Unprotected carotid artery stenting compared to carotid endarterectomy in a community setting.
OBJECTIVE
To evaluate the feasibility and safety of carotid artery stenting (CAS) performed by a dedicated multidisciplinary team in a community hospital.


METHODS
Forty-nine patients (30 men; mean age 74.3 +/- 7.4 years, range 51-88) with 14 symptomatic and 35 asymptomatic >50% carotid stenoses were enrolled into the study and treated with self-expanding stents without cerebral protection. The patients were evaluated at 30 days for death, neurological sequelae, and length of stay. A contemporaneous group of 140 patients (80 men; mean age 72.3 +/- 7.7 years, range 43-89) undergoing carotid endarterectomy (CEA) was used for comparison of the outcome measures. Owing to crossover of failed CAS patients to the CEA group, the data were analyzed according to intention-to-treat and treatment-received.


RESULTS
The only difference in baseline characteristics between the treatment and control groups was the greater frequency of bilateral disease in the CEA group (p=0.009). The CAS procedures were successful in 47 (96.0%) patients; 2 access failures were converted to endarterectomy, and 1 access-site pseudoaneurysm was treated surgically. There were no deaths or myocardial infarctions in either group. In the CAS group, there were no major and only 2 (4.1%) minor strokes compared to 4 (2.9%) major and 4 (2.9%) minor strokes in the CEA group (p>0.05). Median LOS was significantly lower in the CAS group (p<0.0001).


CONCLUSIONS
Careful case selection and multidisciplinary collaboration facilitate the safe performance of carotid stenting in a community setting with acceptable early results.
Madyoon
Hooman
H
Intervention Cardiology, Cardiac Catheterization Laboratory, St Joseph's Medical Center, Stockton, California 95204, USA. cardiology@2xtreme.net
Braunstein
Eric
E
Callcott
Frank
F
Oshtory
Meherji
M
Gurnsey
Lynne
L
Croushore
Linda
L
Macbeth
Andrew
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D017536:Carotid Artery, Common / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D003153:Community Health Services; D016894:Endarterectomy, Carotid / Q000295:instrumentation*; D004869:Equipment Safety / Q000295:instrumentation; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011482:Protective Devices; D012086:Reoperation; D015607:Stents; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome