Advantages and Disadvantages of Carotid Endarterectomy and Carotid Artery Stenting:Notes from a Hybrid Neurosurgeon Kentaro HAYASHI 1 , Yuki MATSUNAGA 1 , Yukishige HAYASHI 1 , Kiyoshi SHIRAKAWA 1 , Mitsuto IWANAGA 1 1Department of Neurosurgery, Sasebo City General Hospital Keyword: carotid endarterectomy , carotid artery stenting , complication , hybrid neurosurgeon pp.1151-1156
Published Date 2019/11/10
DOI https://doi.org/10.11477/mf.1436204092
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 OBJECTIVE:Carotid endarterectomy(CEA)is well-established and performed for carotid artery stenosis all over the world. However, some severe complications and pitfalls have been reported. Carotid artery stenting(CAS)in high-surgical-risk patients is considered an effective alternative to CEA. We reviewed our clinical experience of CEA and CAS and discuss the advantages and disadvantages of each treatment.

 MATERIALS and METHODS:For 13 years, we performed CEA for 133 patients(135 lesions)and CAS for 127 patients with carotid artery stenosis(129 lesions). CAS is indicated for the CEA high-risk patients. Perioperative imaging studies and post-operative statuses were evaluated especially in cases with complications.

 RESULTS:In our CEA series, ischemic stroke occurred in 3 cases, myocardial infarction in 1, cranial nerve palsy in 2, internal carotid artery occlusion in 1, wound hematoma in 2, and hyperperfusion syndrome in 4. The procedure was halted in one case because of an internal shunt problem. All cases of CAS were successfully performed except for one case complicated with myocardial infarction. Ischemic stroke occurred in 7 cases, hyperperfusion syndrome in 2, stent occlusion in 2, and puncture site hematoma in 2. Restenosis appeared in CAS significantly more than in CEA.

 CONCLUSIONS:CEA is a first-line treatment for carotid artery stenosis. However, complications of CEA may result in severe situations. Recognizing pitfalls and careful perioperative management is required. The results of CAS are comparable to those of CEA. Radiological evaluation for the presence of plaque and appropriate selection of an embolus protection device are important.

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