Key result
CAS yields zero symptomatic strokes compared with CEA but carries asymptomatic emboli.
Why the study?
The selection criteria for carotid endarterectomy versus carotid artery stenting in treating carotid artery stenosis considering symptomatic status and anatomical factors were unclear.
Does carotid endarterectomy compared to carotid artery stenting improve outcomes in patients with carotid artery stenosis?
Observational (n=18)
No
Does carotid endarterectomy compared to carotid artery stenting improve outcomes in patients with carotid artery stenosis?
The selection between carotid endarterectomy and stenting should be individualized based on symptom status, plaque vulnerability, and anatomical factors.
Individualized CEA/CAS selection by symptoms and factors may inform decisions; leaves open need for RCTs to confirm benefit.
Carotid endarterectomy (CEA) is a standard surgical procedure used to treat carotid artery stenosis and the associated peri-procedural stroke rate is lower than that associated with carotid artery stenting (CAS). However, the latter is preferred as it is comparatively less invasive. We compared the efficacy of CEA for symptomatic stenosis and CAS for asymptomatic or transient ischemic attack, while considering other factors such as anatomy, renal function, and general status before selecting the final procedure. We operated on 5 lesions using CEA and 14 lesions using CAS. One patient with symptomatic stenosis who was treated using CEA developed symptomatic postoperative stroke. Symptomatic stenosis, vulnerable plaque, and hazardous anastomosis were associated with an increased risk of stenting. A higher location of internal carotid artery stenosis and other anatomical factors should be considered before selecting endarterectomy.
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Nagata et al. (2019) conducted an observational in Carotid artery stenosis (n=18). Carotid endarterectomy (CEA) and Carotid artery stenting (CAS) was evaluated on Postoperative symptomatic infarction. Among 19 lesions treated for carotid artery stenosis, one patient treated with carotid endarterectomy developed a symptomatic postoperative stroke (5.2%), while carotid artery stenting caused no symptomatic strokes but resulted in asymptomatic emboli.