Is the endovascular treatment of carotid stenosis in high-risk patients really safer than carotid endarterectomy?

Background: We assess the outcomes of patients who would have been considered at high-risk from carotid endarterectomy (CEA), who have undergone endovascular treatment. Methods: High-risk patients were classed as those with occlusion of the contralateral internal carotid artery, recurrent stenosis following CEA, stenosis secondary to neck irradiation or treatment prior to coronary bypass surgery. Results: 103 procedures fulfilled at least one inclusion criterion. 58.3% had symptomatic disease. The all stroke/death rate was 9.7%. The major disabling stroke/stroke-related death rate was 3.9%. 63 had a contralateral occlusion, 15 post-CEA, 17 post-radiation and 33 pre-coronary surgery. The major disabling stroke/stroke-related death rates for each subset were 4.8, 6.7, 0 and 0%, respectively. Conclusions: These results suggest that this category of patients is at high-risk of stroke regardless of method of carotid intervention. Copyright (C) 2004 S. Karger AG, Basel.