Carotid stenting: a surgeon's perspective

Recent multicenter studies have determined that the results of carotid stenting (CAS) are comparable to those of endarterectomy. Because most of these trials were performed in academic centers, it will be necessary to determine whether similar results can be obtained in community settings. This study reviewed the results of a single surgeon's experience with CAS performed in a university-affiliated community hospital.

All patients were treated with CAS during a 5-year period. Major and minor perioperative stroke and death, transient ischemic attack, myocardial infarction, restenosis, and late stroke were documented. A 2-tailed t-test was used to compare variables between groups.

A total of 162 carotid artery stents were placed in 149 patients. Ninety-three stents (57.41%) were placed for asymptomatic stenosis, and 69 (42.59%) were placed for symptomatic carotid disease. There were 8 neurologic complications, including 3 transient ischemic attacks (1.85%), 3 minor strokes (1.85%), and 2 major strokes (1.23%). Seven of 8 neurologic events including both major strokes occurred in patients older than 80 years. Octogenarians were significantly more likely to suffer a neurologic event or stroke than those younger than 80 years (p = 0.0004 and p = 0.0179, respectively). There was 1 death within 30 days of the procedure, and there were no symptomatic myocardial infarctions.

When CAS was performed by a vascular surgeon in patients younger than 80 years, the rate of neurologic events was acceptable and similar to the results of carotid endarterectomy in previously published studies. However, the risk of stroke is disproportionately high in octogenarians undergoing CAS. These patients may best be treated surgically.