Elias Kfoury, Dipankar Mukherjee
Inova Fairfax Hospital, Falls Church, VA.
OBJECTIVES: Interpreting the results of the CREST trial suggest that carotid endarterectomy and carotid stenting are somehow equivalent in postoperative morbidity with less stroke rate in carotid endarterectomy (CEA) arm and less myocardial infarction (MI) rate in carotid stenting arm. We hypothesized that stroke rate and myocardial infarction rate lower than the reported results of the CREST trial can be achieved with carotid endarterectomy.
METHODS: A retrospective review of medical charts for patients undergoing CEA was conducted at a large community hospital from July 2007-June 2010. Thirty-day postoperative myocardial infarctions (MI) and strokes were evaluated for patients undergoing CEA.
RESULTS: A total of 663 patient charts were reviewed for patients who underwent carotid endarterectomy. No adjustments were made for surgeon specialty or anesthesia type. Thirty-day postoperative stroke rate and myocardial infarction rate were reviewed. Carotid endarterectomy postoperative stroke rate was 1.36% (total of 9 patients) and myocardial infarction rate was 0.45% (total of 3 patients). No myocardial infarctions were reported and a stroke rate of 0.7 % was detected in 407 carotid endarterectomies done under local anesthesia.
CONCLUSIONS: Our published results fall well below the reported numbers in the CREST study in terms of postoperative stroke rate of 2.3% for carotid endarterectomy and myocardial infarction rate of 2.3%. Since the guidelines for management of patients with carotid artery stenosis are dependent on risk and benefit ratio further evaluation of carotid endarterectomy compared to stenting and medical therapy should be considered with large scale studies.
AUTHOR DISCLOSURES: E. Kfoury, Nothing to disclose; D. Mukherjee, Nothing to disclose.
Posted April 2012