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Advances in Therapy

, Volume 30, Issue 9, pp 845–853 | Cite as

Comparison of Carotid Artery Stenting and Carotid Endarterectomy in Patients with Symptomatic Carotid Artery Stenosis: A Single Center Study

  • M. Hakan TaşEmail author
  • Ziya Şimşek
  • Abdurrahim Colak
  • Yavuzer Koza
  • Pinar Demir
  • Recep Demir
  • Ugur Kaya
  • Ibrahim Halil Tanboga
  • Fuat Gundogdu
  • Serdar Sevimli
Original Research

Abstract

Introduction

Carotid artery stenting (CAS) is believed to be an alternative to carotid endarterectomy (CEA); however, recent studies have demonstrated an increase of complications with stenting that does not reflect our experience. We thus wanted to compare the periprocedural and 1-year follow-up outcomes of CAS with those of CEA among patients with symptomatic extracranial carotid stenosis in a population from eastern Turkey.

Methods

The hospital records of all patients who underwent carotid artery revascularization were retrospectively reviewed. Patients were divided into two groups based on the type of carotid revascularization performed, namely CEA or CAS. Comparisons were made with respect to 30-day and 1-year outcomes of transient ischemic attack (TIA), myocardial infarction (MI), stroke, and all-cause death rates. Composite endpoints for both groups were also analyzed.

Results

Thirty-two CEA and 33 CAS procedures were performed for symptomatic occlusive carotid disease. Baseline characteristics were similar between both groups except for the incidence of diabetes mellitus. No significant differences were found with respect to 30-day mortality, MI, and neurologic morbidity endpoints for CEA and CAS procedures. In the postprocedural 1-year follow-up, only TIA was observed to be significantly higher in the CAS group; the other endpoints did not differ significantly. One-year composite endpoints did not differ between both groups (log-rank P = 0.300).

Conclusion

In our trial of patients with symptomatic carotid artery stenosis, no significant difference could be shown in periprocedural outcomes, postprocedural outcomes except TIA, and in composite endpoints between the CEA and CAS groups. CAS is a safe and efficacious alternative for the treatment of symptomatic carotid artery stenosis.

Keywords

Cardiology Carotid artery stenting Carotid endarterectomy Carotid stenosis Stroke 

Notes

Acknowledgments

No funding or sponsorship was received for this study or publication of this article.

Dr. Taş is the guarantor for this article, and takes responsibility for the integrity of the work as a whole.

Conflict of interest

M. Hakan Taş, Ziya Şimşek, Abdurrahim Colak, Yavuzer Koza, Pinar Demir, Recep Demir, Ugur Kaya, Ibrahim Halil Tanboga, Fuat Gundogdu and Serdar Sevimli declare that they have no conflicts of interest.

Compliance with ethics guidelines

The study conformed to the principles of the Helsinki Declaration of 1975, as revised in 2000 and was approved by the Atatürk University Medical Faculty Ethics Committee. The analysis in this article is based on previously collected data and does not involve any new studies of human or animal subjects performed by any of the authors.

References

  1. 1.
    Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics–2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2007;115:e69–171.PubMedCrossRefGoogle Scholar
  2. 2.
    Boztosun B, Can MM, Kocabay G. Carotid endarterectomy versus stenting: where do we stand today? Turk Kardiyol Dern Ars. 2012;40:642–9.PubMedCrossRefGoogle Scholar
  3. 3.
    North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445–53.CrossRefGoogle Scholar
  4. 4.
    Sheffet AJ, Roubin G, Howard G, et al. Design of the carotid revascularization endarterectomy vs. stenting trial (CREST). Int J Stroke. 2010;5:40–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Mas JL, Hotelier G, Beyssen B, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355:1660–71.PubMedCrossRefGoogle Scholar
  6. 6.
    SPACE Collaborative Group. 30 Day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised noninferiority trial. Lancet. 2006;368:1239–47 (Erratum, Lancet 2006;368:1238).CrossRefGoogle Scholar
  7. 7.
    Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. Catheter Cardiovasc Interv. 2013;81:E76–123.PubMedCrossRefGoogle Scholar
  8. 8.
    Lövblad KO, Plüschke W, Remonda L, et al. Diffusion-weighted MRI for monitoring neurovascular interventions. Neuroradiology. 2000;42:134–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Schlüter M, Tübler T, Steffens JC, Mathey DG, Schofer J. Focal ischemia of the brain after neuroprotected carotid artery stenting. J Am Coll Cardiol. 2003;42:1007–13.PubMedCrossRefGoogle Scholar
  10. 10.
    Bosiers M, Deloose K, Verbist J, Peeters P. What practical factors guide the choice of stent and protection device during carotid angioplasty? Eur J Vasc Endovasc Surg. 2008;35:637–43.PubMedCrossRefGoogle Scholar
  11. 11.
    Gray WA, Hopkins LN, Yadav S, et al. Protected carotid stenting in high-surgical-risk patients: the ARCHeR results. J Vasc Surg. 2006;44:258–68.PubMedCrossRefGoogle Scholar
  12. 12.
    CAVATAS Investigators. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet. 2001;357:1729–37.CrossRefGoogle Scholar
  13. 13.
    Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421–8.CrossRefGoogle Scholar
  14. 14.
    Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1998;339:1415–25.PubMedCrossRefGoogle Scholar
  15. 15.
    Brott TG, Hobson RW 2nd, Howard G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363:11–23.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Healthcare 2013

Authors and Affiliations

  • M. Hakan Taş
    • 1
    Email author
  • Ziya Şimşek
    • 1
  • Abdurrahim Colak
    • 2
  • Yavuzer Koza
    • 1
  • Pinar Demir
    • 1
  • Recep Demir
    • 3
  • Ugur Kaya
    • 2
  • Ibrahim Halil Tanboga
    • 1
  • Fuat Gundogdu
    • 1
  • Serdar Sevimli
    • 1
  1. 1.Department of Cardiology, Faculty of MedicineAtatürk UniversityErzurumTurkey
  2. 2.Department of Cardiovascular Surgery, Faculty of MedicineAtatürk UniversityErzurumTurkey
  3. 3.Department of Neurology, Faculty of MedicineAtatürk UniversityErzurumTurkey

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