title: Protected carotid artery stenting in patients at high risk for carotid endarterectomy.
abstract: OBJECTIVE
  To compare the 30-day, six-month, and one-year outcomes of carotid artery stenting (CAS) and carotid endarterectomy (CEA) in male veterans, and to identify any predictors of adverse outcomes. CAS has been shown to be non-inferior to CEA in patients at high-risk for CEA. The outcome of CAS compared to low-risk CEA is less clear.
  
  
  METHODS
  Retrospective analysis of 96 consecutive patients who underwent CAS (N = 31) or CEA (N = 65). The cumulative 30-day, six-month, and one-year incidence of ipsilateral transient ischemic attack (TIA) or stroke, restenosis or reocclusion, need for target vessel revascularization, non-fatal myocardial infarction (MI), and death were compared.
  
  
  RESULTS
  All patients in the CAS group were at high risk for CEA. Among the CEA group, 50 (76.9%) were at high risk and the remaining 15 (23.1%) were considered to be at low risk. The cumulative incidence of adverse outcomes with CAS and CEA, respectively, at 30 days (3.2% vs 9.2%, P = ns), six months (3.2 vs 18.5%, P = 0.047), and one year (9.7% vs 18.5%, P = ns) favored CAS. This difference was primarily due to adverse events in the high-risk CEA patients. There was no significant difference in outcome between the CAS and low-risk CEA groups. The independent significant predictors for adverse outcomes within six months were the group (P = 0.047) and number of risk factors (P = 0.01). Interestingly, the use of angiotensin-converting enzyme inhibitors (ACE-I) predicted adverse outcomes within one year (P = 0.01).
  
  
  CONCLUSIONS
  CAS may be superior to high-risk CEA with better six-month outcomes. The outcomes with CAS were not significantly different compared to low-risk CEA, suggesting that CAS may be non-inferior to low-risk CEA.
authors: Overton Brooks VA Medical Center and Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors: Prasanna Venkatesh
authors: PV
authors: Kumar
authors: Aishwarya
authors: A
authors: Lakshmi
authors: Rakesh
authors: R
authors: Shrivastava
authors: Aman
authors: A
authors: Mundi
authors: Anshu
authors: A
authors: Tandon
authors: Kavit A
authors: KA
authors: Desouza
authors: Gloria
authors: G
authors: Caldito
authors: Enrique
authors: E
authors: Jimenez
authors: Bobby V
authors: BV
authors: Khan
authors: Neeraj
authors: N
authors: Tandon