Comparison of carotid artery endarterectomy and carotid artery stenting in patients with atherosclerotic carotid stenosis.

BACKGROUND: The choice of carotid artery endarterectomy (CEA) or carotid artery stenting (CAS), as surgical and interventional treatment of atherosclerotic carotid stenosis, respectively, has been controversial in decades, especially for asymptomatic patients with carotid stenosis. Age and the diameter of impaired carotid artery might be 2 important factors to decide whether CEA or CAS should be performed. Besides, contrast-enhanced ultrasound (CEUS) has been confirmed as an effective method to predict the risk of stroke by classifying the carotid plaque into 4 grades. The role of CEUS in the choice of CEA or CAS still remains unclear.

METHODS: A retrospective analysis of 38 patients who underwent CEA with primary closure and 36 patients who underwent CAS in our hospital from October 2008 to January 2013 is conducted. Preoperative CEUS was performed to all patients, and data were collected and analyzed. All CEAs were performed with transverse incision.

RESULTS: The hospital stay was longer for the endarterectomy group than the stenting group (15.39 versus 10.91 d, P < 0.001), with an approximately two-third reduction of hospital costs (¥23686.21 versus ¥60855.34, P < 0.001). The overall incidence of perioperative complications in the endarterectomy group was 7.9%, with no statistically significant difference in the group with internal carotid artery greater than or equal to 5 mm and in the group with internal carotid artery less than 5 mm (9.1% versus 6.3%, P = 0.75). No restenosis occurred in either of the subgroups during the follow-up. In patients older than 70 years, the perioperative complications were 0% in CEA and 10.53% in CAS (P = 0.42); the long-term restenosis was 0% in CEA and 5.26% in CAS (P = 0.67). In patients younger than 70 years, the perioperative complications were 11.5% in CEA and 23.53% in CAS (P = 0.31); the long-term restenosis was 0% in CEA and 0% in CAS (P > 0.01). For patients with grade 4 plaque in CEUS, the incidence of adverse events in the CAS group was significantly higher than that in the CEA group (7.14% versus 55.56%, P < 0.05).

CONCLUSIONS: There were no significant differences in perioperative complications or restenosis rate between the CAS group and the CEA group in this study. Neither the diameter of impaired carotid artery or age could be considered as an indication of applying CEA or CAS. However, CEUS might be used as a perioperative assessment method to decide whether CEA or CAS should be performed to different patients. The higher the grade of plaque enhancement, the higher the risk of adverse events and restenosis for CAS might occur.