Carotid intervention: stent or surgery? A prospective audit.
This study represents a prospective audit comparing carotid artery stenting (CAS) with carotid endarterectomy (CEA), performed by a single surgical team. Between January 2005 and December 2008, 440 patients were referred; 177 had CAS and 263 CEA. Selection of procedure was individualised and contra-indications for CAS included internal carotid artery (ICA) stenosis > 85-90%, intraluminal thrombus, ICA tortuosity, gross surface ulceration of plaque and excessive calcification. Type III aortic arch and arch calcification also precluded CAS. Standard techniques were used for both procedures with a protection device routinely used for CAS. Most CEAs were performed under general anaesthesia, with selective intraluminal shunting. One hundred and eighty-six patients were selected for CAS; nine (48% ) were converted to CEA for technical reasons. The operative risk profile was similar, but significantly more in the CAS group were hypertensive. Almost half (49% ) in the CAS group were asymptomatic vs 26% in the CEA group. All asymptomatics had 70+ % stenosis on Duplex Doppler. Results were reported within one month of the procedure. The stroke rate was 2.3% for CAS vs 1.9% for CEA (p > 0.05). Stroke and death plus one M1 was 4.5% after CAS vs 3.4% after CEA (p > 0.05). Disabling stroke occurred in 1.1% of CAS patients vs 0.4% of CEA patients. These results are satisfactory and compare favourably with other similar series.
Robbs
J V
JV
Vasular Unit, Department of Surgery, Faculty of Health Sciences, University of KwaZulu-Natal, Durban. jvrobbs@mweb.co.za
Mulaudzi
T
T
Paruk
N
N
Pillay
B
B
Rajaruthnam
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D000075202:Contraindications; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000453:epidemiology / Q000209:etiology