A comparison of carotid artery stenting with neuroprotection versus carotid endarterectomy under local anesthesia

Ruth L. Bush, Panagiotis Kougias, Marlon A Guerrero, Dieter F. Lubbe, Wei Zhou, Alan B. Lumsden, Peter H. Lin

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) reduce the risk of stroke in patients with high-grade carotid artery stenosis. Despite the known impact of type of anesthesia on outcome after CEA, none of the current studies comparing CEA with CAS addresses the effect of anesthetic choice on perioperative events. In this study, we compare our results of distally protected CAS versus CEA under local anesthesia. Methods: Clinical data of 345 patients who underwent 372 procedures for carotid artery occlusive disease over a 36-month were retrospectively collected for this analysis. Distal embolic protection was used in CAS procedures. All procedures, both CEA (n = 221, 59%) and CAS (N = 152, 41%), were performed under local anesthesia. The primary outcome measure was aggregate 30-day major ipsilateral stroke and/or death. Follow-up serial Duplex ultrasound examinations were performed. Results: Both patient cohorts were similar in terms of demographic and risk factors, with the exception of a higher incidence of coronary artery disease in the CAS group (59% versus 30%, P <.05). The 30-day stroke and death rates were 3.2% (CAS) and 3.7% (CEA) (P = not significant). Cranial nerve injury only occurred in the CEA patients (2.3%). Perioperative hemodynamic instability was more common among patients in the CAS group (11.9% versus 4.1%, P <.05). Conclusions: Percutaneous carotid stenting with neuroprotection provides comparable clinical success to CEA performed under local anesthetic. Further studies are warranted to validate the long-term efficacy of CAS and to elucidate patient selection criteria for endovascular carotid revascularization.

Original languageEnglish (US)
Pages (from-to)696-700
Number of pages5
JournalAmerican Journal of Surgery
Volume190
Issue number5
DOIs
StatePublished - Nov 2005
Externally publishedYes

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Carotid Endarterectomy
Local Anesthesia
Carotid Arteries
Stroke
Patient Selection
Cranial Nerve Injuries
Neuroprotection
Carotid Artery Diseases
Carotid Stenosis
Local Anesthetics
Anesthetics
Coronary Artery Disease
Anesthesia
Hemodynamics
Demography
Outcome Assessment (Health Care)
Mortality
Incidence

Keywords

  • Carotid endarterectomy
  • Carotid stenting
  • Local anesthesia
  • Neuroprotection

ASJC Scopus subject areas

  • Surgery

Cite this

A comparison of carotid artery stenting with neuroprotection versus carotid endarterectomy under local anesthesia. / Bush, Ruth L.; Kougias, Panagiotis; Guerrero, Marlon A; Lubbe, Dieter F.; Zhou, Wei; Lumsden, Alan B.; Lin, Peter H.

In: American Journal of Surgery, Vol. 190, No. 5, 11.2005, p. 696-700.

Research output: Contribution to journalArticle

Bush, Ruth L. ; Kougias, Panagiotis ; Guerrero, Marlon A ; Lubbe, Dieter F. ; Zhou, Wei ; Lumsden, Alan B. ; Lin, Peter H. / A comparison of carotid artery stenting with neuroprotection versus carotid endarterectomy under local anesthesia. In: American Journal of Surgery. 2005 ; Vol. 190, No. 5. pp. 696-700.
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abstract = "Background: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) reduce the risk of stroke in patients with high-grade carotid artery stenosis. Despite the known impact of type of anesthesia on outcome after CEA, none of the current studies comparing CEA with CAS addresses the effect of anesthetic choice on perioperative events. In this study, we compare our results of distally protected CAS versus CEA under local anesthesia. Methods: Clinical data of 345 patients who underwent 372 procedures for carotid artery occlusive disease over a 36-month were retrospectively collected for this analysis. Distal embolic protection was used in CAS procedures. All procedures, both CEA (n = 221, 59{\%}) and CAS (N = 152, 41{\%}), were performed under local anesthesia. The primary outcome measure was aggregate 30-day major ipsilateral stroke and/or death. Follow-up serial Duplex ultrasound examinations were performed. Results: Both patient cohorts were similar in terms of demographic and risk factors, with the exception of a higher incidence of coronary artery disease in the CAS group (59{\%} versus 30{\%}, P <.05). The 30-day stroke and death rates were 3.2{\%} (CAS) and 3.7{\%} (CEA) (P = not significant). Cranial nerve injury only occurred in the CEA patients (2.3{\%}). Perioperative hemodynamic instability was more common among patients in the CAS group (11.9{\%} versus 4.1{\%}, P <.05). Conclusions: Percutaneous carotid stenting with neuroprotection provides comparable clinical success to CEA performed under local anesthetic. Further studies are warranted to validate the long-term efficacy of CAS and to elucidate patient selection criteria for endovascular carotid revascularization.",
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AU - Bush, Ruth L.

