title: CEA versus CAS: short-term and mid-term results.
abstract: OBJECTIVE
  Ischemic stroke represents a major health problem and it is an important cause of long-term disability. The aim of this study was to compare short-term and mid-term results of carotid endarterectomy and stenting.
  
  
  METHODS
  During a three-year period, we enrolled 300 patients with carotid stenosis that fit with Stroke Prevention and Educational Awareness Diffusion (SPREAD) guidelines and we performed 150 carotid endarterectomy operations (CEA) and 150 carotid artery stenting procedures (CAS) with distal protection devices. All patients underwent preoperative and postoperative: neurological examination, ultrasound imaging, magnetic resonance imaging (MRI) and cognitive tests; moreover all patients were submitted to preoperative, intraoperative and postoperative Transcranial Doppler (TCD) monitoring, in order to detect microembolic signals (MES).
  
  
  RESULTS
  Mortality was zero; two patients developed myocardial infarction in the CEA group during follow-up. The main post-operative results after endarterectomy versus CAS were respectively: neurological deficit: 1.3% vs. 3.3%, embolic lesions at postoperative MRI: 4% vs. 34% and worsening of cognitive tests: 4% vs. 25.3%.
  
  
  CONCLUSIONS
  CEA seems to be the treatment of choice for carotid stenosis, due to its low rate of mortality and morbidity, especially in asymptomatic patients; CAS should be carried out only in particular subgroup of cases, such as: restenosis, previous neck surgery or radian therapy, anatomical high bifurcation or extended lesions. Ongoing multicenter randomized trials may give a definitive answer to this matter.
authors.affiliation: Paride Stefanini Department of Vascular Surgery, Policlinico Umberto 1, Rome, Italy.
authors.forename: M M G
authors.initials: MM
authors.lastname: Felli
authors.forename: A
authors.initials: A
authors.lastname: Alunno
authors.forename: A
authors.initials: A
authors.lastname: Castiglione
authors.forename: A
authors.initials: A
authors.lastname: Malaj
authors.forename: F
authors.initials: F
authors.lastname: Faccenna
authors.forename: J
authors.initials: J
authors.lastname: Jabbour
authors.forename: A
authors.initials: A
authors.lastname: Laurito
authors.forename: D
authors.initials: D
authors.lastname: Stavri
authors.forename: B
authors.initials: B
authors.lastname: Gossetti
mesh_terms: D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000523:psychology / Q000601:surgery / Q000628:therapy*; D003071:Cognition; D038524:Diffusion Magnetic Resonance Imaging; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D018579:Patient Selection; D011237:Predictive Value of Tests; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control* / Q000523:psychology; D013997:Time Factors; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial