Carotid stenting done exclusively by vascular surgeons: First 175 cases

Mark K. Eskandari, G. Matthew Longo, Jon S. Matsumura, Melina R. Kibbe, Mark D. Morasch, Kelley R. Cardeira, William H. Pearce, Anthony D. Whittemore, John E. Connolly, Anthony J. Comerota, Gerald B. Zelenock, Gregorio A. Sicard, Juan C. Parodi

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: Percutaneous CAS may well replace CEA as standard of care. CAS has been performed largely by interventional cardiologists; however, with recent Food and Drug Administration approval, vascular surgeons are now hurriedly attempting to obtain the requisite endovascular skills. Reported are our 30-day and midterm outcomes of CAS. Methods: Retrospective review of 175 cervical carotid stenoses treated with elective CAS from April 2001 to February 2005. All procedures were performed under local anesthesia via percutaneous femoral access in an operating room angiosuite. Mechanical cerebral protection was used in 90% of cases. Data analysis includes demographics, procedural records, and duplex exams over a mean follow-up of 21 months. Results: Mean age is 70 years (74% men and 26% women). Preprocedural neurologic symptoms were present in 32%. Intraoperative complications included 2 seizures (1.1%) and 4 asystolic arrests (2.3%), all managed medically without sequelae. Over the 30-day follow-up there were no deaths, no myocardial infarctions (MIs), 2 major strokes (1.1%), 2 minor strokes (1.1%), 3 transient ischemic attacks (TIAs) (1.7%), and 1 major access-site complication (0.6%). At late follow-up, 3 cases (1.7%) of restenosis occurred; all were treated with repeat angioplasty and remain patent. One (0.6%) asymptomatic occlusion was detected at 6-month follow-up. There have been no late carotid-related complications or deaths. Conclusions: Vascular surgeons possessing advanced catheter-based skills can safely perform CAS and achieve perioperative results comparable to CEA. Such skills are crucial to those surgeons intent on the future management of carotid occlusive disease.

Original languageEnglish (US)
Pages (from-to)431-438
Number of pages8
JournalAnnals of surgery
Volume242
Issue number3
DOIs
StatePublished - Sep 1 2005

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Blood Vessels
Stroke
Drug Approval
Carotid Stenosis
Transient Ischemic Attack
Intraoperative Complications
Local Anesthesia
United States Food and Drug Administration
Operating Rooms
Standard of Care
Neurologic Manifestations
Thigh
Angioplasty
Seizures
Catheters
Myocardial Infarction
Demography
Surgeons
Cardiologists

ASJC Scopus subject areas

  • Surgery

Cite this

Eskandari, M. K., Longo, G. M., Matsumura, J. S., Kibbe, M. R., Morasch, M. D., Cardeira, K. R., ... Parodi, J. C. (2005). Carotid stenting done exclusively by vascular surgeons: First 175 cases. Annals of surgery, 242(3), 431-438. https://doi.org/10.1097/01.sla.0000179650.89508.2f

Carotid stenting done exclusively by vascular surgeons : First 175 cases. / Eskandari, Mark K.; Longo, G. Matthew; Matsumura, Jon S.; Kibbe, Melina R.; Morasch, Mark D.; Cardeira, Kelley R.; Pearce, William H.; Whittemore, Anthony D.; Connolly, John E.; Comerota, Anthony J.; Zelenock, Gerald B.; Sicard, Gregorio A.; Parodi, Juan C.

In: Annals of surgery, Vol. 242, No. 3, 01.09.2005, p. 431-438.

Research output: Contribution to journalArticle

Eskandari, MK, Longo, GM, Matsumura, JS, Kibbe, MR, Morasch, MD, Cardeira, KR, Pearce, WH, Whittemore, AD, Connolly, JE, Comerota, AJ, Zelenock, GB, Sicard, GA & Parodi, JC 2005, 'Carotid stenting done exclusively by vascular surgeons: First 175 cases', Annals of surgery, vol. 242, no. 3, pp. 431-438. https://doi.org/10.1097/01.sla.0000179650.89508.2f
Eskandari MK, Longo GM, Matsumura JS, Kibbe MR, Morasch MD, Cardeira KR et al. Carotid stenting done exclusively by vascular surgeons: First 175 cases. Annals of surgery. 2005 Sep 1;242(3):431-438. https://doi.org/10.1097/01.sla.0000179650.89508.2f
Eskandari, Mark K. ; Longo, G. Matthew ; Matsumura, Jon S. ; Kibbe, Melina R. ; Morasch, Mark D. ; Cardeira, Kelley R. ; Pearce, William H. ; Whittemore, Anthony D. ; Connolly, John E. ; Comerota, Anthony J. ; Zelenock, Gerald B. ; Sicard, Gregorio A. ; Parodi, Juan C. / Carotid stenting done exclusively by vascular surgeons : First 175 cases. In: Annals of surgery. 2005 ; Vol. 242, No. 3. pp. 431-438.
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abstract = "Background: Percutaneous CAS may well replace CEA as standard of care. CAS has been performed largely by interventional cardiologists; however, with recent Food and Drug Administration approval, vascular surgeons are now hurriedly attempting to obtain the requisite endovascular skills. Reported are our 30-day and midterm outcomes of CAS. Methods: Retrospective review of 175 cervical carotid stenoses treated with elective CAS from April 2001 to February 2005. All procedures were performed under local anesthesia via percutaneous femoral access in an operating room angiosuite. Mechanical cerebral protection was used in 90{\%} of cases. Data analysis includes demographics, procedural records, and duplex exams over a mean follow-up of 21 months. Results: Mean age is 70 years (74{\%} men and 26{\%} women). Preprocedural neurologic symptoms were present in 32{\%}. Intraoperative complications included 2 seizures (1.1{\%}) and 4 asystolic arrests (2.3{\%}), all managed medically without sequelae. Over the 30-day follow-up there were no deaths, no myocardial infarctions (MIs), 2 major strokes (1.1{\%}), 2 minor strokes (1.1{\%}), 3 transient ischemic attacks (TIAs) (1.7{\%}), and 1 major access-site complication (0.6{\%}). At late follow-up, 3 cases (1.7{\%}) of restenosis occurred; all were treated with repeat angioplasty and remain patent. One (0.6{\%}) asymptomatic occlusion was detected at 6-month follow-up. There have been no late carotid-related complications or deaths. Conclusions: Vascular surgeons possessing advanced catheter-based skills can safely perform CAS and achieve perioperative results comparable to CEA. Such skills are crucial to those surgeons intent on the future management of carotid occlusive disease.",
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AU - Eskandari, Mark K.

