Surgical or endovascular treatment of carotid stenosis

Abstract

Carotid endarterectomy (CEA) is a proved standard treatment in stenosis of high-grade carotid artery stenosis. On the basis of new experience, percutaneous transluminal angioplasty with stent (PTAS) has gradually been established as an alternative method to carotid endarterectomy. The aim of the three-month investigation was to evaluate PTAS, CEA and conservative medicamentous therapy. A group of 75 patients (78 stenoses) with symptomatic and asymptomatic stenoses of the carotid artery of 70 and more percent were evaluated within a unicentric retrospective study. The period of investigation commenced in August 1999, and lasted 14 months. The patients were treated by PTAS (23 patients), CEA (23 patients). Two patients were treated by bilateral stenting. One patient was subdued to both operation and endovascular treatment, while the former treatment was performed on one side and the latter on the contralateral side. This patient was included into both surgical and endovascular groups. The rest of the patients were treated solely by medicamentous therapy (30 patients). During the period of 30 days after the intervention, one patient in both PTAS and CEA groups (4.3%) developed a severe ipsilateral infarction. Recurrent stenoses were recorded in two patients from the PTAS group (8.7%) (sonographically more than 50%), and in one patient from the CEA group (4.3%). Immediately after stent implantation, 12 patients (52.2%) developed pinlike ischemic lesions observed by means of diffusion-weighted MR imaging (DWI). Hyperintensive signals did not lead to any neurologic deficits. After 3 months, none of the latter lesions were found in any of the patients. In the group treated by conservative therapy, only one of the patients (3%) developed a mild infarction. After the evaluation of our experience with peri-interventional PTAS and CEA complications in our small group of investigated patients, it is possible to state that the performance of both methods can be comparably successful. However, at the moment we cannot consider PTAS as an equivalent method. (Tab. 6, Fig. 2, Ref. 33.).