Evaluation of Short- and Long-Term Outcomes of Patients with Carotid Artery Stenting: 16-Year Experience at a Single Center

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Abstract
Background/Objectives: Carotid artery stenting (CAS) is a preventive treatment for symptomatic moderate-to-severe and asymptomatic severe carotid stenosis. This study evaluated short- and long-term complications and outcomes of CAS. Methods: We retrospectively analyzed 584 patients who underwent CAS at our Neurology Clinic between January 2004 and December 2020. Results: Of 584 patients, 271 (46.6%) were symptomatic and 311 (53.4%) asymptomatic. At 30 days, myocardial infarction (MI) occurred in 2.2%, major stroke in 2.4%, major adverse cardiac and cerebrovascular events (MACCE) in 4.1%, and vascular death in 1.4%. Mean Charlson Comorbidity Index (CCI) was higher in patients with 30-day MACCE (p=0.014) and vascular death (p=0.003). Atrial fibrillation (AF) independently predicted 30-day MACCE (OR 3.57, 95% CI 1.17-10.89) and vascular death (OR 10.17, 95% CI 2.18-47.42); CCI independently predicted MACCE at 5 and 10 years. Diabetes mellitus (69.7%) was not independently associated with MACCE, restenosis, or mortality after adjusting for CCI. Smoking, rather than sex, independently predicted 5-year restenosis (OR 4.61, 95% CI 1.80-11.79); the higher crude restenosis rate in men appears attributable to smoking prevalence. Actuarial analysis showed 10-year overall survival of 81.0%, MACCE-free survival of 75.3%, and restenosis-free survival of 73.4%. Conclusions: CAS is generally safe, but close follow-up is necessary to monitor complications, and careful preoperative risk assessment is essential. CCI and AF status should be considered alongside stroke history, carotid anatomy, and smoking status for perioperative risk assessment.

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