Carotid stenting done exclusively by vascular surgeons: first 175 cases.
BACKGROUND
Percutaneous CAS may well replace CEA as standard of care. CAS has been performed largely by interventional cardiologists; however, with recent Food and Drug Administration approval, vascular surgeons are now hurriedly attempting to obtain the requisite endovascular skills. Reported are our 30-day and midterm outcomes of CAS.


METHODS
Retrospective review of 175 cervical carotid stenoses treated with elective CAS from April 2001 to February 2005. All procedures were performed under local anesthesia via percutaneous femoral access in an operating room angiosuite. Mechanical cerebral protection was used in 90% of cases. Data analysis includes demographics, procedural records, and duplex exams over a mean follow-up of 21 months.


RESULTS
Mean age is 70 years (74% men and 26% women). Preprocedural neurologic symptoms were present in 32%. Intraoperative complications included 2 seizures (1.1%) and 4 asystolic arrests (2.3%), all managed medically without sequelae. Over the 30-day follow-up there were no deaths, no myocardial infarctions (MIs), 2 major strokes (1.1%), 2 minor strokes (1.1%), 3 transient ischemic attacks (TIAs) (1.7%), and 1 major access-site complication (0.6%). At late follow-up, 3 cases (1.7%) of restenosis occurred; all were treated with repeat angioplasty and remain patent. One (0.6%) asymptomatic occlusion was detected at 6-month follow-up. There have been no late carotid-related complications or deaths.


CONCLUSIONS
Vascular surgeons possessing advanced catheter-based skills can safely perform CAS and achieve perioperative results comparable to CEA. Such skills are crucial to those surgeons intent on the future management of carotid occlusive disease.
Eskandari
Mark K
MK
Division of Vascular Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. meskanda@nmh.org
Longo
G Matthew
GM
Matsumura
Jon S
JS
Kibbe
Melina R
MR
Morasch
Mark D
MD
Cardeira
Kelley R
KR
Pearce
William H
WH
D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000706:statistics & numerical data; D016893:Carotid Stenosis / Q000601:surgery*; D013502:General Surgery / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015607:Stents / Q000706:statistics & numerical data; D016896:Treatment Outcome