Outcomes of Symptomatic Extracranial Carotid Artery Stenting in Octogenarians: A Single-Center Retrospective Study on Restenosis, Risk Factors, and Complications
Abstract
1. Introduction
2. Material and Methods
2.1. Study Design and Patient Selection
- Patients aged ≥80 years.
- Symptomatic carotid artery stenosis (50–99%).
- History of transient ischemic attack (TIA) or ischemic stroke attributable to symptomatic extracranial carotid stenosis within the past six months.
- Underwent CAS during the study period.
- Incomplete follow-up data.
- History of a major cerebrovascular event (e.g., disabling stroke) prior to CAS.
2.2. Details of Stents Used
- Open-cell stents (Wallstent, Boston Scientific, Natick, MA, USA);
- Closed-cell stents (Protégé RX carotid stent, Medtronic, Minneapolis, MN, USA).
- Femoral access, the preferred approach in most cases;
- Radial access, used in select cases based on patient anatomy and risk factors.
2.3. Follow-Up and Assessment
- Duplex ultrasonography at regular intervals;
- MRI or CT angiography, if restenosis was suspected.
2.4. Outcome Measures and Analysis
- (1)
- ISR rate based on imaging and clinical symptoms;
- (2)
- Risk factors contributing to restenosis, such as hypertension, diabetes, and smoking history;
- (3)
- Complications, including stroke, restenosis, hematoma, and other adverse events.
2.5. Stenting Procedure and Perioperative Management
2.6. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Significant Risk Factors for In-Stent Restenosis
3.3. Impact of Stent Type and Retreatment on ISR Grade
3.4. Multivariate Analysis of Risk Factors for In-Stent Restenosis (ISR)
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patient Characteristics and Stent Placement Data | |
---|---|
Characteristic | Value, Number (%) |
Age, years, mean ± SD | 85.3 ± 4.40 |
Sex, male | |
Male | 32 (57.1) |
Female | 24 (42.9) |
Medical history and comorbidities | |
History of TIA | 35 (62.5) |
History of cerebral infarction | 21 (37.5) |
Hypertension | 31 (55.4) |
Diabetes mellitus | 25 (44.6) |
Hyperlipidemia | 29 (51.8) |
Smoking | 17 (30.3) |
Procedural Success | 56 (100) |
mRS score | |
0 | 22 (39.3) |
1 | 25 (44.6) |
2 | 9 (16.1) |
Degree of stenosis | |
Moderate | 24 (42.9) |
Severe | 32 (57.1) |
Stent type | |
Open-cell stent | 19 (33.9) |
Closed-cell stent | 37 (66.1) |
Access Side | |
Femoral | 49 (87.5) |
Radial | 7 (21.5) |
Contralateral carotid stenosis | 10 (17.9) |
Restenosis | 7 (12.5) |
Type 3 arch | 9 (16.1) |
Major stroke | 0 (0) |
Death | 0 (0) |
Minor stroke, n (%) | 1 (1.7) |
MI | 0 (0) |
Pseudoaneurysm | 1 (1.7) |
Wound hematoma | 1 (1.7) |
Baseline Characteristics of In-Stent Restenosis | |||
---|---|---|---|
Variable | No In-Stent Restenosis (n: 49) | In-Stent Restenosis (n: 7) | p-Value |
Age, years, mean ± SD | 84.8 ± 4.2 | 88.2 ± 4.7 | 0.045 * |
Sex, n (%) | |||
Male | 29 (59.2) | 3 (42.9) | 0.447 |
Female | 20 (40.8) | 4 (57.1) | |
History of TIA, n (%) | 32 (65.3) | 3 (42.9) | 0.406 |
History of cerebral infarction, n (%) | 17 (34.7) | 4 (57.1) | 0.406 |
Hypertension, n (%) | 25 (51.0) | 6 (85.7) | 0.116 |
Diabetes mellitus, n(%) | 21 (42.9) | 4 (57.1) | 0.688 |
Hyperlipidemia, n (%) | 24 (49.0) | 5 (71.1) | 0.424 |
Smoking, n (%) | 11 (22.4) | 6 (85.7) | 0.002 * |
mRS score, n (%) | |||
0 | 21 (42.9) | 1 (14.3) | 0.312 |
1 | 21 (42.9) | 4 (57.1) | |
2 | 7 (14.3) | 2 (28.6) | |
Degree of stenosis, n (%) | |||
Moderate | 24 (49.0) | 0 (0) | 0.016 * |
Severe | 25 (51.0) | 7 (100) | |
Access Side, n (%) | |||
Femoral | 42 (85.7) | 7 (100) | 0.578 |
Radial | 7 (14.3) | 0 (0) | |
Type 3 arch | 9 (18.4) | 0 (0) | 0.583 |
Contralateral carotid stenosis, n (%) | 7 (14.3) | 3 (42.9) | 0.099 |
Stent type, n (%) | |||
Open-cell stent | 33 (67.3) | 4 (57.1) | 0.679 |
Closed-cell stent | 16 (32.7) | 3 (42.9) |
Course of In-Stent Restenosis Retreatment | |||||
---|---|---|---|---|---|
Case | Age/Sex | ISR Grade | Previous Stent Type | Retreatment | Complication |
1 | 84/M | 50% | open-cell | BMT | None |
2 | 92/F | 50% | closed-cell | BMT | None |
3 | 91/M | 70–80% | open-cell | CAS | None |
4 | 82/F | 70% | open-cell | CAS | None |
5 | 94/F | 50–60% | closed-cell | BMT | None |
6 | 91/F | 50% | open-cell | BMT | None |
7 | 84/M | 70% | closed-cell | CAS | None |
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Ertuğrul, Ö.Z.; Karaaslan, F.; Yılmaz, R.; Tuncer, M.C. Outcomes of Symptomatic Extracranial Carotid Artery Stenting in Octogenarians: A Single-Center Retrospective Study on Restenosis, Risk Factors, and Complications. Medicina 2025, 61, 519. https://doi.org/10.3390/medicina61030519
Ertuğrul ÖZ, Karaaslan F, Yılmaz R, Tuncer MC. Outcomes of Symptomatic Extracranial Carotid Artery Stenting in Octogenarians: A Single-Center Retrospective Study on Restenosis, Risk Factors, and Complications. Medicina. 2025; 61(3):519. https://doi.org/10.3390/medicina61030519
Chicago/Turabian StyleErtuğrul, Özgür Zülfükar, Fırat Karaaslan, Reşit Yılmaz, and Mehmet Cudi Tuncer. 2025. "Outcomes of Symptomatic Extracranial Carotid Artery Stenting in Octogenarians: A Single-Center Retrospective Study on Restenosis, Risk Factors, and Complications" Medicina 61, no. 3: 519. https://doi.org/10.3390/medicina61030519
APA StyleErtuğrul, Ö. Z., Karaaslan, F., Yılmaz, R., & Tuncer, M. C. (2025). Outcomes of Symptomatic Extracranial Carotid Artery Stenting in Octogenarians: A Single-Center Retrospective Study on Restenosis, Risk Factors, and Complications. Medicina, 61(3), 519. https://doi.org/10.3390/medicina61030519