Carotid Stent Explant Indications and Outcomes

Abstract

Background: Carotid artery stenting is an alternative to carotid endarterectomy, especially in patients deemed to have significant anatomic or medical risk for the latter. There is scant literature, however, on indications for and outcomes of carotid stent (CAS) explant. We sought to determine indications and outcomes of CAS explant at our institution.

Methods: We queried a prospectively maintained institutional vascular surgery database as well as hospital records to identify patients undergoing carotid stent explant from 2010-2020. Ten patients were identified. Their charts were reviewed to obtain demographic, comorbidity, procedural, and outcomes data. Data of particular interest were preoperative atherosclerotic factors, indications for CAS explant, carotid repair strategy, and 30-day post-procedural complications. Data were analyzed for ranges and means.

Results: Ten patients were identified. Comorbidity was common: all patients had at least 1 atherosclerotic risk factor, with hypertension and hypercholesterolemia being the most common. Seven (70.0%) patients had recurrent stenosis as the indication for explant. Seven (70.0%) presented symptomatically. Five (50.0%) cases of restenosis had been refractory to angioplasty. There were 3 (30.0%) instances of CAS explant due to infection. Only 1 (12.5%) index CAS was performed at our institution. There was a mean hospital length of stay of 4.5 days. One patient had vocal cord paralysis requiring no intervention. There was no (0%) 30-day mortality, stroke, or postoperative wound infections.

Conclusions: Our series had 0% 30-day mortality, stroke, and postoperative wound infection suggesting that CAS explant may be performed safely. Our series is small but represents the largest single institution series to date. This procedure may become increasingly common in the coming years with the more frequent use of CAS; additional data is needed to rigorously understand outcomes.