Data from the registry was presented at EuroPCR, Paris, France, in May 2013. The data reflects a single-centre experience of carotid artery stenting in a small cohort of 65 diabetic patients.
Riccardo Colantonio, Operative Unit of Cardiology, San Pietro Fatebenefratelli Hospital, Rome, Italy, told delegates that in the last 10 years, carotid stenting had become an alternative to surgery, especially when patients were considered “high risk” for surgery. “In particular, diabetes has been demonstrated to be a strong predictor of adverse outcomes in patients undergoing carotid endarterectomy, but its significance in predicting the outcome of patients undergoing carotid artery stenting has not been established,” Colantonio said.
Sixty five consecutive diabetic patients underwent carotid artery stenting between January 2009 and December 2011. Of these, 36.9% (24/65) were on insulin therapy at the time. The other members of the cohort were on oral blood-sugar controlling medication. Nearly 75% (48/65) had hypertension. Concomitant coronary artery disease was present in nearly 60% (38/65) and nearly 60% of these had had a previous myocardial infarction (22/38). The average follow-up duration was 23.5±8.4 months. Clinical follow-up data was available for 92.3% of patients (60/65).
“The incidence of 30-day Major Adverse Cardiac and Cerebrovascular Events (MACCE) was 0. The cumulative long-term outcomes were MACCE: 6.1% (4/65), death: 1.5% (1/65), stroke: 3% (2/65), and myocardial infarction: 1.5% (1/65),” Colantonio noted.
He explained that physicians in the study used stents that had a closed-cell design in 70.7% (46/65) cases and performed post-dilatation routinely. “The procedure success rate was 100%. During the procedure 7500 units of prophylactic unfractionated heparin was administered and patients were on dual antiplatelet therapy for one month. We used a cerebral embolic protection device on all patients with proximal occlusion on just one patient,” he said.
“In our experience, carotid artery stenting results in positive clinical outcomes even for patients with diabetes and concomitant coronary artery disease. However, it would be useful to have prospective randomised controlled trials comparing endarterectomy, stenting and best medical therapy,” Colantonio said.