Carotid artery stenting compared to carotid endarterectomy performed exclusively in a veteran population: One center's experience with midterm results

Katherine E. Brown, Dustin J. Fanciullo, Taylor Hicks, David S. Landau, Henry M. Baraniewski, Mark D. Morasch, Jon S. Matsumura, William H. Pearce, Mark K. Eskandari, Melina R. Kibbe

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

OBJECTIVE:: To evaluate a single center's experience with carotid artery stenting (CAS) and carotid endarterectomy (CEA) performed by vascular surgeons in an entirely veteran population. METHODS:: Data from the Lakeside and Jesse Brown Veterans Affairs Medical Centers (VAMC) from September 1997 to December 2006 were retrospectively reviewed. Indications for CAS or CEA included asymptomatic carotid stenosis >70% or symptomatic stenosis >50%. Demographic data, procedural details, and clinical outcomes are reported. RESULTS:: A cohort of 104 patients (98% men) underwent 113 CAS procedures with 100% technical success. Cerebral protection was used in 98% of the procedures. Average age was 70 years (15 patients 80 years old); 30% were symptomatic. Previous ipsilateral CEA, neck dissection or irradiation was present in 10.6% of procedures. The 30-day transient ischemic attack, stroke, and death rates were 2.7%, 3.5%, and 0.0% respectively. The 1-year all cause death rate was 6.2%. During the same time period, 79 patients (98% male) underwent 91 CEA procedures. Average age was 67 years (9 patients 80 years old); 45% were symptomatic. The 30-day transient ischemic attack, stroke, and death rates were 1%, 2.2%, and 1% respectively. The 1-year all cause death rate was 5.5%. There were no statistically significant differences in outcome within asymptomatic and symptomatic patient groups between CAS and CEA, respectively. CONCLUSIONS:: CAS is a safe and efficacious alternative for the treatment of carotid artery stenosis in a veteran population and outcomes compare favorably to contemporary CAS and CEA trials. Veterans should be offered CAS as a treatment option for carotid artery stenosis by vascular surgeons or interventionalists who are trained to perform this procedure and have the appropriate resources.

Original languageEnglish (US)
Pages (from-to)110-116
Number of pages7
JournalAnnals of surgery
Volume248
Issue number1
DOIs
StatePublished - Jul 2008

ASJC Scopus subject areas

  • Surgery

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