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  • Title: Carotid artery stenting compared to carotid endarterectomy performed exclusively in a veteran population: one center's experience with midterm results.
    Author: Brown KE, Fanciullo DJ, Hicks T, Landau DS, Baraniewski HM, Morasch MD, Matsumura JS, Pearce WH, Eskandari MK, Kibbe MR.
    Journal: Ann Surg; 2008 Jul; 248(1):110-6. PubMed ID: 18580214.
    Abstract:
    OBJECTIVE: To evaluate a single center's experience with carotid artery stenting (CAS) and carotid endarterectomy (CEA) performed by vascular surgeons in an entirely veteran population. METHODS: Data from the Lakeside and Jesse Brown Veterans Affairs Medical Centers (VAMC) from September 1997 to December 2006 were retrospectively reviewed. Indications for CAS or CEA included asymptomatic carotid stenosis >70% or symptomatic stenosis >50%. Demographic data, procedural details, and clinical outcomes are reported. RESULTS: A cohort of 104 patients (98% men) underwent 113 CAS procedures with 100% technical success. Cerebral protection was used in 98% of the procedures. Average age was 70 years (15 patients >or=80 years old); 30% were symptomatic. Previous ipsilateral CEA, neck dissection or irradiation was present in 10.6% of procedures. The 30-day transient ischemic attack, stroke, and death rates were 2.7%, 3.5%, and 0.0% respectively. The 1-year all cause death rate was 6.2%. During the same time period, 79 patients (98% male) underwent 91 CEA procedures. Average age was 67 years (9 patients >or=80 years old); 45% were symptomatic. The 30-day transient ischemic attack, stroke, and death rates were 1%, 2.2%, and 1% respectively. The 1-year all cause death rate was 5.5%. There were no statistically significant differences in outcome within asymptomatic and symptomatic patient groups between CAS and CEA, respectively. CONCLUSIONS: CAS is a safe and efficacious alternative for the treatment of carotid artery stenosis in a veteran population and outcomes compare favorably to contemporary CAS and CEA trials. Veterans should be offered CAS as a treatment option for carotid artery stenosis by vascular surgeons or interventionalists who are trained to perform this procedure and have the appropriate resources.
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