同一施設におけるCEAとCASの治療成績の比較  [in Japanese] Comparison Between Carotid Endarterectomy and Carotid Artery Stenting: Perioperative Outcomes in an Institution  [in Japanese]

A recent randomized trial showed that carotid artery stenting (CAS) is comparable to carotid endarterectomy (CEA) in high-risk patients with severe carotid-artery stenosis. However, selection criteria between CEA and CAS are not consistent among institutions. We retrospectively compared perioperative results of these 2 revascularization strategies in our hospital. We reviewed records of 78 cases who underwent CEA or CAS with protection devices in Kurashiki Central Hospital. CAS was indicated for patients with surgically high-risk conditions. When soft plaque was suspected by preoperative carotid imaging, CEA was indicated in principle. CEA was performed for 47 vessels (mean age: 69.2±6.0 years, 75% symptomatic) and CAS for 31 vessels (mean age: 70.5±6.6 years, 65% symptomatic). Soft plaque was detected by preoperative imaging in 57% of CEA patients and in 6% of CAS patients (p<0.01). The 30-day morbidity/mortality rate was 2.1% in CEA (n=1) and 9.7% in CAS (n=3) (p=0.30). Asymptomaitc hyperintensities on diffusion-weighted imaging after revascularization were detected in 23% of CEA patients and 45% of CAS patients (p=0.02). Considering the higher risk conditions in the CAS group, perioperative results were comparable between CAS and CEA. At present, revascularization strategies should be selected based on patients' conditions and plaque characterization.