomatic and 3.2% in asymptomatic patients—and was higher in the initial than in the recent stage (11.1% [6/54] vs. 1.7% [2/171], p=0.0028).
Conclusions: PTA represents an acceptably safe therapeutic alternative to surgical revascularization when performed by experienced operators.