Abstract T P96: Short-term and Mid-term Results of Carotid Artery Revascularization as Carotid Artery Stenting for First-line Treatment: Single Center Experience in Japan
Objective: Penetration ratio of carotid artery stenting (CAS) in carotid revascularization caught up that of carotid endarterectomy (CEA) in 2005, exceeding more than 60% in recent years after CREST in Japan. We choose CAS for first-line treatment, while CEA is applied to CAS high-risk patients dependent on factors including accessibility, plaque diagnosis, and symptom. The aim of this study is to evaluate short-term and mid-term results of single center experience of 266 consecutive cases with CAS / CEA.
Materials / Methods: This is a retrospective analysis of 227 CAS and 39 CEA during January 2009 to March 2013. The primary outcome measures (short-term results) were any periprocedural (within 30 days after procedure) death, stroke, and acute coronary syndrome, and the rate of postoperative positive lesion in diffusion weighted imaging (DWI) on MRI. The mid-term results include death, stroke, and restenosis requiring retreatment during the follow-up periods.
Results: There were no significant differences in age, underlying disease, and the severity of stenosis in both CEA and CAS group. However, the percentage of symptomatic lesion and the MRI T1WI plaque-sternocleidomastoid muscle ratio (index of the vulnerability of plaque) were higher in CEA than CAS group (69% vs. 48%, p=0.015; 1.79±0.46 vs. 1.31±0.37, p<0.0001). Short-term results revealed no mortality in both groups, any stroke 2.6% CEA vs. 4.9% CAS (p=1); major stroke 2.6% CEA vs. 0.9% CAS (p=0.38); acute coronary syndrome 0% CEA vs. 0.9% CAS (p=1); the rate of DWI-positive 24% vs. 39% (p=0.10). Mid-term results during the follow-up periods (CEA 18.3±13.5 month, CAS 20.3±14.1 month): death 5.1% CEA vs. 5.7% CAS (p=1), stroke 7.7% CEA vs. 11.0% CAS (p=0.78), restenosis requiring retreatment 0% vs. 6.6% (p=0.14).
Conclusion: The short-term and the mid-term results were excellent and equivalent in CAS and CEA although we apply CEA to high-risk lesions such as fragile plaque or symptomatic lesion. Our protocol, in which most patients undergo less invasive CAS as the first-line while CEA is selected for CAS high-risk patients, enables to provide high quality treatment for carotid artery revascularization.
Author Disclosures: H. Miyata: None. I. Nakahara: None. S. Matsumoto: None. T. Ohta: None. Y. Fukushima: None. R. Ishibashi: None. M. Gomi: None. H. Nishi: None. S. Watanabe: None.
This research has received full or partial funding support from the American Heart Association, National Center.
- © 2014 by American Heart Association, Inc.