title: A multispecialty consensus-based approach to carotid artery revascularization is feasible in routine clinical practice and results in excellent clinical outcomes.
abstract: BACKGROUND
  Carotid artery stenting (CAS) and endarterectomy (CEA) are considered competing rather than complementary carotid artery revascularization (CAR) strategies. However, patient characteristics that increase procedural risk are quite different for CAS or CEA. We hypothesized that selecting a CAR strategy based on individual patient characteristics using a multispecialty consensus based (MSCB) approach will result in superior outcomes in the overall CAR group. We evaluated the feasibility of an MSCB approach to CAR in routine clinical practice.
  
  
  METHODS
  We performed a retrospective review of patients undergoing CEA or CAS at the Kansas City Veterans hospital over a 2-year period. As routine clinical practice, each case was discussed in a weekly "vascular conference" by vascular surgery, radiology, and interventional cardiology physicians and a revascularization strategy was chosen. Thirty-day and 1-year incidences of stroke, transient ischemic attack, myocardial infarction, and death were recorded.
  
  
  RESULTS
  Eighty CAR procedures were performed (45 CEAs and 35 CASs). The CAS group had an average of 1.9 surgical high-risk features, while the CEA group had 0.5 (P<.05). The CAS group had significantly more common carotid stenosis, stenoses considered too high or low for CEA, and more long internal carotid artery lesions. For the overall CAR group, 30-day incidence of stroke/transient ischemic attack, myocardial infarction, and death was 2.5% and 1-year incidence of stroke and death was 5%.
  
  
  CONCLUSIONS
  An MSCB approach allows the choice of an optimal CAR strategy with excellent clinical outcomes. Reporting outcomes for the overall CAR may be a better way of assessing and comparing outcomes of CAR across healthcare systems rather than CEA or CAS outcomes separately.
authors.affiliation: Mid America Cardiology, University of Kansas Hospital, 3901 Rainbow Blvd, Kansas City, KS 66160 USA. kamal.gupta@sbcglobal.net.
authors.forename: Kamal
authors.initials: K
authors.lastname: Gupta
authors.forename: Kelly Jo
authors.initials: KJ
authors.lastname: Steffen
authors.forename: Balasubramanium
authors.initials: B
authors.lastname: Natarajan
authors.forename: Mazda
authors.initials: M
authors.lastname: Biria
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.forename: George
authors.initials: G
authors.lastname: Cherian
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000150:complications / Q000628:therapy*; D016893:Carotid Stenosis / Q000150:complications / Q000628:therapy*; D032921:Consensus; D016894:Endarterectomy, Carotid; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000379:methods; D010348:Patient Care Team; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome