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CEA versus CAS: short-term and mid-term results
M M G Felli1, A Alunno, A Castiglione
1Paride Stefanini Department of Vascular Surgery, Policlinico Umberto 1, Rome, Italy.
Insights
Carotid endarterectomy (CEA) shows better short-term and mid-term outcomes than carotid artery stenting (CAS) for carotid stenosis, with lower rates of neurological deficit and cognitive decline. CEA is preferred for most patients.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Ischemic stroke is a leading cause of long-term disability.
- Carotid stenosis is a significant risk factor for stroke.
- Comparing surgical and endovascular interventions is crucial for stroke prevention.
Purpose of the Study:
- To compare the short-term and mid-term outcomes of carotid endarterectomy (CEA) and carotid artery stenting (CAS).
- To evaluate the efficacy and safety of CEA versus CAS in patients with carotid stenosis.
Main Methods:
- A prospective study involving 300 patients with carotid stenosis.
- 150 patients underwent CEA, and 150 underwent CAS with distal protection.
- Comprehensive pre- and post-operative assessments including neurological exams, imaging (MRI), cognitive tests, and Transcranial Doppler (TCD) monitoring for microembolic signals (MES).
Main Results:
- Zero mortality in both groups.
- CEA group: 1.3% neurological deficit, 4% embolic lesions (MRI), 4% cognitive decline.
- CAS group: 3.3% neurological deficit, 34% embolic lesions (MRI), 25.3% cognitive decline.
- Two myocardial infarctions occurred in the CEA group during follow-up.
Conclusions:
- Carotid endarterectomy (CEA) is the preferred treatment for carotid stenosis, particularly in asymptomatic patients, due to lower morbidity.
- Carotid artery stenting (CAS) is reserved for specific cases like restenosis, post-radiation/surgery, or complex anatomy.
- Further multicenter randomized trials are needed for definitive conclusions.
Aim:
Ischemic stroke represents a major health problem and it is an important cause of long-term disability. The aim of this study was to compare short-term and mid-term results of carotid endarterectomy and stenting.
Methods:
During a three-year period, we enrolled 300 patients with carotid stenosis that fit with Stroke Prevention and Educational Awareness Diffusion (SPREAD) guidelines and we performed 150 carotid endarterectomy operations (CEA) and 150 carotid artery stenting procedures (CAS) with distal protection devices. All patients underwent preoperative and postoperative: neurological examination, ultrasound imaging, magnetic resonance imaging (MRI) and cognitive tests; moreover all patients were submitted to preoperative, intraoperative and postoperative Transcranial Doppler (TCD) monitoring, in order to detect microembolic signals (MES).
Results:
Mortality was zero; two patients developed myocardial infarction in the CEA group during follow-up. The main post-operative results after endarterectomy versus CAS were respectively: neurological deficit: 1.3% vs. 3.3%, embolic lesions at postoperative MRI: 4% vs. 34% and worsening of cognitive tests: 4% vs. 25.3%.
Conclusion:
CEA seems to be the treatment of choice for carotid stenosis, due to its low rate of mortality and morbidity, especially in asymptomatic patients; CAS should be carried out only in particular subgroup of cases, such as: restenosis, previous neck surgery or radian therapy, anatomical high bifurcation or extended lesions. Ongoing multicenter randomized trials may give a definitive answer to this matter.
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