Comparison of Carotid Endarterectomy and Stenting for Symptomatic Internal Carotid Artery Near-Occlusion

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Fig 1.
A, Early arterial phase shows severe ICA stenosis (black arrows) with a larger caliber external carotid artery (white arrow). B, Later arterial phase shows delayed filling of distal ICA (black arrow). C, Collateral filling of the distal ICA by the ophthalmic artery (black arrow) from the internal maxillary artery branch (white arrows).
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Fig 2.
A, Baseline CTA of the neck revealing severe stenosis of the right ICA at the origin (white arrow) with collapse of the distal wall (black arrow). B, Follow-up CTA of the neck after treatment with CEA. There is no evidence of residual stenosis (white arrow) with maturation or regaining of the caliber of the distal ICA (black arrow).
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Fig 3.
A, Early arterial phase shows severe right ICA stenosis (black arrow) with delayed distal ICA filling (white arrows). B, Cross-filling of the right middle cerebral artery (black arrows) after left carotid injection. C, Poststent right carotid injection shows brisk filling of distal ICA.
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Fig 4.
Algorithm for the management of symptomatic near-occlusion of the internal carotid artery.

Table 1:

Demographics, vascular risk factors, and clinical/imaging findings

Table 2:

Outcomes for CEA and CAS groups

Outcome (%)	CAS (n = 14)	CEA (n = 25)	P Value
Restenosis	2/10 (20%)	4/23 (17.4%)	1.0
Follow-up intervention	1 (7%)	3 (12%)	1.0
Vessel maturation	11 (79%)	21 (84%)	0.7
Perioperative complication	0 (0%)^{^a}; 1/17 (5.9%)	1 (4%)^{^a}; 1/28 (3.6%)	1.0^{^a}; 1.0
Stroke/MI/death at 1 yr	1 (7%)	0 (0%)	.36

Note:—MI indicates myocardial infarction.
↵a Perioperative complication rates after including an additional 6 patients (CAS = 3, CEA = 3) who were otherwise excluded from analyses due to insufficient follow-up.