27. Carotid Stenting Done Exclusively By Vascular Surgeons: First 150 Cases
Mark K. Eskandari, MD*, G. Matthew Longo, MD*, Jon S. Matsumura, MD*, Melina R. Kibbe, MD*, Mark D. Morasch, MD*, William H. Pearce, MD
Northwestern University, Feinberg School of Medicine, Chicago, IL
Percutaneous carotid angioplasty and stenting (CAS) threatens to replace carotid endarterectomy (CEA) as standard of care. CAS has been performed largely by interventional cardiologists; however, with recent FDA approval, vascular surgeons are now hurriedly attempting to obtain the requisite endovascular skills. Reported are our 30-day and late outcomes of CAS.
Retrospective review of 150 cervical carotid stenoses treated with elective CAS, April 2001-November 2004. All procedures were performed in an OR angiosuite under local anesthesia via percutaneous femoral access. Mechanical cerebral protection was used in 87% of cases. Data analysis includes demographics, procedural records and duplex exams over a mean follow-up of 15 months (range 0-43 months).
Mean age is 70 years (74% men and 26% women). Preprocedural neurologic symptoms were present in 36%. Intra-operative complications included two seizures (1.3%) and four asystolic arrests (2.6%), all managed medically without sequelae. Over the 30-day follow-up, there were no deaths, no myocardial infarctions, two major strokes (1.3%), one minor stroke (0.6%), three TIAs (1.3%), and one major access site complication (0.6%). At late follow-up, three cases (2.0%) of restenosis occurred; all were treated with repeat angioplasty and remain patent. One (0.6%) asymptomatic occlusion was detected at six-month follow-up. There have been no late carotid-related complications or deaths.
Vascular surgeons possessing advanced catheter-based skills can safely perform CAS and achieve perioperative results comparable to CEA. Such skills can be obtained through formal training programs and are crucial to those surgeons intent on the future management of carotid occlusive disease.