Background Stroke is the second leading cause of death worldwide and the leading cause of disability in the U.S. Carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) are well established treatments modalities that have been shown to decrease stroke recurrence in patients with underlying carotid artery disease.
Methods Retrospective chart review was conducted on patients who underwent CEA or CAS at our tertiary care institution between 2009 and 2016. Patient demographics, risk factors, symptoms, modified Rankin Score (mRS) and NIHSS pre- and postoperatively, complications and restenosis occurrence were collected. Significant restenosis was defined as a carotid peak systolic velocity (PSV) of ≥250 cm/s, or ≥70% stenosis by CTA/MRA or catheter angiogram.
Results In total, 317 cases (204 CEA and 113 CAS) were analyzed. Patients were predominantly non-Hispanic Caucasian (84.5%), males (61.2%) with hypertension (87.1%), and hyperlipidemia (82.0%). The mean (±SD) age was 68 (±11) years. Most patients (84.7%) had symptomatic carotid disease at the time of the procedure. Differences in median post-operative NIHSS and mRS were not significant based on pre-treatment symptomatic/asymptomatic status and treatment modality (CEA/CAS). The perioperative complication rate was low (2.2%); of these, permanent neurologic deficit was seen in only 0.6%, and mortality in 0.3% of patients. Restenosis was found in 7.3% of patients, without significant difference between CEA and CAS at time of last follow-up. Restenosis was asymptomatic in the majority of patients (91.3%).
Conclusion Despite less stringent inclusion/exclusion criteria used in prior large randomized control trials, findings from our ‘real-world’, single-center, predominantly symptomatic cohort demonstrate excellent patient outcomes, and low restenosis and complication rates with both CEA and CAS.
Disclosures B. Howie: None. A. Witek: None. M. Bain: None. S. Hussain: None. G. Toth: None.
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