Performance of carotid endarterectomy (CEA) may be associated with an increased risk in patients with significant comorbid medical conditions, neck irradiation, or previous CEA. This study compared the results of CEA with carotid angioplasty and stenting (CAS) in high-risk patients
treated for carotid stenosis. Five hundred forty-five patients who underwent CEA and 148 patients who underwent CAS were evaluated. For patients undergoing CEA, general anesthesia was used in 91 per cent, electroencephalographic monitoring was used in 63 per cent, and shunting was performed
in 19.8 per cent. Cerebral protection devices were used in 145/148 of CAS cases, and self-expanding stents were used in all cases. Evaluated end points included major cardiovascular events, and a composite of death, stroke, or myocardial infarction for the duration of the follow-up. Mean follow-up
was 18 months for CAS and 23 months for CEA. Significant differences were present in patient age (CAS, 75 ± 11.0 years vs CEA, 71 ± 9 years, P = 0.012), however, there were no significant differences (P = NS) in gender or smoking history. The
mean modified Goldman Score was significantly higher for CAS (21.1 ± 14.8 [95% confidence interval = 18, 24]) than for CEA (6.3 ± 6.8 [95% confidence interval = 5.7, 6.9]; P = 0.0001) patients. The incidence of periprocedural complications did not
vary significantly between patients treated with CAS (CVA, 1.4%; myocardial infarction [MI], 1.4%; death, 0.7%; CVA/MI/death, 3.4%) compared with CEA (CVA, 1.8%; MI, 1.1%; death, 0.4%; CVA/MI/death, 4.0%). CAS is equivalent to CEA in safety and efficacy, even when performed in patients who
may be at increased surgical risk.
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Document Type: Research Article
From the Division of Vascular Surgery, New York Presbyterian Hospital, Cornell University, Weill Medical School, and Columbia University, College of Physicians and Surgeons, New York, New York
Publication date: 01 August 2006
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