Carotid Endarterectomy with Adjunctive Carotid Stenting: Complimentary, not Competetitive Techniques

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Michael N. Tameo, MD., Keith D. Calligaro, MD, Matthew J. Dougherty, MD
Pennsylvania Hospital, Philadelphia, PA, USA.

CAROTID ENDARTERECTOMY WITH ADJUNCTIVE CAROTID STENTING: COMPLIMENTARY, NOT COMPETITIVE TECHNIQUES
Objectives: Stenosis of the cephalad internal carotid artery can present a challenge making it difficult to obtain a technically satisfying distal endpoint during endarterectomy. Surgical revision of distal defects can be difficult and yield unsatisfactory results. The purpose of this review is to evaluate the efficacy of intraoperative carotid stenting as an adjunct to endarterectomy to salvage technical defects identified at the cephalad internal carotid artery endarterectomy site.
Methods: Between January 2001 and June 2007, 12 patients were found to have technical defects located at the cephalad internal carotid artery endarterectomy site on intaoperative completion arteriogram. All defects were treated with carotid stenting. Patient age ranged from 53 to 84 (mean 68) years old. Indications for surgery were asymptomatic stenosis (8), amaurosis fugax (2) and cerobrovascular accident (2). Operative time ranged from 2 to 5 (mean 2.9) hours. Cervical block was used in all but 1 patient who received general anesthesia.
Results: Technically satisfying results with stenting were achieved in all 12 patients. One patient suffered a perioperative cerbrovascular accident. However, neurologic symptoms were noted prior to placement of the stent in this patient. There were no additional complications. All stents remained patent on duplex follow-up averaging 12 months.
Conclusion: Intraoperative salvage carotid stenting is an effective and safe adjunct to endarterectomy when technical defects are identified at the cephalad internal carotid artery endarterectomy site.

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