Abstract
In this study we report our surgical results of CAS and CEA for carotid stenosis and suggest an appropriate treatment strategy for patients with high risks such as bilateral carotid stenosis or medical risk factors. From January 2001 to December 2005 we surgically treated 182 patients with carotid stenosis. Seventy-nine lesions were treated by CEA and 145 by CAS, respectively. Although CEA was considered the first choice for severe carotid stenosis, CAS was chosen for treatment when CEA was considered a higher risk for patients. Stenosis of carotid arteries was relieved in all cases after CEA or CAS. Surgical mortality of CEA was 1.1% (1/94). Surgical mortality of CAS was 0.7% (1/145). Carotid stenotic lesions can be treated with comparably low morbidity and mortality rates using CEA or/and CAS considering each characteristic of carotid stenosis of patients even with medically high risk or bilateral carotid stenosis.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Bettmann MA, Katzen BT, Whisnant J, Brant-Zawadzki M, broderick JP, Furlan AJ, Hershey LA, Howard V, Kuntz R, Loftus CM, Pearce W, Roberts A, Roubin G (1998) Carotid stenting and angioplasty: a statement for healthcare professionals from the councils on cardiovascular radiology, stroke, cardio-thoracic and vascular surgery, epidemiology and prevention, and clinical cardiology, American Heart Association. Stroke 29: 336–348
Cao P, De Rango P, Verzini F, Maselli A, Norgiolini L, Giordano G (2006) Outcome of carotid stenting versus endarterectomy a casecontrol study. Stroke 37: 1221–1226
Coward LJ, Featherstone RL, Brown MM (2005) Safety and efficacy of endovascular treatment of carotid artery stenosis compared with carotid endarterectomy: a Cochrane systematic review of the randomized evidence. Stroke 36: 905–911
Das S, Bendok BR, Getch CC, Awad IA, Batjer HH (2005) Update on current registries and trials of carotid artery angioplasty and stent placement. Neurosurg Focus 18: e2
Executive Committee for the Asymptomatic Carotid Atherosclerosis Study (1995) Endarterectomy for asymptmatic carotid artery stenosis. JAMA 273: 1421–1428
Hobson RW (2000) CREST (Carotid revascularization endarterectomy versus stent trial): background, design, and current status. Semin Vasc Surg 13: 139–143
Kastrup A, Groschel K, Krapf H, Brehm BR, Dichgans J, Schulz JB (2003) Early outcome of carotid angioplasty and stenting with and without cerebral protection devices. A systematic review of the literature. Stroke 34: 813–819
North American Symotomatic Carotid Endarterectomy Trial (1991) Methods, patient characteristics, and progress. Stroke 22: 711–720
North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325: 445–453
Ouriel K, Hertzer NR, Beven EG, O’Hara PJ, Krajewski LP, Clair DG, Greenberg RK, Sarac TP, Olin JW, Yadav JS (2001) Preproceedural risk stratification: identifying an appropriate population for carotid stenting. J Vasc Surg 33: 728–732
Powell RJ, Schermerhorn M, Nolan B, Lenz J, Rzuidlo E, Fillinger M, Walsh D, Wyers M, Zwolak R, Cronenwett JL (2004) Early results of carotid stent placement for treatment of extracranial carotid bifurcation occlusive disease. J Vasc Surg 39: 1193–1199
Rothwell PM, Slattery J, Warlow CP (1997) Clinical and angiographic predictors of stroke and death from carotid endarterectomy: systematic review. BMJ 315: 1571–1577
Transluminal Angioplasty Study (CAVATAS) (2001) Endovascular versus surgical treatment in patients with carotid stenosis in the carotid and vertebral artery transluminal angioplasty study (CAVATAS): a randomised trial. Lancet 357: 1729–1737
Tsukahara T, Akiyama Y, Nomura M, Hashimoto N (1977) Carotid endarterectomy: standard techniques to avoid complications. Jpn J Neurosurg 6: 731–736
Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K, Stenting and Angioplasty with protection in Patients at High Risk for Endarterectomy Investigators (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351: 1493–1501
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2008 Springer-Verlag
About this paper
Cite this paper
Tsukahara, T., Hatano, T., Nakakuki, T., Tsuji, Y., Aoyama, T., Ogata, H. (2008). Combined treatment using CEA and CAS for carotid arterial stenosis. In: Yonekawa, Y., Tsukahara, T., Valavanis, A., Khan, N. (eds) Changing Aspects in Stroke Surgery: Aneurysms, Dissections, Moyamoya Angiopathy and EC-IC Bypass. Acta Neurochirurgica Supplements, vol 103. Springer, Vienna. https://doi.org/10.1007/978-3-211-76589-0_19
Download citation
DOI: https://doi.org/10.1007/978-3-211-76589-0_19
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-76588-3
Online ISBN: 978-3-211-76589-0
eBook Packages: MedicineMedicine (R0)