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CLINICAL STUDY

Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital

^a Central Baptist Hospital, Lexington, Kentucky, USA

Manuscript received January 5, 2001; revised manuscript received July 31, 2001, accepted August 8, 2001.

^* Reprint requests and correspondence: Dr. William H. Brooks, Neurosurgical Associates, 1401 Harrodsburg Road, Lexington, Kentucky 40505 USA

OBJECTIVES

The goal of this study was to determine whether carotid angioplasty and stenting (CAS) is equivalent to carotid endarterectomy (CEA) in patients with symptomatic carotid stenosis >70% by a randomized, controlled trial in a community hospital.

BACKGROUND

Carotid angioplasty and stenting has been suggested to be as effective as CEA for treatment of symptomatic carotid artery stenosis.

METHODS

A total of 104 patients presenting with cerebrovascular ischemia ipsilateral to carotid stenosis were selected randomly for CEA or carotid stenting and followed for two years.

RESULTS

Stenosis decreased to an average of 5% after CAS. The patency of the reconstructed artery remained satisfactory regardless of the technique as determined by sequential ultrasound. One death occurred in the CEA group (1/51); one transient ischemic attack occurred in the CAS group (1/53); no individual sustained a stroke. The perception of procedurally related pain/discomfort was similar. Hospital stay was similar, although the CAS group tended to be discharged earlier (mean = 1.8 days vs. 2.7 days). Complications associated with CAS prolonged hospitalization when compared with those sustaining a CEA-related complication (mean = 5.6 days vs. 3.8 days). Return to full activity was achieved within one week by 80% of the CAS group and 67% of the patients receiving CEA. Hospital charges were slightly higher for CAS.

CONCLUSIONS

Carotid stenting is equivalent to CEA in reducing carotid stenosis without increased risk for major complications of death/stroke. Because of shortened hospitalization and convalescence, CAS challenges CEA as the preferred treatment of symptomatic carotid stenosis if a reduction in costs can be achieved.

Abbreviations and Acronyms   ACT = activated clotting time   CAS = carotid angioplasty and stenting   CEA = carotid endarterectomy   CVA = cerebral vascular accident   MRI = magnetic resonance imaging   NIH = National Institute of Health   NASCET = North American Symptomatic Carotid Endarterectomy Trial   TIA = transient ischemic attack

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