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The effect of carotid stenting on endarterectomy practice--A single institution experience
A Ali1, A O'Callaghan1, T Moloney1
1Department of Vascular Surgery, Beaumont University Hospital, Dublin, Ireland.
Insights
Carotid endarterectomy (CEA) volumes decreased after carotid artery stenting (CAS) introduction. Despite this, CEA outcomes in high-risk patients remained acceptable, supporting its continued use for carotid revascularization.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurosurgery
Background:
- Surgeon volume is linked to carotid endarterectomy (CEA) quality.
- Carotid artery stenting (CAS) may reduce CEA procedure volumes.
- Assessing CEA outcomes after CAS introduction is crucial.
Purpose of the Study:
- To evaluate the impact of carotid artery stenting (CAS) on carotid endarterectomy (CEA) volumes.
- To analyze CEA surgical outcomes before and after CAS implementation.
- To determine if CEA remains a viable option for carotid stenosis treatment.
Main Methods:
- Retrospective cohort study design.
- Analysis of 757 carotid endarterectomy cases (1988-2010).
- Comparison of outcomes in patients treated before (pre-2001) and after (post-2001) CAS introduction.
Main Results:
- CEA volume decreased post-CAS introduction.
- Perioperative stroke rate reduced from 4.9% to 3.3%.
- Major adverse event rate was 4.1% post-CAS; no correlation found between stroke/MAE and procedure volume.
Conclusions:
- Carotid artery stenting has reduced carotid endarterectomy volumes.
- Carotid endarterectomy outcomes are acceptable in a high-risk patient cohort.
- Carotid endarterectomy remains a preferred revascularization procedure.
Objectives:
The number of operations performed per surgeon is thought to determine the quality of carotid endarterectomy (CEA) surgery. The advent of carotid artery stenting (CAS) threatens to reduce the volume of CEA. This paper assesses CEA and the effects of the introduction of CAS service on outcomes.
Design:
Retrospective cohort study.
Methods:
Clinical data and results of CEA were reviewed retrospectively for the treatment of carotid stenosis, between January 1988 and December 2010. CEA patients were grouped into those treated before and after the introduction of CAS to our hospital in 2001.
Results:
757 patients underwent a CEA between 1988 and 2010. The perioperative stroke rate prior to the introduction of CAS was 4.9%, and 3.3% after stent introduction in 2001. In this latter period, 85.5% had symptomatic stenosis which suggests that the patients were not low risk. The major adverse event rate (inclusive of death and myocardial infarction) post introduction of CAS from 2001 to 2010 was 4.1%. There was no correlation between post-operative stroke/MAE and procedure volume, despite the trend of decreasing CEA numbers over time.
Conclusion:
The introduction of carotid artery stenting has led to a decrease in carotid endarterectomy volume. However, outcomes in our high risk patient population are acceptable. Therefore, CEA remains the procedure of choice for carotid artery revascularization.
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