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Unprotected carotid artery stenting compared to carotid endarterectomy in a community setting
Hooman Madyoon1, Eric Braunstein, Frank Callcott
1Intervention Cardiology, Cardiac Catheterization Laboratory, St Joseph's Medical Center, Stockton, California 95204, USA. cardiology@2xtreme.net
Insights
Carotid artery stenting (CAS) is feasible and safe in community hospitals when performed by a multidisciplinary team. This procedure showed comparable stroke rates to carotid endarterectomy (CEA) but with a significantly shorter hospital stay.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Carotid artery stenosis poses a significant risk of stroke.
- Carotid endarterectomy (CEA) is a traditional surgical treatment.
- Carotid artery stenting (CAS) offers a less invasive alternative.
Purpose of the Study:
- To assess the feasibility and safety of CAS in a community hospital setting.
- To evaluate the performance of CAS by a dedicated multidisciplinary team.
- To compare CAS outcomes with CEA.
Main Methods:
- 49 patients with significant carotid stenosis underwent CAS using self-expanding stents without cerebral protection.
- A control group of 140 patients underwent CEA.
- Outcomes including death, neurological sequelae, and length of stay were analyzed.
Main Results:
- CAS procedures were successful in 96% of patients.
- No deaths or myocardial infarctions occurred in either group.
- CAS had comparable stroke rates to CEA (4.1% vs 5.8%) but a significantly shorter median length of stay (LOS).
Conclusions:
- CAS can be safely performed in a community hospital with careful patient selection and multidisciplinary collaboration.
- CAS demonstrates acceptable early results and clinical benefits, including reduced LOS.
- This approach supports the expansion of advanced vascular interventions in community healthcare settings.
Purpose:
To evaluate the feasibility and safety of carotid artery stenting (CAS) performed by a dedicated multidisciplinary team in a community hospital.
Methods:
Forty-nine patients (30 men; mean age 74.3 +/- 7.4 years, range 51-88) with 14 symptomatic and 35 asymptomatic >50% carotid stenoses were enrolled into the study and treated with self-expanding stents without cerebral protection. The patients were evaluated at 30 days for death, neurological sequelae, and length of stay. A contemporaneous group of 140 patients (80 men; mean age 72.3 +/- 7.7 years, range 43-89) undergoing carotid endarterectomy (CEA) was used for comparison of the outcome measures. Owing to crossover of failed CAS patients to the CEA group, the data were analyzed according to intention-to-treat and treatment-received.
Results:
The only difference in baseline characteristics between the treatment and control groups was the greater frequency of bilateral disease in the CEA group (p=0.009). The CAS procedures were successful in 47 (96.0%) patients; 2 access failures were converted to endarterectomy, and 1 access-site pseudoaneurysm was treated surgically. There were no deaths or myocardial infarctions in either group. In the CAS group, there were no major and only 2 (4.1%) minor strokes compared to 4 (2.9%) major and 4 (2.9%) minor strokes in the CEA group (p>0.05). Median LOS was significantly lower in the CAS group (p<0.0001).
Conclusions:
Careful case selection and multidisciplinary collaboration facilitate the safe performance of carotid stenting in a community setting with acceptable early results.