Using selected shunt with anesthesia of stent application in carotis artery stenosis is carotis alternative to endarterectomy?

Cerebrovascular disease; despite its reduced incidence due to the works to reduce the risk factors especially in industialised countries; is still the most important reason of mortality and morbidity in the adult population following coronary artery disease and malignancy. It is an important threat to the public health and is subject for many studies. The results of these studies lead to the develoment and application of new management strategies. The most common etiology for all the cases with stroke is the atherosclerotic disease of the carotid arteries. Internal carotid artery stenosis is an important etiology for ischemic stroke. The insidence of internal carotid artery stenosis is 0,5% in the sixth decade and it rises up to 10% over the age of 80.In the two major studies related with the subject; North America Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST); it has been shown that endarterectomy is superior to medical treatment in the prevention of ischemic cerebral paralysis in symptomatic carotid artery stenosis over 70%.With the advanced technology, baloon angioplasty and stent techniques have been developed as an alternative for carotid endarterectomy. In the recent studies, the endovascular treatment is reported to be equivalent with and even superior to carotid artery endarterectomy. Carotid artery endarterectomy is already accepted to be the standart method for management of extracranial carotid artery stenosis. In the last 2 decades, minimally invasive endovascular techniques started with angioplasty and increased with the development of stent applications and they are becoming more and more popular. In this study 82 patients who underwent carotid endarterectomy under regional anesthesia using carotid artery shunts selectively were compared to 39 patients who underwent carotid artery stenting. The demographic data of the two groups were similar. Postoperative complications, major cerebrovascular occlusion rates, minor cerebrovascular occlusion rates, lenghts of intensive care unit stay, anticoagulation management strategies and costs were compared. Minor cerebrovascular occlusion rate and treatment cost was significantly higher in the stent group. Lately with the industrial development new stent and filter types can be prefered especially in patients with recurrent internal carotid artery stenosis and those who received radiotherapy on the neck. However, when carotid endarterectomy without using a shunt under regional anesthesia is compared to stenting, it is still much more safe, cheap and has much lower mortality and morbidity. As a result; when modern and competent managent of symptomatic and asymptomatic internal carotid artery stenosis is the subject of interest, carotid endarterectomy fulfills the demand considering safety, efficacy, speed and cost