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Carotid Endarterectomy and Carotid Artery Stenting in the Light of ICSS and CREST Studies

  • V. Benes
  • O. Bradac
Conference paper
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 129)

Abstract

Objective. We analyzed the results of internal carotid artery (ICA) stenosis treatment at our institution according to the treatment modality—carotid endarterectomy (CEA) vs. carotid artery stenting (CAS).

Methods. During 2003–2015, a total of 1894 procedures were performed for ICA stenosis. CEA was done in 1064 cases and CAS in 830 cases.

The primary outcome was disabling stroke (mRS > 2) or myocardial infarction within 30 days of treatment. Secondary outcomes were transitory ischemic attacks (TIAs), minor strokes (stroke without impaired activities of daily living), and any other significant complications.

Results. Major mortality and morbidity were divided according to their treatment groups; this reached 0.9% in the CEA and 2.5% in the CAS group (p = 0.007). Minor stroke was recorded at 1.5% and 2.7% in the CEA and CAS groups (p = 0.077), TIAs in 1.0% (CEA) and 4.0% (CAS) (p < 0.001), and any complication in 12.4% (CEA) and 13.0% (CAS) (p = 0.694).

Conclusions. CEA is a safe procedure in patients who meet the correct treatment indications. In all subgroup analyses CEA proved to be equal to or better than CAS. This study supports the idea of CEA being the preferred treatment and CAS being reserved for selected cases only.

Keywords

Carotid artery stenting (CAS) Carotid endarterectomy (CEA) Complication Outcome Stroke 

Notes

Acknowledgments

Supported by grants AZV 16-29148A and MO1012.

Conflict of interest The authors declare that they have no conflict of interest.

