The CAPTURE registry: Predictors of outcomes in carotid artery stenting with embolic protection for high surgical risk patients in the early post‐approval setting

Abstract

In general, carotid stenting is performed safely in patients with severe stenosis at high surgical risk, with best outcomes in younger asymptomatic patients. However, there are certain patient and procedural characteristics that are associated with poorer outcomes. In these patients, the risk of stenting should be considered vis-à-vis both the anticipated benefit as well as the alternative surgical and medical options.

Randomized Controlled Trial of Symptomatic Middle Cerebral Artery Stenosis

“…Studies have shown that recent stroke is one of the major risk factors for procedural complications, which usually resulted from unstable plaques. 24,26,27 Second, the operators are highly experienced, having performed more than 500 intracranial angioplasty and stenting for intracranial atherosclerosis in the 5 years before the trial. In contrast, the SAMMPRIS trial only required the operators to have experience with intracranial stenting, not necessarily for treating intracranial atherosclerosis.…”

Neurological Outcome of Stenting in Carotid Occlusive Diseases.

“…The cause of difference may be explained by the difference in pathology of the plaque more than the degree of the stenosis as the cases in the current study are symptomatic which characterized by presence of plaques with fissures, intramural microthrombi or inflammation so stenotic lesions are more vulnerable to vascular complications (22 This difference can be explained by that all cases included in the current study carotid stenosis due to atherosclerosis while other studies carotid in-stent restenosis occurs [mostly in non-atherosclerotic carotid stenosis lesions (radiation induced carotid stenosis and post-endarterectomy restenosis) which have more liability to restenosis.…”

Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis

“…Recent symptoms may be a marker for unstable plaque, which could increase the risk of distal embolism during stenting, as has been reported with extracranial carotid stenting. 26,27 Another explanation for the higher rate of periprocedural stroke in this trial is that the rigorous protocol for evaluating events (i.e., evaluation of all potential end points by neurologists, the adjudication process, and sitemonitoring visits) could have resulted in the detection of some milder strokes that may not have been detected in the registries. However, the percentage of primary end-point strokes in the PTAS group that were disabling or fatal (35%; 16 of 46 patients) is higher than the percentage of primary end-point strokes that were categorized as major in the stenting group (21%) or the endarterectomy group (28%) in a recent randomized trial involving patients with extracranial carotid stenosis.…”