Carotid artery stenting compared to carotid endarterectomy performed exclusively in a veteran population: one center's experience with midterm results.
OBJECTIVE
To evaluate a single center's experience with carotid artery stenting (CAS) and carotid endarterectomy (CEA) performed by vascular surgeons in an entirely veteran population.


METHODS
Data from the Lakeside and Jesse Brown Veterans Affairs Medical Centers (VAMC) from September 1997 to December 2006 were retrospectively reviewed. Indications for CAS or CEA included asymptomatic carotid stenosis >70% or symptomatic stenosis >50%. Demographic data, procedural details, and clinical outcomes are reported.


RESULTS
A cohort of 104 patients (98% men) underwent 113 CAS procedures with 100% technical success. Cerebral protection was used in 98% of the procedures. Average age was 70 years (15 patients >or=80 years old); 30% were symptomatic. Previous ipsilateral CEA, neck dissection or irradiation was present in 10.6% of procedures. The 30-day transient ischemic attack, stroke, and death rates were 2.7%, 3.5%, and 0.0% respectively. The 1-year all cause death rate was 6.2%. During the same time period, 79 patients (98% male) underwent 91 CEA procedures. Average age was 67 years (9 patients >or=80 years old); 45% were symptomatic. The 30-day transient ischemic attack, stroke, and death rates were 1%, 2.2%, and 1% respectively. The 1-year all cause death rate was 5.5%. There were no statistically significant differences in outcome within asymptomatic and symptomatic patient groups between CAS and CEA, respectively.


CONCLUSIONS
CAS is a safe and efficacious alternative for the treatment of carotid artery stenosis in a veteran population and outcomes compare favorably to contemporary CAS and CEA trials. Veterans should be offered CAS as a treatment option for carotid artery stenosis by vascular surgeons or interventionalists who are trained to perform this procedure and have the appropriate resources.
Brown
Katherine E
KE
Division of Vascular Surgery, Northwestern University, Chicago, IL 60611, USA.
Fanciullo
Dustin J
DJ
Hicks
Taylor
T
Landau
David S
DS
Baraniewski
Henry M
HM
Morasch
Mark D
MD
Matsumura
Jon S
JS
Pearce
William H
WH
Eskandari
Mark K
MK
Kibbe
Melina R
MR
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014481:United States; D014728:Veterans