References

  1. 1.
    Halm EA, Tuhrim S, Wang JJ, Rockman C, Riles TS, Chassin MR. Risk factors for perioperative death and stroke after carotid endarterectomy: results of the new york carotid artery surgery study. Stroke. 2009;40:221–9.CrossRefGoogle Scholar
  2. 2.
    Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, Rankin RN, Clagett GP, Hachinski VC, Sackett DL, Thorpe KE, Meldrum HE, Spence JD. 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.CrossRefGoogle Scholar
  3. 3.
    NASCET. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991;325:445–53.CrossRefGoogle Scholar
  4. 4.
    NASCET. Clinical alert: benefit of carotid endarterectomy for patients with high-grade stenosis of the internal carotid artery. National Institute of Neurological Disorders and Stroke Stroke and Trauma Division. North American Symptomatic Carotid Endarterectomy Trial (NASCET) investigators. Stroke. 1991;22:816–7.CrossRefGoogle Scholar
  5. 5.
    NASCET. North American Symptomatic Carotid Endarterectomy Trial. Methods, patient characteristics, and progress. Stroke. 1991;22:711–20.CrossRefGoogle Scholar
  6. 6.
    ECST. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. European Carotid Surgery Trialists’ Collaborative Group. Lancet. 1991;337:1235–43.CrossRefGoogle Scholar
  7. 7.
    ECST. Endarterectomy for moderate symptomatic carotid stenosis: interim results from the MRC European Carotid Surgery Trial. Lancet. 1996;347:1591–3.CrossRefGoogle Scholar
  8. 8.
    ECST. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998;351:1379–87.CrossRefGoogle Scholar
  9. 9.
    Warlow CP. Symptomatic patients: the European Carotid Surgery Trial (ECST). J Mal Vasc. 1993;18:198–201.PubMedGoogle Scholar
  10. 10.
    ACAS. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. 1995;273:1421–8.CrossRefGoogle Scholar
  11. 11.
    ACAS. Carotid endarterectomy for patients with asymptomatic internal carotid artery stenosis. National Institute of Neurological Disorders and Stroke. J Neurol Sci. 1995;129:76–7.CrossRefGoogle Scholar
  12. 12.
    Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, Thomas D. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. 2004;363:1491–502.CrossRefGoogle Scholar
  13. 13.
    Halliday A, Harrison M, Hayter E, Kong X, Mansfield A, Marro J, Pan H, Peto R, Potter J, Rahimi K, Rau A, Robertson S, Streifler J, Thomas D. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet. 2010;376:1074–84.CrossRefGoogle Scholar
  14. 14.
    Bonati LH, Ederle J, McCabe DJ, Dobson J, Featherstone RL, Gaines PA, Beard JD, Venables GS, Markus HS, Clifton A, Sandercock P, Brown MM. Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial. Lancet Neurol. 2009;8:908–17.CrossRefGoogle Scholar
  15. 15.
    Brooks WH, McClure RR, Jones MR, Coleman TC, Breathitt L. Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital. J Am Coll Cardiol. 2001;38:1589–95.CrossRefGoogle Scholar
  16. 16.
    Brooks WH, McClure RR, Jones MR, Coleman TL, Breathitt L. Carotid angioplasty and stenting versus carotid endarterectomy for treatment of asymptomatic carotid stenosis: a randomized trial in a community hospital. Neurosurgery. 2004;54:318–24; discussion 324–325.CrossRefGoogle Scholar
  17. 17.
    CAVATAS. 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
  18. 18.
    Coward LJ, McCabe DJ, Ederle J, Featherstone RL, Clifton A, Brown MM. Long-term outcome after angioplasty and stenting for symptomatic vertebral artery stenosis compared with medical treatment in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized trial. Stroke. 2007;38:1526–30.CrossRefGoogle Scholar
  19. 19.
    Ederle J, Bonati LH, Dobson J, Featherstone RL, Gaines PA, Beard JD, Venables GS, Markus HS, Clifton A, Sandercock P, Brown MM. Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial. Lancet Neurol. 2009;8:898–907.CrossRefGoogle Scholar
  20. 20.
    Ringleb PA, Allenberg J, Bruckmann H, Eckstein HH, Fraedrich G, Hartmann M, Hennerici M, Jansen O, Klein G, Kunze A, Marx P, Niederkorn K, Schmiedt W, Solymosi L, Stingele R, Zeumer H, Hacke W. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet. 2006;368:1239–47.CrossRefGoogle Scholar
  21. 21.
    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. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493–501.CrossRefGoogle Scholar
  22. 22.
    Bonati LH, Dobson J, Featherstone RL, Ederle J, van der Worp HB, de Borst GJ, Mali WP, Beard JD, Cleveland T, Engelter ST, Lyrer PA, Ford GA, Dorman PJ, Brown MM, International Carotid Stenting Study investigators. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet. 2015;385:529–38.CrossRefGoogle Scholar
  23. 23.
    Brott TG, Howard G, Roubin GS, Meschia JF, Mackey A, Brooks W, Moore WS, Hill MD, Mantese VA, Clark WM, Timaran CH, Heck D, Leimgruber PP, Sheffet AJ, Howard VJ, Chaturvedi S, Lal BK, Voeks JH, Hobson RW II, Investigators C. Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med. 2016;374:1021–31.CrossRefGoogle Scholar
  24. 24.
    Ederle J, Davagnanam I, van der Worp HB, Venables GS, Lyrer PA, Featherstone RL, Brown MM, Jager HR, ICSS investigators. Effect of white-matter lesions on the risk of periprocedural stroke after carotid artery stenting versus endarterectomy in the International Carotid Stenting Study (ICSS): a prespecified analysis of data from a randomised trial. Lancet Neurol. 2013;12:866–72.CrossRefGoogle Scholar
  25. 25.
    Kuliha M, Roubec M, Prochazka V, Jonszta T, Hrbac T, Havelka J, Goldirova A, Langova K, Herzig R, Skoloudik D. Randomized clinical trial comparing neurological outcomes after carotid endarterectomy or stenting. Br J Surg. 2015;102:194–201.CrossRefGoogle Scholar
  26. 26.
    Bradac O, Mohapl M, Kramar F, Netuka D, Ostry S, Charvat F, Lacman J, Benes V. Carotid endarterectomy and carotid artery stenting: changing paradigm during 10 years in a high-volume centre. Acta Neurochir. 2014;156:1705–12.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery, First Medical FacultyMilitary University Hospital and Charles UniversityPragueCzech Republic

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