Randomized trials (NASCET, ECAS, ACAS) have shown absolute benefit of carotid endarterectomy (CEA) for patients with high grade stenosis. For carotid stenting (CAS), safety and efficacy (and durability) as first-choice treatment have not been established. The present prospective, multicenter (not-randermized) trial ; Japan Carotid Atherosclerosis Study (JCAS) has started to analyze present practice and propose treatment guidelines for Japanese patients.
Until the end of September 2004, 1, 013 patients ; 882 males (87%) and 131 female (13%), and mean age was 69.8 years (52-89 years), have been registered. 510 patients (51%) had any neurological symptoms : cerebral stroke (29%), TIA (17%), ocular symptoms (5%), and 503 (49%) patients are asymptomatic. Sixtypercent of these patients had hypertension, 30% had diabetes mellitus and 30% had a previous coronary disease. Sexual difference was not observed in the incidence of thse previous diseases and medical risks.
Of these 1, 014 patients, 444 CEAs (44%) and 317 CASs (31%) were performed. Total complication rate, including neurologic and nonneurologic ones, were 10.6% in CEA and 9, 6% in CAS. Morbidity and mortality rates during one month after surgical treatment were 2.7% (12 cases) in CEA and 3.5% (11 cases) in CAS. Of 12 patients with persistent complication after CEAs, 7 ischemic cerebral symptoms mainly due to distal embolism, 3 hemorrhagic stroke/neurologic deficits due to hyperperfusion syndrome, 2 cranial palsy, and 1 fatal cardiac failure were included. Of 317 CASs, 6 persistent ischemic symptoms due to distal emblism, 2 hemorrhagic stroke, 1 long term hypotention, and 2 technical complication related to angiography were observed.