AU - Longo, G. Matthew

AU - Matsumura, Jon S.

AU - Kibbe, Melina R.

AU - Morasch, Mark D.

AU - Cardeira, Kelley R.

AU - Pearce, William H.

AU - Whittemore, Anthony D.

AU - Connolly, John E.

AU - Comerota, Anthony J.

AU - Zelenock, Gerald B.

AU - Sicard, Gregorio A.

AU - Parodi, Juan C.

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N2 - Background: Percutaneous CAS may well replace CEA as standard of care. CAS has been performed largely by interventional cardiologists; however, with recent Food and Drug Administration approval, vascular surgeons are now hurriedly attempting to obtain the requisite endovascular skills. Reported are our 30-day and midterm outcomes of CAS. Methods: Retrospective review of 175 cervical carotid stenoses treated with elective CAS from April 2001 to February 2005. All procedures were performed under local anesthesia via percutaneous femoral access in an operating room angiosuite. Mechanical cerebral protection was used in 90% of cases. Data analysis includes demographics, procedural records, and duplex exams over a mean follow-up of 21 months. Results: Mean age is 70 years (74% men and 26% women). Preprocedural neurologic symptoms were present in 32%. Intraoperative complications included 2 seizures (1.1%) and 4 asystolic arrests (2.3%), all managed medically without sequelae. Over the 30-day follow-up there were no deaths, no myocardial infarctions (MIs), 2 major strokes (1.1%), 2 minor strokes (1.1%), 3 transient ischemic attacks (TIAs) (1.7%), and 1 major access-site complication (0.6%). At late follow-up, 3 cases (1.7%) of restenosis occurred; all were treated with repeat angioplasty and remain patent. One (0.6%) asymptomatic occlusion was detected at 6-month follow-up. There have been no late carotid-related complications or deaths. Conclusions: Vascular surgeons possessing advanced catheter-based skills can safely perform CAS and achieve perioperative results comparable to CEA. Such skills are crucial to those surgeons intent on the future management of carotid occlusive disease.

AB - Background: Percutaneous CAS may well replace CEA as standard of care. CAS has been performed largely by interventional cardiologists; however, with recent Food and Drug Administration approval, vascular surgeons are now hurriedly attempting to obtain the requisite endovascular skills. Reported are our 30-day and midterm outcomes of CAS. Methods: Retrospective review of 175 cervical carotid stenoses treated with elective CAS from April 2001 to February 2005. All procedures were performed under local anesthesia via percutaneous femoral access in an operating room angiosuite. Mechanical cerebral protection was used in 90% of cases. Data analysis includes demographics, procedural records, and duplex exams over a mean follow-up of 21 months. Results: Mean age is 70 years (74% men and 26% women). Preprocedural neurologic symptoms were present in 32%. Intraoperative complications included 2 seizures (1.1%) and 4 asystolic arrests (2.3%), all managed medically without sequelae. Over the 30-day follow-up there were no deaths, no myocardial infarctions (MIs), 2 major strokes (1.1%), 2 minor strokes (1.1%), 3 transient ischemic attacks (TIAs) (1.7%), and 1 major access-site complication (0.6%). At late follow-up, 3 cases (1.7%) of restenosis occurred; all were treated with repeat angioplasty and remain patent. One (0.6%) asymptomatic occlusion was detected at 6-month follow-up. There have been no late carotid-related complications or deaths. Conclusions: Vascular surgeons possessing advanced catheter-based skills can safely perform CAS and achieve perioperative results comparable to CEA. Such skills are crucial to those surgeons intent on the future management of carotid occlusive disease.

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