Is carotid stenting of complicated plaques safe?

Background. Specific plaque characteristics, such as ulcers and subocclusive lesions, may increase the complication rate in carotid stenting (CAS) procedures, however, few data have been published in this regard. Aim. Our goal was to investigate the risk of technical failure and neurological symptoms in complicated and uncomplicated plaques after CAS. Methods. From January 2005 to March 2007, all patients submitted to CAS were divided into two groups depending on plaque morphology: complicated plaque patients (ComP) (plaques with ulcers diameter > 2 mm and plaques determining subocclusive stenosis [i.e., > 99%]); the rest being uncomplicated plaques (UnComP). The two groups were compared in terms of baseline characteristics, preoperative neurological symptoms, cerebral computed tomography, type of arch, presence of stenosis or occlusion of the contralateral carotid, type of stent and protection system, and technical and clinical outcome. Differences across groups in the frequency of technical success and neurological symptoms were compared using standard bivariate analyses and confirmed with logistic regression. Results. Of 298 consecutive patients undergoing CAS, 77 had complicated plaques (25.8%) and 221 uncomplicated plaques (74.2%). The two groups were not different in terms of baseline characteristics (excluding age) and preoperative symptoms. Overall, technical success was achieved in 91.2% of the sample, postoperative neurological symptoms occurred in 7.7% of the patients. All symptoms were temporary. We found no significant differences between the two groups regarding neurological complications (7.8% vs. 7.7% P = 0.98) and technical failure (9.1% vs. 8.6%, P = 0.97), also controlling for age and gender. At multivariate analyses, an older age was a significant predictor of technical failure (OR 1.13; 95% CI 1.05-1.22). Conclusion. The plaque morphology does not seem to be associated with CAS failure and may not be considered a contraindication to CAS.