A Comparative Analysis of the Outcomes of Carotid Stenting and Carotid Endarterectomy in the Management of Carotid Stenosis
Keywords:Stroke, carotid stenosis, Carotid endarterectomy (CEA), carotid artery stenting (CAS)
Carotid Stenosis is an important cause of stroke (20%) which is associated with high morbidity and mortality rates. The management is mainly by surgery or carotid stenting. This study reviews 3 years of experience and the outcomes in the treatment of carotid stenosis by the two methods. The study aimed to evaluate and compare the outcomes of both procedures during a 3yr period at a vascular Surgery department of the Cisanello Hospital. 302 pts were retrospectively analyzed; 151 pts assigned for each procedure. The average intervention time was significantly higher for the CEA group O.R: 0.556; 95% C.I; 0.349- 0.886, P: 0.014 but technical successes were achieved in 100% of CEA pts, whereas were achieved in 91.39% of the CAS group. The periprocedural stroke was nonsignificant between the two procedures. The Periprocedural TIA were show significant difference with more incidences in CAS pts [O.R: 7.292, 95% C.I; 1.150- 45.856, P: 0.032] but almost all pts improved. The cranial nerve injuries were a specific complication of CEA [11.9%]. The recurrent stenosis was seen only in CAS pts [2.9%] with O.R: 0.493, 95% C.I; 0.104- 2.345, P: 0.410. Both procedures are effective and comparable in outcomes in the management of carotid Stenosis.
Barnett, H. J., Taylor, D. W., Eliasziw, M., Fox, A. J., Ferguson, G. G., Haynes, R. B., Rankin, R. N., Clagett, G. P., Hachinski, V. C., & Sackett, D. L. (1998). Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. New England journal of medicine, 339(20), 1415-1425. DOI: https://doi.org/10.1056/NEJM199811123392002
Bates, E. R., Babb, J. D., Casey, D. E., Cates, C. U., Duckwiler, G. R., Feldman, T. E., Gray, W. A., Ouriel, K., Peterson, E. D., & Rosenfield, K. (2007). ACCF/SCAI/SVMB/SIR/ASITN 2007 clinical expert consensus document on carotid stenting: a report of the American College of Cardiology foundation task force on clinical expert consensus documents (ACCF/SCAI/SVMB/SIR/ASITN clinical expert consensus document committee on carotid stenting). Journal of the American College of Cardiology, 49(1), 126-170. DOI: https://doi.org/10.1177/1358863X06076103
Brott, T. G., Hobson, R. W., Howard, G., Roubin, G. S., Clark, W. M., Brooks, W., Mackey, A., Hill, M. D., Leimgruber, P. P., & Sheffet, A. J. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England journal of medicine, 363(1), 11-23. DOI: https://doi.org/10.1056/NEJMoa0912321
Chambers, B., You, R., & Donnan, G. (2000). Carotid endarterectomy for asymptomatic carotid stenosis (Cochrane review). la: Cochrane Library, Issue 4, 2002. Update Software. DOI: https://doi.org/10.1002/14651858.CD001923
Cina, C., Clase, C., & Haynes, R. (2000). Carotid endarterectomy for symptomatic carotid stenosis (Cochrane Review). The Cochrane Library, 4. DOI: https://doi.org/10.1002/14651858.CD001081
Committee, C. S. G. (2009). Guidelines for patient selection and performance of carotid artery stenting. Journal of Medical Imaging and Radiation Oncology, 53(6), 538-545. DOI: https://doi.org/10.1111/j.1754-9485.2009.02120.x
Cunningham, E. J., Bond, R., Mayberg, M. R., Warlow, C. P., & Rothwell, P. M. (2004). Risk of persistent cranial nerve injury after carotid endarterectomy. Journal of neurosurgery, 101(3), 445-448. DOI: https://doi.org/10.3171/jns.2004.101.3.0445
Eastcott, H. H. G., Pickering, G. W., & Rob, C. G. (1954). Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia. The Lancet, 264(6846), 994-996. DOI: https://doi.org/10.1016/S0140-6736(54)90544-9
Eckstein, H.-H., Ringleb, P., Allenberg, J.-R., Berger, J., Fraedrich, G., Hacke, W., Hennerici, M., Stingele, R., Fiehler, J., & Zeumer, H. (2008). Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. The Lancet Neurology, 7(10), 893-902. DOI: https://doi.org/10.1016/S1474-4422(08)70196-0
Ederle, J., Dobson, J., Featherstone, R., Bonati, L., van der Worp, H., de Borst, G., Lo, T., Gaines, P., Dorman, P., & Macdonald, S. (2010). International Carotid Stenting Study investigators: Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet, 375(9719), 985-997. DOI: https://doi.org/10.1016/S0140-6736(10)60239-5
Ederle, J. r., Featherstone, R. L., & Brown, M. M. (2009). Randomized controlled trials comparing endarterectomy and endovascular treatment for carotid artery stenosis: a Cochrane systematic review. Stroke, 40(4), 1373-1380. DOI: https://doi.org/10.1161/STROKEAHA.108.531228
Halliday, A., Mansfield, A., & MARRO, J. (2004). PETO C, PETO R, POTTER], THOMAS D; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet, 363, 1491-1502. DOI: https://doi.org/10.1016/S0140-6736(04)16146-1
Hobson, R. W., Weiss, D. G., Fields, W. S., Goldstone, J., Moore, W. S., Towne, J. B., Wright, C. B., & Group, V. A. C. S. (1993). Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. New England journal of medicine, 328(4), 221-227. DOI: https://doi.org/10.1056/NEJM199301283280401
Horrocks, M. (2000). When should I reoperate for recurrent stenosis. In Carotid artery surgery: a problem-based approach (pp. 371-374). Harcourt Publishers Ltd, London, UK.
