Comparison of nonneurological events in high-risk patients treated by carotid angioplasty versus endarterectomy

Abstract

Objective To compare results of carotid angioplasty and stenting (CAS) with carotid endarterectomy (CEA) in high cardiac risk patients. Methods Patients ineligible for carotid revascularization by North American Symptomatic Carotid Endarterectomy Trial/Asymptomatic Carotid Atherosclerosis Study criteria were treated with CAS (n = 11) or CEA (n = 10). Results Significant numbers had cardiac (CAS 72%, CEA 60%; P = 0.66) and hypertensive (CAS 82%, CEA 80%; P = 0.64) risk factors. Adverse hemodynamic events were more frequent in the CAS group (CAS 73%, CEA 20%; P = 0.03). Major complications were noted in 1 patient in each group (CAS, myocardial infarction; CEA, death). Postoperative stay was similar (CAS 2.1 ± 1.4, CEA 1.8 ± 1.1 days; P = 0.60). However, 4 in the CAS group were readmitted within 1 month (congestive heart failure 2, myocardial infarction 1, rest pain 1), compared with no new events in the CEA group ( P = 0.09). Conclusions Currently, the use of CAS in patients with cardiac risk factors may not be justifiable.