Vol 6, No 3 (2004)
Published online: 2004-10-04
Early and late results of endovascular treatment vs. endarterectomy in symptomatic stenosis of the internal carotid artery: a comparative study
Chirurgia Polska 2004;6(3):123-132.
Abstract
Background: Aim of the study was to compare the perioperative and late results of endovascular therapy of internal carotid artery (ICA) stenosis with open surgery in patients with critical stenosis.
Material and method: An endarterectomy was performed in 54 patients (36 males and 18 females) of the age of 58-76 (mean 65). The procedure duration was 42-82 min (mean 65 min). The patients were discharged from hospital after 4-27 days (mean 8 days). Fifty patients of the age of 63-81 (mean 74) underwent endovascular therapy (38 males and 12 females). The procedure duration was 42-82 min (mean 65 min). The patients were discharged from the hospital after 2-24 days (mean 3.4 days). In the main part of the endovascular group, neuroprotection was applied.
Results: Ischaemic stroke occurred in 2 patients in the endovascular group during the procedure, and in another 3 patients (6%), symptoms of TIA occurred. A number of bradycardia and hypotonia episodes were observed. In the patients who underwent open surgery, 3 cases of ischaemic stroke occurred in which one had a fatal outcome. In 3 patients, TIA was diagnosed and in one myocardial infarction took place. No statistically significant differences in ischaemic stroke occurrence and the mortality rate were found between the groups (p < 0.05). In the 12 month follow-up, no statistically significant differences were found in the late complications rate (p < 0.05).
In both groups 2 patients died during the follow-up, and the mortality rate was 4% and 3.8% in the endovascular and surgical groups respectively. Myocardial infarction with a fatal outcome occurred in 2 patients (2 in the endovascular and 1 in the surgical group), however in the surgical group also a massive ischaemic stroke with fatal outcome was observed. In the endovascular (4%) as well as in the surgical group (1.9%) cases of asymptomatic restenosis of up to 50% occurred.
Conclusions: There are no differences in the perioperative and late results in the 12 month follow-up between the endovascular and endarterectomy groups of patients with elevated surgery risk who underwent critical (> 70%) ICA stenosis therapy. Further research on large groups of patients with a longer follow-up period is necessary. In the face of satisfactory early and late results, the length of experience in usage and the cost effectiveness, endarterectomy of ICA stenosis is the first choice in the treatment of cases of critical stenosis.
Material and method: An endarterectomy was performed in 54 patients (36 males and 18 females) of the age of 58-76 (mean 65). The procedure duration was 42-82 min (mean 65 min). The patients were discharged from hospital after 4-27 days (mean 8 days). Fifty patients of the age of 63-81 (mean 74) underwent endovascular therapy (38 males and 12 females). The procedure duration was 42-82 min (mean 65 min). The patients were discharged from the hospital after 2-24 days (mean 3.4 days). In the main part of the endovascular group, neuroprotection was applied.
Results: Ischaemic stroke occurred in 2 patients in the endovascular group during the procedure, and in another 3 patients (6%), symptoms of TIA occurred. A number of bradycardia and hypotonia episodes were observed. In the patients who underwent open surgery, 3 cases of ischaemic stroke occurred in which one had a fatal outcome. In 3 patients, TIA was diagnosed and in one myocardial infarction took place. No statistically significant differences in ischaemic stroke occurrence and the mortality rate were found between the groups (p < 0.05). In the 12 month follow-up, no statistically significant differences were found in the late complications rate (p < 0.05).
In both groups 2 patients died during the follow-up, and the mortality rate was 4% and 3.8% in the endovascular and surgical groups respectively. Myocardial infarction with a fatal outcome occurred in 2 patients (2 in the endovascular and 1 in the surgical group), however in the surgical group also a massive ischaemic stroke with fatal outcome was observed. In the endovascular (4%) as well as in the surgical group (1.9%) cases of asymptomatic restenosis of up to 50% occurred.
Conclusions: There are no differences in the perioperative and late results in the 12 month follow-up between the endovascular and endarterectomy groups of patients with elevated surgery risk who underwent critical (> 70%) ICA stenosis therapy. Further research on large groups of patients with a longer follow-up period is necessary. In the face of satisfactory early and late results, the length of experience in usage and the cost effectiveness, endarterectomy of ICA stenosis is the first choice in the treatment of cases of critical stenosis.
Keywords: strokecarotid internal arterycritical stenosisendarterectomyangioplastystentneuroprotection
