A COMPARISON OF ANGIOPLASTY WITH STENTING VERSUS ENDARTERECTOMY FOR THE TREATMENT OF CAROTID-ARTERY STENOSIS

Carotid endarterectomy has been established as the standard treatment for high-grade carotid stenosis. The results of an ongoing prospective trial for the safety of percutaneous angioplasty with stenting (PTAS) were compared to retrospectively reviewed patients treated with carot id endarterectomy (CEA). During the same 14-month period, 273 patients underwent treatment of 310 carotid bifurcation stenoses: 107 by PTA w ith stenting, 166 by CEA. indications for treatment included stroke 46 (16.8%), transient ischemic attack 109 (39.9%), syncope 7 (2.6%), and high-grade asymptomatic stenosis 111 (40.7%). Combined early stroke a nd death rates are listed as follows: [GRAPHICS] Important nonneurolog ic complications were evident in six (5.6%) PTAS patients and two (1.2 %) CEA patients. Six-month follow-up data was available for 193 patien ts (71%) with the following results: seven (6.5%) minor strokes in the PTAS group, one (0.6%) minor stroke in the CEA group, one (0.9%) majo r stroke in the PTAS group, one (0.6%) major stroke in the CEA group, four deaths (3.7%) in the PTAS group, and six deaths (3.6%) in the CEA group. Early results from PTA with stenting are promising but not saf er than CEA for the treatment of carotid artery stenosis. Long-term fo llow-up is needed to determine the ultimate durability of this new tec hnique. PTA with stenting may be an alternative for the treatment of c arotid bifurcation lesions in selective high-risk surgical patients.