AU - Kougias, Panagiotis

AU - Guerrero, Marlon A

AU - Lubbe, Dieter F.

AU - Zhou, Wei

AU - Lumsden, Alan B.

AU - Lin, Peter H.

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N2 - Background: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) reduce the risk of stroke in patients with high-grade carotid artery stenosis. Despite the known impact of type of anesthesia on outcome after CEA, none of the current studies comparing CEA with CAS addresses the effect of anesthetic choice on perioperative events. In this study, we compare our results of distally protected CAS versus CEA under local anesthesia. Methods: Clinical data of 345 patients who underwent 372 procedures for carotid artery occlusive disease over a 36-month were retrospectively collected for this analysis. Distal embolic protection was used in CAS procedures. All procedures, both CEA (n = 221, 59%) and CAS (N = 152, 41%), were performed under local anesthesia. The primary outcome measure was aggregate 30-day major ipsilateral stroke and/or death. Follow-up serial Duplex ultrasound examinations were performed. Results: Both patient cohorts were similar in terms of demographic and risk factors, with the exception of a higher incidence of coronary artery disease in the CAS group (59% versus 30%, P <.05). The 30-day stroke and death rates were 3.2% (CAS) and 3.7% (CEA) (P = not significant). Cranial nerve injury only occurred in the CEA patients (2.3%). Perioperative hemodynamic instability was more common among patients in the CAS group (11.9% versus 4.1%, P <.05). Conclusions: Percutaneous carotid stenting with neuroprotection provides comparable clinical success to CEA performed under local anesthetic. Further studies are warranted to validate the long-term efficacy of CAS and to elucidate patient selection criteria for endovascular carotid revascularization.

AB - Background: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) reduce the risk of stroke in patients with high-grade carotid artery stenosis. Despite the known impact of type of anesthesia on outcome after CEA, none of the current studies comparing CEA with CAS addresses the effect of anesthetic choice on perioperative events. In this study, we compare our results of distally protected CAS versus CEA under local anesthesia. Methods: Clinical data of 345 patients who underwent 372 procedures for carotid artery occlusive disease over a 36-month were retrospectively collected for this analysis. Distal embolic protection was used in CAS procedures. All procedures, both CEA (n = 221, 59%) and CAS (N = 152, 41%), were performed under local anesthesia. The primary outcome measure was aggregate 30-day major ipsilateral stroke and/or death. Follow-up serial Duplex ultrasound examinations were performed. Results: Both patient cohorts were similar in terms of demographic and risk factors, with the exception of a higher incidence of coronary artery disease in the CAS group (59% versus 30%, P <.05). The 30-day stroke and death rates were 3.2% (CAS) and 3.7% (CEA) (P = not significant). Cranial nerve injury only occurred in the CEA patients (2.3%). Perioperative hemodynamic instability was more common among patients in the CAS group (11.9% versus 4.1%, P <.05). Conclusions: Percutaneous carotid stenting with neuroprotection provides comparable clinical success to CEA performed under local anesthetic. Further studies are warranted to validate the long-term efficacy of CAS and to elucidate patient selection criteria for endovascular carotid revascularization.

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KW - Neuroprotection

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