Does carotid stenting measure up to endarterectomy? A vascular surgeon's experience

Hypothesis: Carotid angioplasty and stenting seems to have equal or better outcomes in high-risk patients than carotid endarterectomy. Design: Single-center case-control study. Setting: University hospital tertiary referral center. Patients: Individuals (n=53) undergoing elective carotid angioplasty and stenting for cervical carotid stenosis (n= 57) between April 2001 and October 2003. All patients were referred to and treated by the primary author (M.K.E.). Results: Mean±SD age was 68.8±1.2 years (64% men [34] and 36% women [19]), and overall mean±SD rate of stenosis was 79%±10%. Preprocedural neurologic symptoms were present in 42% of the group. Indications for treatment included prior neck surgery with irradiation (4), recurrent stenosis (19), and severe comorbidities (34). Duplex scanning 24 hours after stenting showed immediate mean percentage reductions in peak systolic velocity and end diastolic velocity of 74% and 76%, respectively. After a 30-day follow-up period, there were no deaths and no major or minor strokes. One patient (1.7%) developed transient amaurosis fugax 12 hours after the procedure. Four patients (7.0%) experienced access-related complications. Intraoperative complications included 1 seizure (1.7%) and 1 asystolic arrest (1.7%), both treated successfully. During follow-up, 3 cases of re-stenosis (5.0%) occurred. One asymptomatic occlusion (1.7%) was detected at the 6-month follow-up visit. There have been no late carotid-related complications or deaths. Conclusions: Vascular surgeons possessing advanced catheter-based skills can safely perform carotid angioplasty and stenting and can achieve perioperative results comparable with carotid endarterectomy. Determination of the true efficacy and durability of carotid angioplasty and stenting as compared with endarterectomy awaits ongoing randomized national trials.