Carotid angioplasty and stenting in high-risk patients - Commentary

BACKGROUND: Carotid angioplasty with stenting (PTAS) is now being investigated as an alternative to carotid endarterectomy (CEA). Proven superiority in at least three areas of PTAS will need be accomplished before angioplasty supplants CEA; namely, safety, cost, and durability. METHODS: One hundred and seven patients served as the basis for this previously reported review. Both safety (morbidity and mortality) as well as cost issues were evaluated. Other non-neurologic complications were are also investigated. RESULTS: The in-hospital and 30-day risk of all strokes and death from PTAS was 9.3%, with a 3.6% major stroke and death rate. Minor strokes were found to be statistically more frequent in the PTAS group than with CEA. Nonprofessional fees were more expensive in the PTAS group than CEA ($30,140 versus $21,670). CONCLUSIONS: At the present time PTAS has not proven itself worthy to supplant CEA. The durability of the procedure has not been sufficiently evaluated. Non-neurologic complications are also not trivial with PTAS.