Carotid Artery Angioplasty and Stenting: Introduction of a New Technique into an Established Canadian Vascular Surgery Center.

Albacker TB, Nouh T, Abraham CZ, MacKenzie KS, Corriveau MM, Obrand DI, Sheiner N,
Steinmetz OK 
Division of Vascular Surgery, McGill University, Montreal, Canada  

Background:  The aim of this study was to review our experience with the introduction of carotid artery angioplasty and stenting (CAS) as a treatment for carotid stenosis in high-risk patients and compare clinical outcomes to carotid endarterectomy (CEA) patients treated over the same time period at our center.

Methods: CAS was introduced to a vascular surgery group over a three year period with all cases performed under the supervision of a single experienced endovascular surgeon. 161 patients underwent 172 carotid revascularization procedures (45 CAS and 127 CEA) In the CAS group 93% were high risk according to the reporting standards of the American Society of Interventional and Therapeutic Neuroradiology and Society of Interventional Radiology. Demographic, operative and follow up data were retrospectively collected on all patients. Death, stroke and restenosis rates were compared at 30 days and later follow-up. Degree of stenosis on follow-up exams was determined by Duplex ultrasound.

Results: There were no differences in baseline risk factors or indications for intervention between groups, except that more CAS than CEA patients were considered high cardiac risk (13% vs. 2 %, p<0.05) High risk carotid lesions were present in 67% of CAS patients. Cardiac event, stroke and death rates are shown in the table.

* Fisher’s exact test

Mean follow-up (F/U) for all patients was 13 months (range 0-42 months). Restenosis rate (>50%) was higher in CAS than CEA (35% vs15 %; p=0.02).  3 patients had reintervention in the CAS group and 1 patient in the CEA group had redo CEA .

Conclusion: Restenosis >50% and stroke was observed more frequently in our initial experience with high-risk patients undergoing CAS compared with low-risk patients undergoing CEA during the same time period. Further study to evaluate the effect of the learning curve for early results as well as follow-up for intermediate and long-term durability of CAS is required.