title: Carotid endarterectomy versus carotid artery stenting: findings in regard to neuroclinical outcomes and diffusion-weighted imaging.
abstract: The purpose of our study was to evaluate prospectively the frequency and significance of brain lesions after elective carotid endarterectomy (CAE) and carotid artery stenting (CAS) by using diffusion-weighted magnetic resonance imaging (DW MRI) and then to correlate imaging findings with neuroclinical outcomes. From February 2003 through March 2005, 95 consecutive patients underwent surgical endarterectomy or CAS (with a cerebral protection device) at our institution. A total of 59 CAE procedures were performed in 46 consecutive patients (mean age, 65.8 +/- 9 yr), and 56 CAS procedures were performed in 49 consecutive patients (mean age, 66.3 +/- 9 yr). Diffusion-weighted magnetic resonance imaging of the brain was performed in all patients within 24 hours of the procedure, both before and after. The post-procedural stroke rate was slightly higher in the CAS group, but this difference was not significant (5.4% vs 0). One early and 1 late death occurred in the stent group. Although the incidence of ischemic lesions was similar in both groups (surgery group, 12.5%; stent group, 13.5%), new DW MRI lesions were higher in the endarterectomy group (27.1% vs 12.5%, P=0.041). This difference was due chiefly to nonischemic lesions such as hemorrhage and watershed ischemia. In the analysis of patients with embolic ischemia, incidences of symptomatic stroke (P=0.046) and large infarct (P=0.013) were higher in the stent group. When we used protective devices during CAS, the incidence of embolic complications was similar to that of surgical enarterectomy. On the other hand, the clinical results of CAS need improvement.
authors.affiliation: Department of Cardiovascular Surgery, Ege University Hospital, 35100 Bornova-Izmir, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Posacioglu
authors.forename: Cagatay
authors.initials: C
authors.lastname: Engin
authors.forename: Celal
authors.initials: C
authors.lastname: Cinar
authors.forename: Anil Z
authors.initials: AZ
authors.lastname: Apaydin
authors.forename: Ismail
authors.initials: I
authors.lastname: Oran
authors.forename: Mustafa
authors.initials: M
authors.lastname: Parildar
authors.forename: Cem
authors.initials: C
authors.lastname: Calli
authors.forename: Emrah
authors.initials: E
authors.lastname: Oguz
authors.forename: Ahmet
authors.initials: A
authors.lastname: Memis
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000517:prevention & control*; D002339:Carotid Arteries / Q000473:pathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome