Carotid Artery Stenosis Carotid Artery Stenosis : : Stenting vs. Stenting vs. Endarterectomy Endarterectomy Városmajor Study. Városmajor Study. L. Entz,, E.Dósa, K. Hüttl. L. Entz,, E.Dósa, K. Hüttl. Department of Cardiovascular Surgery, Semmelweis University, Budapest, Hungary Oxford,ACST-2 2014
Carotid Artery Stenosis : Stenting vs. Endarterectomy Városmajor Study. L. Entz ,, E.Dósa , K. Hüttl. Department of Cardiovascular Surgery , Semmelweis University, Budapest , Hungary Oxford,ACST-2 2014. Conflict of Interest. None. Introduction Clinical Trials :C EA vs. CAS. - PowerPoint PPT Presentation
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Carotid Artery StenosisCarotid Artery Stenosis:: Stenting vs. Endarterectomy Stenting vs. Endarterectomy
Városmajor Study.Városmajor Study.
L. Entz,, E.Dósa, K. Hüttl. L. Entz,, E.Dósa, K. Hüttl.
Department of Cardiovascular Surgery,
Semmelweis University,
Budapest, Hungary
Oxford,ACST-2 2014
Conflict of InterestConflict of Interest
NoneNone
IntroductionIntroductionClinical TrialsClinical Trials:C:CEA vs. CASEA vs. CAS
CAVATAS CAVATAS • Very Very high high perioperative perioperative
strokestroke//morbidity/mortalitymorbidity/mortality for for both both CEACEA (9,9%)(9,9%) and CASand CAS (26%) (26%)
Results of the study on postoperative intracranial Results of the study on postoperative intracranial hemorrhage (ICH) in cases of CEA/CAS in USAhemorrhage (ICH) in cases of CEA/CAS in USA
Timaran et al. J Vasc Surg 2009:49.(3):623-8Timaran et al. J Vasc Surg 2009:49.(3):623-8
The Nationwide Inpatient Sample was used for the year The Nationwide Inpatient Sample was used for the year 20052005
135,093 patients 135,093 patients were revascularized, were revascularized, 90,4% CEA90,4% CEA, , 9,6%CA9,6%CASS
Postop.stroke rate: CEA 1,1% CAS: 2.1% Postop.stroke rate: CEA 1,1% CAS: 2.1% p<0.001 p<0.001 In-hosp. Mortality: CEA 0.6% CAS: 1.1% In-hosp. Mortality: CEA 0.6% CAS: 1.1% p<0.001p<0.001 ICH CEA 0.016% CAS: 0.15% ICH CEA 0.016% CAS: 0.15% p<0.001 p<0.001
Conclusion: CAS was an independent predictor for:Conclusion: CAS was an independent predictor for: postop. stroke (OR:1.77)postop. stroke (OR:1.77) in-hosp. mortality (OR:1.49) in-hosp. mortality (OR:1.49) ICH (OR: 5.9 ) ICH (OR: 5.9 )
CEA/CAS CEA/CAS Experience at Varosmajor ClinicExperience at Varosmajor Clinic
01.01.2003-12.31.200801.01.2003-12.31.2008
Limitations:Limitations:Retrospective studyRetrospective studyOnly iOnly in-hospital stroke/morbidity/mortalityn-hospital stroke/morbidity/mortalityThere is a significant difference between the There is a significant difference between the two groups in the number of symptomatic two groups in the number of symptomatic patientspatients
However:However:
the results are satisfactorythe results are satisfactory
large number of cases on both sideslarge number of cases on both sides
Clinical DatClinical DataaN=3974N=3974
CEA=2509 PCEA=2509 P M:M: 1455(58%)1455(58%) F :F : 1054(42%)1054(42%)
Mean ageMean age: 66: 66.9 .9 years years (20-90)(20-90)
CAS=1465 PCAS=1465 P M:M: 921(62,8%)921(62,8%) F :F : 544(37,2%)544(37,2%)
Mean age: 66.9 Mean age: 66.9 years years (39-91)(39-91)
CAROTID CEA + CASCAROTID CEA + CAS
Clinical PresentationClinical Presentation
CEACEA AsymptomaticAsymptomatic St. I+ IIb St. I+ IIb
15811581 P Ptsts.(63%).(63%)
SymptomaticSymptomaticIIa-IV.b. IIa-IV.b. 928928 P Pts.ts..(37%).(37%)
CASCAS AsymptomaticAsymptomatic St. I+ IIbSt. I+ IIb
11061106 P Ptsts. (75,5%). (75,5%)
SymptomaticSymptomatic359359 P Ptsts. (24,5%). (24,5%)
Major stroke rate of symptomatic patientsMajor stroke rate of symptomatic patients
PreopPreop. stages. stages Postop.Postop.
strokestroke
CEACEA
Postop. Postop.
strokestroke
CASCAS
I.I. 4242
2.09%2.09%2525
2.25%2.25%
IIa-IVIIa-IV 2323
2,47%2,47%44
1.4%1.4%
p=0,136p=0,136
There is a sThere is a significant ignificant diffdifference erence in favor of CEA in favor of CEA vs. CAS vs. CAS in postopin postoperative erative TIA-rateTIA-ratess
Both procedures have Both procedures have Low PSMM rateLow PSMM ratess
CAS can be performed CAS can be performed by by experienced operatorexperienced operatorss in in high volume centerhigh volume center