Carotid stenting

There is a great deal of excitement in the medical community regarding two recent studies evaluating the treatment of carotid artery disease in high-risk surgical candidates. These trials demonstrated that carotid artery stenting was a highly effective and potentially safer alternative for this patient group.

The SAPPHIRE trial was reported at the American Heart Association meeting in November, 2002. This was a multicenter study of high–risk surgical patients who were randomized to receive either carotid endarterectomy or carotid stenting accompanied by the use of a filter device for distal neuroprotection from embolic events. The 30-day primary endpoint was the combined incidence of stroke, death, or myocardial infarction. Carotid stenting with distal protection reduced this endpoint by 50% compared to carotid surgery ( 5.8% versus 12.6%, p = 0.047).

The ARCHER study was presented at the ACC meeting in March, 2003. ARCHER was a multicenter registry of carotid artery stenting also using a filter device for distal protection. This trial also confirmed an extremely favorable 30-day combined risk of stroke, death, or myocardial infarction of 7.7%. The expected combined endpoint for surgery in this group was 14%. this result correlated quite well with the results from SAPPHIRE.

Iowa Heart has been involved in carotid stenting since its inception. Carotid stenting procedures have been performed at Iowa Heart since 1996. We have performed more than 125 cases in high-risk surgical candidates with a combined 30-day endpoint for stroke, death, or myocardial infarction of 5.1%. This establishes Iowa Heart as one of the most experienced centers in the nation, with results as good or better than the recent national trials.

As recognized leaders in this field, we were invited to participate in the ARCHER and MAVERIC studies, and were one of only a handful of sites selected to participate in the CREST trial. This study is a landmark investigation sponsored by the NIH to compare the outcomes of elective carotid stenting with distal protection versus carotid surgery in average risk patients.

For more information, or to refer patients for carotid stenting, contact the office of your choice or call (515) 235-5000.