To review two years of consecutive patients undergoing carotid artery stenting (CAS) at our centre and assess indications and outcomes of CAS in patients over age 70.

Based on results from the CREST trial, carotid endarterectomy (CEA) is generally preferred over carotid artery stenting (CAS) for patients over age 70 with symptomatic extracranial carotid stenosis.

We retrospectively identified consecutive patients who received CAS from June 1, 2019 to May 31, 2021. We captured baseline characteristics, pre-stent and intra-procedural imaging, complications in the first 24 hours post-CAS, and whether Vascular Surgery was involved.

We identified 143 consecutive patients who underwent CAS, of whom 134 (94%) were symptomatic. The average age was 70.5 years and 77 (54%) were over age 70; 62% were male. CAS was performed within 48 hours in 20% and within 14 days in 65% of symptomatic patients. In the first 24 hours post-CAS, two patients (1.4%) experienced myocardial infarction, though none had a stroke or died. Common complications included hypotension (56/143, 39%), bradycardia (23/143, 16%), and groin hematoma (18/143, 13%). Few (33%) patients had a clearly documented preference for CAS. Vascular surgery was not consulted in the majority (57, 74%). Only 20 patients (26%) were assessed by vascular surgery. 6 (30%) were declined CEA due to their cardiopulmonary status, 5 (25%) were declined due to anatomical reasons, and 3 (15%) preferred CAS.

Despite trial data suggest that CEA is the preferred means of revascularization for patients over age 70 with symptomatic carotid stenosis, most patients in our study population receiving CAS were over age 70. They rarely had documentation of anatomical, medical, or technical contraindications to CEA. Complications post-stenting were very frequent, though serious adverse events were rare. Our findings suggest that decision-making surrounding carotid revascularization at our centre is not aligned with Canadian or other international guidelines.