title: A comparison of carotid artery stenting with neuroprotection versus carotid endarterectomy under local anesthesia.
abstract: BACKGROUND
  Carotid endarterectomy (CEA) and carotid artery stenting (CAS) reduce the risk of stroke in patients with high-grade carotid artery stenosis. Despite the known impact of type of anesthesia on outcome after CEA, none of the current studies comparing CEA with CAS addresses the effect of anesthetic choice on perioperative events. In this study, we compare our results of distally protected CAS versus CEA under local anesthesia.
  
  
  METHODS
  Clinical data of 345 patients who underwent 372 procedures for carotid artery occlusive disease over a 36-month were retrospectively collected for this analysis. Distal embolic protection was used in CAS procedures. All procedures, both CEA (n = 221, 59%) and CAS (N = 152, 41%), were performed under local anesthesia. The primary outcome measure was aggregate 30-day major ipsilateral stroke and/or death. Follow-up serial Duplex ultrasound examinations were performed.
  
  
  RESULTS
  Both patient cohorts were similar in terms of demographic and risk factors, with the exception of a higher incidence of coronary artery disease in the CAS group (59% versus 30%, P <.05). The 30-day stroke and death rates were 3.2% (CAS) and 3.7% (CEA) (P = not significant). Cranial nerve injury only occurred in the CEA patients (2.3%). Perioperative hemodynamic instability was more common among patients in the CAS group (11.9% versus 4.1%, P <.05).
  
  
  CONCLUSIONS
  Percutaneous carotid stenting with neuroprotection provides comparable clinical success to CEA performed under local anesthetic. Further studies are warranted to validate the long-term efficacy of CAS and to elucidate patient selection criteria for endovascular carotid revascularization.
authors.affiliation: Michael E. DeBakey VA Medical Center, Division of Vascular Surgery and Endovascular Therapy, Houston VAMC (112), 2002 Holcomb Blvd, Baylor College of Medicine, Houston, TX 70030, USA. rbush@bcm.tmc.edu
authors.forename: Ruth L
authors.initials: RL
authors.lastname: Bush
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kougias
authors.forename: Marlon A
authors.initials: MA
authors.lastname: Guerrero
authors.forename: Dieter F
authors.initials: DF
authors.lastname: Lubbe
authors.forename: Wei
authors.initials: W
authors.lastname: Zhou
authors.forename: Alan B
authors.initials: AB
authors.lastname: Lumsden
authors.forename: Peter H
authors.initials: PH
authors.lastname: Lin
mesh_terms: D000368:Aged; D000772:Anesthesia, Local; D001783:Blood Flow Velocity; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015996:Survival Rate; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex