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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2008 June;15(2):81-6
Internal carotid artery revascularization. A four-year experience with our treatment protocol
Monaca V., Battaglia G., Turiano S. A., Tringale R., Vinciguerra D., Di Dio S., Marletta G., Guzzo G., Spataro M.
Department of Vascular Surgery Vittorio Emanuele Hospital, Ferrarotto S. Bambino, Catania, Italy
Aim. The aim of this study was to evaluate the results obtained in the treatment of carotid disease using presently validated procedures, i.e. carotid artery stenting (CAS) and carotid endarterectomy (CEA). The surgery team performs indifferently both surgical or interventional procedures.
Methods. From January 2003 to August 2007, 1 255 procedures have been carried out in the Department of Vascular Surgery; 1008 were CEA and 247 were CAS. The procedure best suited for each patient are chosen on the basis of a strict protocol which takes into account risk factors, lesion morphology, neck anatomy, vascular access. Patients were divided into two further subgroups (symptomatic and asymptomatic patients) to better analyze their characteristics. CEA was carried out by performing, under general anesthesia, the conventional technique of endarterectomy plus patch. CAS was performed under local anesthesia by routine use of brain protection devices.
Results. Perioperative mortality was 0.8% in the CEA group (0.7% asymptomatic, 1.5% symptomatic) and 1.6% in the CAS group (3.3% symptomatic, 1.4% asymptomatic) [P=0.11], the stroke rate is 0.7% in the CEA group, and 1.6% in the CAS group [P=0.58]. Finally, the death/stroke/myocardial infarction rate in the CEA group was 3.3%, whereas in the CAS group was 5.3% [P=0.97]. In the CEA group an incidence of 3.7% and 4.7% was observed, respectively, in cranial nerve damage and reopening for cervical hematoma. In a two-year follow-up a 0.6% mortality rate in the CEA group vs a 2.1% in the CAS group [P=0.13] was observed, and a 0.6% stroke rate in the CAS group vs a 1.0% rate in the CEA group [P=0.87]; the global death/stroke/MI data was 1.9% vs 5.1%. This was the only statistically significant data [P=0.02]. Restenosis was 0.6% in the CEA group and 3.8% in the CAS group: the difference was statistically significant (P=0.0001).
Conclusion. The above mentioned data emphasize satisfactory results obtained following the patient care protocol. CAS is reserved to well selected cases. Results of the endovascular procedure were very similar to those of the surgical procedure. Endovascular procedure is, thus, to be considered as a valuable additional tool, especially in high-risk patients. The authors stress that surgeons should choose, with no conditioning at all, the best approach for each patient. In order to do so, it is fundamental to master, in addition to the conventional surgical techniques, also the endovascular ones.