The long-term outcome of carotid artery stenting or antiplatelet therapy in patients with severe carotid artery stenosis.

Objective: To identify the prognosis factors of the patients with high-degree carotid artery stenosis and evaluate the effects of carotid artery stenting and antiplatelet therapy prospectively.

Methods: Patients with severe carotid artery stenosis were enrolled in this study consecutively. Intervention was carotid artery stenting combined with antiplatelet therapy or antiplatelet therapy solely. No randomized method was used in this trail. Patients were monitored for 2 years after enrolling in this study. The primary end point was defined as neurological outcome (measured by modified Rankin score). The secondary end points were the composite of stroke, transient ischemic attack (TIA), acute myocardial infarction and sudden death.

Results: One hundred and three patients were enrolled into this work between May 2001 and August 2006 at the Fourth Hospital, Peking University. Forty patients were treated with stent placement, and 63 patients were treated only with antiplatelet drug. The baseline characteristics (gender, age, medical history, blood pressure, total cholesterol and triglyceride) were similar between the groups. Binary logistic analysis indicated that intra-artery intervention was an independent protective factor for malignant functional outcome (modified Rankin scale 3-6; relative risk: 0.13, p<0.001, 95% confidence interval: 0.036-0.46). For further follow-up, the median time of cardiovascular events in the two groups were 55 and 54 months, respectively. K-M analysis showed no statistical significance difference.

Conclusion: Carotid artery stenting combined with antiplatelet therapy may be helpful for high-risk patients with severe carotid artery stenosis. The benefit/harm of intra-artery intervention for patients with stroke or TIA suffered as a result of severe carotid artery stenosis in the long-term needs further evaluation.