8th Baltic Congress of Radiology

Interventional Radiology

poster abstract

Background. Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for the treatment of atherosclerotic carotid artery stenosis. Recent population-based studies showed that CAS for carotid stenosis is associated with a higher risk of periprocedural stroke or death than CEA, especially for symptomatic carotid stenosis. On the other hand, CEA is a morbid surgical procedure with its attendant wound infections, hematomas, and cranial nerve palsies in 5% of patients. The aim was to assess the benefits and risks of CAS compared with CEA in people with symptomatic or asymptomatic carotid stenosis.

Methods. We retrospectively reviewed outcomes of patients undergoing CAS or CEA for asymptomatic or symptomatic carotid stenosis at our institution in year 2021. The patients were chosen according to the computed tomography angiography (CTA) Carotid stenosis measurement was performed using North American Symptomatic Carotid Endarterectomy trial (NASCET) methodology. CAS procedures were performed under local anesthesia in the majority through the common femoral artery. All patients received dual anti-platelet therapy on the day and 6 months after procedure. Carotid artery stenting was always done by using cerebral protection FilterWire(Boston Scientific) device and post-dilatation. Carotid artery pre-dilatation was done selectively. Double-layer Roadsever stent (Terumo) or carotid Wallstent(Boston Scientific) were used. Cervical and cerebral angiographic views were obtained before and after stent deployment. CEA operations were performed in general anesthesia, by routinely using Pruitt-Inahara (LeMaitre Vascular) or linear intraluminal shunts, majority with patch angioplasty. Patients with clinical neurological deterioration due to ischemic lesions after the procedure had CTA. The collected data was revised, coded and analyzed by using Statistical Package for Social Science (SPSS 26, IBM, Armonk, USA).

Results. The study included 28 CAS patients (mean age 69.07±7.8 years) and 100 CEA patients (mean age 68±9.3 years) during the year 2021 done in our hospital. The main reasons for CAS were high carotid bifurcation, restenosis and radiation therapy before. In CAS group 1 patient had intraoperative minor vertebrobasilaris stroke, 4 minor puncture site hematomas were observed. The mean hospital stay in CAS was 3.18±4.9 days. In CEA group, 1 patient had intraoperative ACM stroke, 1 patient had surgical wound hematoma. Three symptomatic patients had CEA after i.v. thrombolysis. The mean hospital stay in CEA was 5.3±3.5 days. No death or M.I. was observed. The percentage of CAS was 22% form study population.

Conclusions. CEA was performed with statistically significant prevalence over CAS in symptomatic patients (Chi square p=0.036). Mean hospital stay for patients without complications was 2 days, shorter in CAS, but not statistically significant. There was no significant relevance of heterogenicity of the treatment method in terms of age, sex, stenosis or other factors. In short-term outcomes, both methods showed acceptable results of treatment.

Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for the treatment of carotid artery stenosis. We retrospectively reviewed outcomes of patients undergoing CAS or CEA. In CAS group 1 patient had intraoperative minor vertebrobasilaris stroke. In CEA group, 1 patient had intraoperative ACM stroke. CEA was performed with statistically significant prevalence over CAS in symptomatic patients. In short-term outcomes, both methods showed acceptable results of treatment.

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