Carotid angioplasty and stenting vs carotid endarterectomy for treatment of asymptomatic disease: Single-center experience

Background: Carotid angioplasty and stenting (CAS) with embolic protection is an acceptable alternative to carotid endarterectomy (CEA) in selected patients with symptomatic cervical carotid artery disease. Whether outcomes after CAS are comparable to those after CEA in the larger population of patients with asymptomatic disease is unclear. Hypothesis: Carotid angioplasty and stenting performed in patients with asymptomatic disease will result in early outcomes equivalent to those with CEA performed in patients with asymptomatic disease at our center and in 2 landmark studies of CEA. Design: Single-center retrospective review. Setting: Urban hospital. Patients: Three hundred twenty-six patients (202 men [62%] and 124 women [38%]; mean age, 71 years) with asymptomatic carotid artery stenoses treated with either CAS (n=120) or CEA (n=206) between January 1, 2001, and December 31, 2006. Overall mean degree of stenosis was 81.2%. Interventions: Carotid angioplasty and stenting was performed using self-expanding nitinol stents coupled with a mechanical embolic protection system. Carotid endarterectomy was performed using general anesthesia with selective shunting based on carotid stump pressure. Main Outcome Measures: Stroke, myocardial infarction, and death rates at 30 days after surgery. Results: At 30 days after surgery, there was no statistical difference between outcomes after CAS (2 strokes [1.7%], 2 myocardial infarctions [1.7%], and 1 death [0.8%]) compared with CEA (2 strokes [1.0%], 3 myocardial infarctions [1.5%], and no deaths). Conclusion: Vascular surgeons who have advanced catheter-based skills can safely perform CAS in patients with asymptomatic disease with periprocedural results comparable to those with CEA.