• Vascular Annual Meeting
• Call for Abstracts
• General Information
• Exhibitor Information
• Alumni Association Information
• 2009 Meeting Information
• Future Meeting Dates
• Contact Us

Home > Vascular Annual Meeting > PP16. Carotid Stenting (CAS) vs. Carotid Endarterectomy (CEA)...

PP16. Carotid Stenting (CAS) vs. Carotid Endarterectomy (CEA): Patients Choice?

Kenneth Granke1, Brenada Allende1, Micheal Bojalian1, Angelikea Vouyouka2, Jacob Gordon1, John Malleis1
1Wayne State Medical School, Detroit, MI; 2Mt Sinai Hospital, New York, NY

OBJECTIVES: Trials on CAS, typically in high risk patients, suggest a 1% higher stroke rate but show equivalency to CEA. Unfortunately, the CEA results usually exceed the accepted limits of proven benefit set in ACAS and NACET. To assess benefit at one institution, patients were prospectively offered their choice of CAS or CEA, regardless of risk status.

METHODS: Between October 2002 and May 2007, with IRB approval, consecutive patients at a VA hospital were analyzed after they selected either CAS or CEA. They were informed of a possible 1% greater risk of stroke with CAS. A single Neurologist (JG) verified neurological exams. Variables compared: age, beta-blocker use, diabetes (DM), hypertension (HTN), coronary artery disease (CAD), respiratory disease (RD), intermittent claudication (IC), stroke, TIA, amaurosis fugax, operative room time, transfusion, length of stay (LOS), myocardial infarction, nerve injury, hematoma, stroke and death. Statistical analysis was performed using Fischer’s Exact and Mann-Whitney Tests.

RESULTS: 92 patients underwent 98 procedures (48 CEA /50 CAS). Although 75% were high risk, there were no differences in high/low risk, asymptomatic/symptomatic patient choice of CAS vs. CEA, nor between: age, HTN, DM, CAD, IC. The CEA group had a higher incidence of RD (p=0.015), TIA (p=0.008) and smoking (p=0.002). Operative time was higher in CEA vs. CAS (2.1 hr. vs. 1.3 hr; p=0.02). There was no difference in LOS or transfusion. CEA had higher major complications: MI (2 vs. 0%), nerve injury (4 vs. 0%) and hematoma (11 vs. 3%) compared to CAS (p<0.01). The 30 day stroke/mortality rates were no different: 0/2% and 2.1/0 % for CEA and CAS, respectively. Mean follow-up was 27.2 vs. 22.8 months for CEA vs. CAS, respectively with no late neurological symptoms and similar deaths. One restenosis in each group was treated with CAS. Four patients had contra lateral treatments (3 CEA underwent CAS and 1 CAS underwent CEA).
CONCLUSIONS: When both surgical and endovascular treatment outcomes are within established standards, pre-operative risk status need not be the factor for recommending CAS. Consideration should be given to in-dividual and /or institutional perioperative outcomes to guide reimbursement recommendations to allow the patient a choice between CEA and CAS.

AUTHOR DISCLOSURES: K. Granke, speaker, king pharmaceuticals; B. Allende, None; M. Bojalian, None; A. Vouyouka, None; J. Gordon, None; J. Malleis, None.