Linfante, I., Andreone, V., Akkawi, N., & Wakhloo, A. K. (2009). Internal carotid artery stenting in patients over 80 years of age: Single‐center experience and review of the literature. Journal of Neuroimaging, 19(2), 158-163. DOI: https://doi.org/10.1111/j.1552-6569.2008.00269.x
Mas, J.-L., Trinquart, L., Leys, D., Albucher, J.-F., Rousseau, H., Viguier, A., Bossavy, J.-P., Denis, B., Piquet, P., & Garnier, P. (2008). Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. The Lancet Neurology, 7(10), 885-892. DOI: https://doi.org/10.1016/S1474-4422(08)70195-9
Narins, C. R., & Illig, K. A. (2006). Patient selection for carotid stenting versus endarterectomy: a systematic review. Journal of vascular surgery, 44(3), 661-672. DOI: https://doi.org/10.1016/j.jvs.2006.05.042
Organ, N., Walker, P., Jenkins, J., & Foster, W. (2008). 15 year experience of carotid endarterectomy at the Royal Brisbane and Women's Hospital: outcomes and changing trends in management. European Journal of Vascular and Endovascular Surgery, 35(3), 273-279. DOI: https://doi.org/10.1016/j.ejvs.2007.09.013
Ouriel, K., Yadav, J., & Green, R. M. (2004). Standards of practice: carotid angioplasty and stenting. Journal of vascular surgery, 39(4), 916-917. DOI: https://doi.org/10.1016/j.jvs.2004.01.028
Ricotta, J. J., & Malgor, R. D. (2008). A review of the trials comparing carotid endarterectomy and carotid angioplasty and stenting. Perspectives in vascular surgery and endovascular therapy, 20(3), 299-308. DOI: https://doi.org/10.1177/1531003508324614
Sidawy, A., Zwolak, R., White, R., Siami, F., Schermerhorn, M., & Sicard, G. (2009). Outcomes Committee for the Society for Vascular Surgery. Risk-adjusted 30-day outcomes of carotid stenting and endarterectomy: results from the SVS Vascular Registry. J Vasc Surg, 49(1), 71-79.
Sidawy, A. N., Zwolak, R. M., White, R. A., Siami, F. S., Schermerhorn, M. L., Sicard, G. A., & Surgery, O. C. f. t. S. f. V. (2009). Risk-adjusted 30-day outcomes of carotid stenting and endarterectomy: results from the SVS Vascular Registry. Journal of vascular surgery, 49(1), 71-79. DOI: https://doi.org/10.1016/j.jvs.2008.08.039
Tu, J. V., Hannan, E. L., Anderson, G. M., Iron, K., Wu, K., Vranizan, K., Popp, A. J., & Grumbach, K. (1998). The fall and rise of carotid endarterectomy in the United States and Canada. New England journal of medicine, 339(20), 1441-1447. DOI: https://doi.org/10.1056/NEJM199811123392006
van der Vaart, M. G., Meerwaldt, R., Reijnen, M. M., Tio, R. A., & Zeebregts, C. J. (2008). Endarterectomy or carotid artery stenting: the quest continues. The American journal of surgery, 195(2), 259-269. DOI: https://doi.org/10.1016/j.amjsurg.2007.07.022
How to Cite
Copyright (c) 2021 Hasan I. Fadel Saad, Mustafa Noom , Khalid Shnab, Abdel Magid El Osta
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of the articles Published by Almukhtar Journal of Science (MJSc) is retained by the author(s), who grant MJSc a license to publish the article. Authors also grant any third party the right to use the article freely as long as its integrity is maintained and its original authors and cite MJSc as original publisher. Also they accept the article remains published by MJSc website (except in occasion of a retraction of the article).