Comparison of nonneurological events in high-risk patients treated by carotid angioplasty versus endarterectomy.
OBJECTIVE
To compare results of carotid angioplasty and stenting (CAS) with carotid endarterectomy (CEA) in high cardiac risk patients.


METHODS
Patients ineligible for carotid revascularization by North American Symptomatic Carotid Endarterectomy Trial/Asymptomatic Carotid Atherosclerosis Study criteria were treated with CAS (n = 11) or CEA (n = 10).


RESULTS
Significant numbers had cardiac (CAS 72%, CEA 60%; P = 0.66) and hypertensive (CAS 82%, CEA 80%; P = 0.64) risk factors. Adverse hemodynamic events were more frequent in the CAS group (CAS 73%, CEA 20%; P = 0.03). Major complications were noted in 1 patient in each group (CAS, myocardial infarction; CEA, death). Postoperative stay was similar (CAS 2.1 +/- 1.4, CEA 1.8 +/- 1.1 days; P = 0.60). However, 4 in the CAS group were readmitted within 1 month (congestive heart failure 2, myocardial infarction 1, rest pain 1), compared with no new events in the CEA group (P = 0.09).


CONCLUSIONS
Currently, the use of CAS in patients with cardiac risk factors may not be justifiable.
Kasirajan
Karthikeshwar
K
University of New Mexico School of Medicine, Division of Vascular Surgery, 2-ACC, 915 Camino de Salud, NE, Albuquerque, NM 87131-5341, USA. kkasirajan@salud.unm.edu
Matteson
Brian
B
Marek
John M
JM
Langsfeld
Mark
M
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D002340:Carotid Artery Diseases / Q000453:epidemiology / Q000628:therapy*; D002561:Cerebrovascular Disorders / Q000209:etiology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000209:etiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology