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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2005 Giugno;12(2):47-54
Endovascular therapy versus surgery in carotid stenosis. Personal experience
Emanuelli G. 1, Marina R. 2, Bizzi U. 1, Perona F. 3, Pecora N. 4
1 Vascular Surgery Unit III Galeazzi Orthopedic Institute, Milan, Italy
2 Neuroradiology Unit San Gerardo Hospital, Monza, Italy
3 Vascular and Interventional Radiology Unit Galeazzi Orthopedic Institute, Milan, Italy
4 Department of Surgical Sciences University of Milano-Bicocca, Milan, Italy
Aim. The currently accepted treatment for carotid artery stenosis is carotid endarterectomy (CEA) on the basis of multicentric randomized trials that recommend CEA for stroke prevention; nevertheless, endovascular treatment has been introduced for patients showing multiple comorbidities that make them ineligible according to the NASCET criteria. We report our experience in the management of patients addressed to classical CEA and to endovascular intervention to give a contribution to the debate regarding the role of stenting and angioplasty in carotid artery disease.
Methods. We submitted to CEA 200 patients meeting the NASCET criteria: 52.0% were asymptomatic and 48.0% had a previous TIA or stroke. One hundred-thirteen patients were treated with endovascular technique receiving primary carotid stenting followed by angioplasty.
Results. The percentage of early major and minor complications for CEA were 2.5% and 4.5%, 2.15% the restenoses within 2 years from surgery assessed on a follow-up of about 50% of the treated lesions. The complications for the patients submitted to Stent-PTA were: 1 case of transitory asystolia, 1 occlusion of the treated carotid for missing the postprocedural antiplatelet therapy, 1 comitial case and 1 ictus following overflow after revascularization, and 1 death for cardiac arrest. During the follow-up period no intimal hyperplasia was detected by color Doppler ultrasonography when angioplasty followed the primary stenting of the vessel.
Conclusion. The surgical technique for CEA guarantees a quite reduced restenosis rate when compared with data from the literature. The endovascular procedure early complicance rate matches perfectly international published data, with the difference that we have no restenoses.
Even if sufficient, our data are not randomized and no comparison is allowed among complications rate in classical CEA and in Stent-PTA, the endovascular technique for carotid stenosis is a feasible alternative to CEA for selected groups of patients who meet the NASCET exclusion criteria.