Carotid Endarterectomy and Carotid Artery Stenting in a Predominantly Symptomatic Real-World Patient Population.

Carotid Endarterectomy and Carotid Artery Stenting in a Predominantly Symptomatic Real-World Patient Population.

Howie Benjamin A; Witek Alex M; Hussain M Shazam; Bain Mark D; Toth Gabor

World neurosurgery

2019

2019-04

OBJECTIVE: Carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) are well established treatments that have been shown to decrease stroke recurrence in patients with underlying carotid artery disease. We assessed clinical outcome, safety and restenosis rates for patients who underwent standardized CEA or CAS at our tertiary care center using patient selection criteria based on available scientific evidence. METHODS: Retrospective chart review of patients who underwent CEA or CAS between 2009 and 2016. RESULTS: In total, 314 cases (204 CEA and 110 CAS) were analyzed. Patients were predominantly non-Hispanic Caucasian (84.4%), males (61.1%) with hypertension (86.9%) and hyperlipidemia (81.8%). Most patients (84.5%) had symptomatic carotid disease. No significant differences were observed in median post-operative NIHSS and mRS scores based on pre-treatment symptomatic status, or treatment modality (CEA vs CAS). Most patients (85.9%) had favorable outcomes (mRS 0-2) at a median follow-up of 11.7 months (IQR 1.8- 28.8). The perioperative complication rate was low (3.2%), and permanent neurologic deficit was seen in only 3 patients (1%). Restenosis was found in 7.3% without significant difference between CEA and CAS at last follow-up. Restenosis was asymptomatic in the majority of patients. CONCLUSIONS: Our findings in a real-world predominantly symptomatic cohort demonstrate that favorable patient outcomes, and low restenosis and complication rates can be achieved with both CEA and CAS by the utilization of a consistent institutional patient selection and treatment process.

Carotid; Endarterectomy; Outcomes; Restenosis; Stenting

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

NEOMED College of Medicine

NEOMED Student Publications