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Title: The safety of carotid artery surgery and stenting
Author: Doig, D. A.
ISNI:       0000 0004 8502 5484
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2015
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Introduction Carotid endarterectomy (CEA) remains the standard of care for patients with greater than 50% symptomatic carotid artery stenosis to prevent recurrent stroke. The International Carotid Stenting Study (ICSS) compared the safety and efficacy of carotid angioplasty and stenting (CAS), with CEA. This thesis aims to determine which baseline patient characteristics, processes of care or vascular anatomical variants are associated with risk of stroke, myocardial infarction (MI) or death within 30 days of either procedure, and whether existing models to predict the risk of these complications performed well in ICSS patients. Methods ICSS was a multicentre international randomized controlled open trial. Medically stable patients with >50% symptomatic carotid artery stenosis due to atherosclerosis were randomized to either CAS or CEA. Procedures were carried out by accredited operators according to trial protocol. Results Women in ICSS experienced a higher risk of stroke, (MI) or death within 30 days of CEA, although sex was not an independent risk factor for this endpoint. They also experienced a significantly higher risk of haematoma and cranial nerve palsy after surgery. The risk of surgery was not significantly influenced by type of anaesthesia, surgical reconstruction or shunt use. The risk of stroke, MI or death following CAS rose with increasing age and was higher with open-cell design stents. The risk of CAS was not influenced by vascular anatomical variation seen on pre-stenting catheter angiography. Cerebral protection devices (CPDs), designed to prevent debris causing stroke, did not protect against periprocedural stroke. Existing risk scores for CEA and CAS tested in ICSS had insufficient power to discriminate between low- and high-risk groups. Conclusions New methods of predicting the risk of carotid revascularization are needed to allow patients and clinicians to make informed choices about treatment for symptomatic carotid artery stenosis.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available