Early Outcome of Carotid Angioplasty and Stenting versus Carotid Endarterectomy in a Single Academic Center

Abstract

Background: Evidence is accumulating that carotid angioplasty and stenting (CAS) might become an alternative to carotid endarterectomy (CEA) for the treatment of high-grade carotid artery disease (CAD). Evaluating the efficacy of this novel technique in single institutions in addition to performing further large trials can help to guide optimal patient management in everyday practice. Methods: In this study we compared the early outcome of 100 prospectively followed patients who underwent CAS with a retrospectively reviewed group of 142 patients that underwent CEA over the same time period. Only patients who had received pre- and postsurgical evaluations by a neurologist were included. According to the criteria set forth by the large trials the occurrence of minor or major strokes, myocardial infarction and death within 30 days was analysed. Results: Both groups had similar age and sex distributions, as well as cerebrovascular risk factors. In the group of CAS patients 63 (63%) and in the group of CEA patients 92 (65%) had a symptomatic carotid stenosis, respectively. For symptomatic patients the overall complication rate (any stroke or death) was 6.5% (3 minor and 3 major strokes) in the surgical and 8% (2 minor strokes, 2 major strokes, and 1 death) in the non-surgical group (n.s.). For asymptomatic patients there was one minor stroke (2%) in the surgical and no stroke or death in the non-surgical group. As a frequent non-neurological complication the post-procedural course was complicated by groin hematoma requiring surgery in 3 CAS patients, and neck hematoma requiring additional surgery in 3 CEA patients. Conclusions: Within our academic institution we found comparable complication rates for CAS and CEA in patients with symptomatic or asymptomatic high-grade CAD. Although these early results are promising and support the notion that CAS may become an alternative treatment option for CAD in everyday practice, the long-term efficacy of CAS has to be evaluated critically by means of further prospective studies.

Early Outcome of Carotid Angioplasty and Stenting With and Without Cerebral Protection Devices

“…14,18,22 The large variability of the early complication rates, ranging from 0% to 17%, (or at least those that are reported and published) stresses the need for ongoing evaluations of all complication rates during CAS within single institutions. 52 Since the low complications rates of large multicenter CEA trials cannot be generalized to everyday clinical practice without reservation, 70,71 this call for continuing evaluations should also include all surgical procedures within single institutions.…”

Clinical Predictors of Transient Ischemic Attack, Stroke, or Death Within 30 Days of Carotid Angioplasty and Stenting

“…14,15 Because it is a special policy of our hospital that principally all patients with a symptomatic and asymptomatic carotid stenosis are primarily admitted to the Department of Neurology and are routinely seen after CAS, all patients had received preprocedural and postprocedural neurological evaluations within our department. To document patency of the stent, an ultrasound follow-up study was performed routinely 1 to 2 days after CAS in all patients.…”

“…14,15 With the exception of 8 cases, all procedures had been performed with the patient under conscious sedation.…”

Incidence of New Brain Lesions After Carotid Stenting With and Without Cerebral Protection

“…18 Initially, all CAS procedures had been performed without cerebral protection devices. When cerebral protection devices became available, the choice of which type of device to use, if any, depended on the personal preference of the interventional neuroradiologist performing the procedure.…”