title: Safety and efficacy of carotid angioplasty and stenting in high-risk patients.
abstract: Performance of carotid endarterectomy (CEA) may be associated with an increased risk in patients with significant comorbid medical conditions, neck irradiation, or previous CEA. This study compared the results of CEA with carotid angioplasty and stenting (CAS) in high-risk patients treated for carotid stenosis. Five hundred forty-five patients who underwent CEA and 148 patients who underwent CAS were evaluated. For patients undergoing CEA, general anesthesia was used in 91 per cent, electroencephalographic monitoring was used in 63 per cent, and shunting was performed in 19.8 per cent. Cerebral protection devices were used in 145/148 of CAS cases, and self-expanding stents were used in all cases. Evaluated end points included major cardiovascular events, and a composite of death, stroke, or myocardial infarction for the duration of the follow-up. Mean follow-up was 18 months for CAS and 23 months for CEA. Significant differences were present in patient age (CAS, 75 +/- 11.0 years vs CEA, 71 +/- 9 years, P = 0.012), however, there were no significant differences (P = NS) in gender or smoking history. The mean modified Goldman Score was significantly higher for CAS (21.1 +/- 14.8 [95% confidence interval = 18, 24]) than for CEA (6.3 +/- 6.8 [95% confidence interval = 5.7, 6.9]; P = 0.0001) patients. The incidence of periprocedural complications did not vary significantly between patients treated with CAS (CVA, 1.4%; myocardial infarction [MI], 1.4%; death, 0.7%; CVA/MI/death, 3.4%) compared with CEA (CVA, 1.8%; MI, 1.1%; death, 0.4%; CVA/MI/death, 4.0%). CAS is equivalent to CEA in safety and efficacy, even when performed in patients who may be at increased surgical risk.
authors.affiliation: Division of Vascular Surgery, New York Presbyterian Hospital, Cornell University, Weill Medical School, New York, New York 10021, USA.
authors.forename: Rabih A
authors.initials: RA
authors.lastname: Chaer
authors.forename: Brian G
authors.initials: BG
authors.lastname: Derubertis
authors.forename: Susan M
authors.initials: SM
authors.lastname: Trocciola
authors.forename: Stephanie C
authors.initials: SC
authors.lastname: Lin
authors.forename: Robert
authors.initials: R
authors.lastname: Hynecek
authors.forename: Harry L
authors.initials: HL
authors.lastname: Bush
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Morrissey
authors.forename: James F
authors.initials: JF
authors.lastname: McKinsey
authors.forename: K Craig
authors.initials: KC
authors.lastname: Kent
authors.forename: Peter L
authors.initials: PL
authors.lastname: Faries
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016001:Confidence Intervals; D003327:Coronary Disease / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color