Carotid artery angioplasty and stenting: introduction of a new technique into an established vascular surgery center.
BACKGROUND
The aim of this study was to review our initial experience with the introduction of carotid artery angioplasty and stenting as a treatment for carotid stenosis in high-risk patients and compare clinical outcomes to carotid endarterectomy patients treated over the same time period at our center.


METHODS
A total of 265 carotid revascularization procedures (45 carotid artery angioplasty and stenting and 220 carotid endarterectomy) were performed over 3 years period. In the carotid artery angioplasty and stenting group, 93% were at high risk according to the current reporting standards. Death, neurological events, and restenosis rates were compared at 30 days and at most recent follow-up.


RESULTS
Mean follow-up for all patients was 18 months (range 0-48 months). Carotid artery angioplasty and stenting group had higher cardiac risk than carotid endarterectomy group (13% vs 2%, P < .05). High-risk carotid lesions were present in 67% of carotid artery angioplasty and stenting patients. There was a tendency toward higher restenosis rate in carotid artery angioplasty and stenting than in carotid endarterectomy patients (35% vs 15%, P = .06). Combined stroke and death was higher in the carotid stenting group (4% and 9%) compared to the carotid endarterectomy group (0.5% and 0.5%) at 30 days and at late follow-up, respectively (P = .04 and .00).


CONCLUSIONS
Restenosis and stroke were observed more frequently in our initial experience in patients undergoing carotid artery angioplasty and stenting compared with carotid endarterectomy patients during the same time period. These differences disappeared in high-risk patients. Further studies, to evaluate the effect of the learning curve on early results as well as follow-up for intermediate and long-term durability of carotid artery angioplasty and stenting in high-risk patients, are required.
Albacker
Turki B
TB
Division of Vascular Surgery, Department of Surgery, McGill University, Montreal, Canada. dr_turki@yahoo.com
Nouh
Thamer A
TA
Alabbad
Saleh I
SI
Corriveau
Marc M
MM
Mackenzie
Kent S
KS
Obrand
Daniel I
DI
Steinmetz
Oren K
OK
Abraham
Cherrie Z
CZ
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015641:Radiography, Interventional; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome