359840

Stroke is one of the important reasons of morbidity and mortality worldwide. At least 15-20 % of ischemic strokes are attributable to carotid artery atherosclerosis. Since carotid artery endarterectomy (CEA) was first performed in 1950, in conjunction with the advanced technology and increased experience under the guidance of randomized controlled trials, balloon angioplasty and carotid artery stenting (CAS), which have similar mortality and morbidity, have become comparable with CEA. In this study, we compared a single center's experince periprocedural and late clinical outcomes and restenosis ratio of carotid artery stenting with carotid endarterectomy among patients with extracranial carotid stenosis. The hospital records of all symptomatic and asymptomatic carotid artery disease patients who underwent carotid artery revascularization were retrospectively reviewed between 2001 and 2013. Patients were divided into two groups based on the type of carotid revascularization performed, namely CEA or CAS. In this study retrospectively 176 patients (194 carotid arter stenosis) who underwent carotid endarterectomy under regional anesthesia were compared to 108 patients (115 carotid arter stenosis) who underwent carotid artery stenting. Baseline characteristics were similar between both groups except for the incidence of hyperlipidemia and smoking. The surgical group had more asymptomatic patients. Comparisons were made with respect to 30-day and late (>1 month) outcomes of transient ischemic attack (TIA), stroke, amaurosis fugax and all-cause death rates, anticoagulation management strategies, length of stay in hospital. Restenosis is evaluated with carotid doppler ultrasonography. Progressing more than %50 stenosis is excepted restenosis. No significant differences were found with respect to 30-day mortality and neurologic morbidity endpoints for CEA and CAS procedures (CAS %13 ve CEA %7,7). In the CAS group 30 day neurologic complications rates were higher than CEA and there were more major local complications after endarterectomy. Length of stay in hospital (CAS 4,5±4,4 ve CEA 5,9±5,8; p<0,001) were significantly greater for the surgical group. Mean control time in CEA group 18 months, in CAS group 8 months(p=0.003). In the postprecuderal follow up stroke, mortality and restenosis was higher in the CEA group, only restenosis in symptomatic patients restenosis was observed to be significantly higher in the CEA group (CEA %16,4 vs CAS %4,4; p=0,045); the other endpoints did not differ significantly. Carotid stenting and endarterectomy in order to minimize complications, patient selection, pre and post procedure needs to be very careful. Endovascular stent treatment of carotid artery atherosclerotic disease is progressing for vascular surgery, especially for patients that are high risk for standart CEA. The increasing experience, development of cerebral protection systems and new treatment protocals increasing CAS feasibility. Keywords: Carotid arter stenosis, stenting, endarterectomy, restenosis