A multispecialty consensus-based approach to carotid artery revascularization is feasible in routine clinical practice and results in excellent clinical outcomes

Carotid artery stenting (CAS) and endarterectomy (CEA) are considered competing rather than complementary carotid artery revascularization (CAR) strategies. However, patient characteristics that increase procedural risk are quite different for CAS or CEA. We hypothesized that selecting a CAR strateg...

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Bibliographic Details
Published in:The Journal of invasive cardiology 2014-03, Vol.26 (3), p.123-127
Main Authors: Gupta, Kamal, Steffen, Kelly Jo, Natarajan, Balasubramanium, Biria, Mazda, Singh, Vikas, Cherian, George
Format: Article
Language:English
Subjects:
Aged
Carotid Artery Diseases - complications
Carotid Artery Diseases - therapy
Carotid Stenosis - complications
Carotid Stenosis - therapy
Consensus
Endarterectomy, Carotid
Feasibility Studies
Follow-Up Studies
Humans
Incidence
Ischemic Attack, Transient - epidemiology
Middle Aged
Myocardial Infarction - epidemiology
Myocardial Revascularization - methods
Patient Care Team
Retrospective Studies
Stents
Stroke - epidemiology
Treatment Outcome
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Summary:Carotid artery stenting (CAS) and endarterectomy (CEA) are considered competing rather than complementary carotid artery revascularization (CAR) strategies. However, patient characteristics that increase procedural risk are quite different for CAS or CEA. We hypothesized that selecting a CAR strategy based on individual patient characteristics using a multispecialty consensus based (MSCB) approach will result in superior outcomes in the overall CAR group. We evaluated the feasibility of an MSCB approach to CAR in routine clinical practice. We performed a retrospective review of patients undergoing CEA or CAS at the Kansas City Veterans hospital over a 2-year period. As routine clinical practice, each case was discussed in a weekly "vascular conference" by vascular surgery, radiology, and interventional cardiology physicians and a revascularization strategy was chosen. Thirty-day and 1-year incidences of stroke, transient ischemic attack, myocardial infarction, and death were recorded. Eighty CAR procedures were performed (45 CEAs and 35 CASs). The CAS group had an average of 1.9 surgical high-risk features, while the CEA group had 0.5 (P
ISSN:1557-2501