Abstract
The aim of the present study was to clarify the current practices related to the use of carotid artery stenting (CAS) in comparison with carotid endarterectomy (CEA) for cervical internal carotid artery stenosis (CICAS) in neurosurgical facilities without full-time neuroendovascular specialists. A total of 82 patients (68 men and 14 women; mean age of 72.4 years) with CICAS treated surgically at Kanmon Medical Center during a 13-year period from April 2002 to March 2015 were identified, and their medical records were reviewed. Seventy-six CEAs (47 for symptomatic lesions and 29 for asymptomatic lesions) and 16 CASs (9 for symptomatic lesions and 7 for asymptomatic lesions) were performed in 68 and 15 patients, respectively. CAS has been performed since 2009, and 30 CEAs (21 for symptomatic lesions and 9 for asymptomatic lesions) were performed during the same period. Both sets of clinical data were compared and analyzed. No apparent difference in the characteristics of the stenotic lesion were observed. The main reasons for performing CAS were a high location of the stenotic lesion and serious previous disease. Cerebral ischemia occurred as a complication in 4 patients who had undergone CAS, but had no adverse influence on outcome; however it adversely influenced the outcome in 1 of 4 patients who had undergone CEA. Although currently few patients undergo CAS for CICAS, these results support its validity and safety in neurosurgical facilities that lack full-time neuroendovascular specialists. Accordingly the proportion of CAS procedures performed relative to CEA will likely increase in the future, also in such neurosurgical facilities.
