Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2018, vol. 27, nr 12, December, p. 1691–1695

doi: 10.17219/acem/75902

Publication type: original article

Language: English

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Carotid artery stenting versus endarterectomy for the treatment of both symptomatic and asymptomatic patients with carotid artery stenosis: 2 years’ experience in a high-volume center

Dariusz Janczak1,A,E, Maciej Malinowski1,A,E, Agnieszka Ziomek1,B,C, Jakub Kobecki2,B,D, Michał Leśniak1,B,D, Tadeusz Dorobisz3,A,B, Karolina Dorobisz4,B,D, Dawid Janczak3,B,C, Mariusz Chabowski1,2,C,D

1 Division of Surgical Procedures, Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Poland

2 Department of Surgery, 4th Military Teaching Hospital, Wrocław, Poland

3 Division of Oncology and Palliative Care, Faculty of Health Sciences, Wroclaw Medical University, Poland

4 Department of Otolaryngology, Head and Neck Surgery, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Poland

Abstract

Background. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the 2 current standard treatments for carotid artery stenosis. There is still no well-defined consensus with regard to their superiority. However, the minimally invasive nature of endovascular treatment makes CAS increasingly popular among vascular surgeons.
Objectives. The aim of the study is to compare the safety and efficacy of CEA and CAS in patients with symptomatic and asymptomatic carotid artery stenosis.
Material and Methods. A single-center, retrospective analysis of patients who were treated for carotid artery stenosis using CAS or CEA between January 2014 and December 2015 was carried out. There were 471 patients (266 CEA and 205 CAS) who were eligible for inclusion. The vast majority of the patients had significant (>70%) stenosis of the internal carotid artery (92.1% of CEA and 87.8% of CAS). The occlusion of the contralateral carotid artery was observed in 9.8% of all cases (2.6% of CEA vs 17.7% of CAS).
Results. The occurrence of complications, such as stroke, myocardial infarction (MI) and death, did not vary statistically between the groups. There were 9 events of stroke in the CEA group (3.4%) and 8 in the CAS group (3.9%), 3 of which were fatal. There were no significant differences between the 2 groups (χ2 = 0.76; p > 0.05). There was no higher risk of mortality in any group (Fisher’s exact test; p = 0.08). Symptomatic patients had a higher incidence of stroke than asymptomatic patients across both groups (χ2 = 6.36; p < 0.05; hazard ratio 3.03 (1.26–7.33)).
Conclusion. Carotid endarterectomy is equally effective as CAS in stroke prevention, but is associated with a higher incidence of cranial nerve palsy, access site hematoma and other non-stroke complications. Symptomatic patients had a higher incidence of stroke, regardless of the treatment method.

Key words

carotid artery stenting, carotid endarterectomy, carotid artery stenosis

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