A COMPARISON OF CAROTID ANGIOPLASTY WITH STENTING VERSUS ENDARTERECTOMY WITH REGIONAL ANESTHESIA

Introduction: Percutaneous transluminal angioplasty with stenting (PTA S) has been considered a potential alternative to carotid endarterecto my (CEA) for stroke prevention. Interventionalists have suggested that PTAS carries less anesthetic risk than CEA. The treatment of carotid stenosis with local or regional anesthesia (LRA) allows direct intrapr ocedural neurologic evaluation and avoids the potential risks of gener al anesthesia. Methods: We retrospectively analyzed the clinical chart s of 377 patients who underwent 414 procedures for the elective treatm ent of carotid stenosis in 433 cerebral hemispheres with LRA between A ugust 1994 and May 1997. Group I (312 hemispheres) underwent PTAS, and group II (121 hemispheres) underwent CEA. Results: The indications fo r treatment included the following: asymptomatic severe stenosis (n = 272; 62.8%), transient ischemic attack (TIA; n = 100; 23.1%), and prio r stroke (n = 61; 14.1%). The early neurologic results for the patient s in group I (n = 268) included II TIAs (4.1%), 23 strokes(8.6%), and 3 deaths (1.1%). The early neurologic results for the patients in grou p II (n = 109) included 2 TIAs (1.8%),one stroke (0.9%), and no deaths . The total stroke and death rates were 9.7% for the patients in group I and 0.9% for the patients in group II (P = .0015). The cardiopulmon ary events that led to additional monitoring were evident after 96 pro cedures in group I (32.8%) and 21 procedures in group II (17.4%; P = . 002). Conclusion: PTAS carries a higher neurologic risk and requires m ore monitoring than CEA in the treatment of patients with carotid arte ry stenosis with LRA. The proposed benefit for the use of PTAS to avoi d general anesthesia cannot be justified when compared with CEA perfor med with LRA.