brains: carotid stenting

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  • 1. Should We Be Doing This? Brains: Carotid Stenting Keith G Oldroyd Department of Cardiology Western Infirmary

2. Carotid Intervention

  • CEA results
    • Symptomatic
    • Asymptomatic
  • CAS + DP registries
  • CEA vs CAS in RCTs
  • Setting up a CAS service
  • MY WORST COMPLICATION!!

3. 4. 5. 6. 7. 8. 9. NASCET/ECST/VA309

  • 6092 patients with > 35K patients years

Sub-totals trend towards benefit at 2 years, gone by 5 years Amaurosis fugax only no benefit Absolute benefit increases with age Lancet Jan 11, 2003 70 (no sub-totals) 0.04 4.6 1549 50-69 0.60 3.2 1429 30-49 0.05 -2.2 1746 < 30 p Stroke RR(%) n % stenosis 10. NASCET 11. CEA rate/100,000 in Scotland by Health Board Stroke rate =200 per 100K 80% ischaemic =160 50% carotid stenosis = 80 12. CEA Rate / million >40 yrs old 13. MRC Asymptomatic Carotid Surgery Trial (ACST)

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