Carotid Endarterectomy and Carotid Artery Stenting in Brazil
Carotid Endarterectomy and Carotid Artery Stenting in Brazil
Cerebrovascular disease is a leading cause of death and the leading cause of serious
 long-term disability. Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are
 alternative strategies for stroke prevention in patients with atherosclerotic carotid
 disease.The safety and efficacy of CAS compared to CEA still remains questioned, and CEA has
 been considered to the first-line treatment of carotid stenosis in worldwide. The purpose of
 this study is to compare the practice and outcomes of CAS and CEA in a real world setting at
 Public University Hospitals in Brazil.
This study will be a prospective analysis of the treatment of patients with carotid stenosis
 through carotid endarterectomy and carotid artery stenting performed at 5 centers proposed by
 five years with the Vascular Study Group from public Universities of Sao Paulo state in
 Brazil. The primary outcome measures will be:

 1. any in-hospital stroke.

 2. any stroke, death, or myocardial infarction (MI). Patients undergoing CEA in conjunction
 with cardiac surgery will be excluded. Multivariate logistic regression will be
 performed to identify predictors of stroke or death in patients undergoing CEA and CAS.

 The characteristics and background of patients who underwent CAS and CEA include: age,
 gender, carotid endarterectomy high risk; also presentation of symptoms, and degree of
 stenosis will be analyzed. Next, procedural success, periprocedural antiplatelet use, embolic
 protection device use, the type of stent (open-cell or closed-cell) or patch to carotid, the
 execution of pre ballooning or post ballooning dilatation at carotid artery stenting, and
 procedure-related complications will be analyzed to clarify the current strategy and the
 treatment results of both techniques . Degree of stenosis have been measured in accordance
 with North American Symptomatic Carotid Endarterectomy Trial method.

 Outcomes will be stratified by symptomatic and asymptomatic status. Symptomatic patients are
 defined as having a neurologic event, including any hemispheric or ocular transient ischemic
 attack,major or minor stroke preceding the intervention ipsilateral to the treated lesion.
 Technical success relates to periprocedural events that occur from the initiation of the
 procedure and extend through the first 24-hour postoperative period. Primary technical
 success was defined on an intent-to-treat basis, and it will requires the successful
 exclusion of the carotid plaque by surgical or interventional means. Technical success
 include the outcomes and complications of preoperative carotid angiograms whenever these
 imaging studies are obtained prior to the carotid intervention. For carotid endarterectomy,
 primary technical success implies a successful removal of the carotid plaque and closure of
 the artery with or without patch and less than a 30% residual stenosis. For carotid stenting,
 the introduction and deployment of the embolic protection device and the carotid stent in the
 absence of stroke, myocardial infarction, death, surgical conversion, or vascular obstruction
 constitutes primary technical success.

 All complications should be categorized as local vascular, local nonvascular, and systemic.
 Other complications. As with any vascular procedures, complications after carotid
 interventions should be reported in a systematic and standardized manner with a description
 of the degrees of severity. Although assigning a degree of severity to all complications of
 different methods of treatment may be difficult, severity scales should be provided whenever
 possible so adverse events can be assessed and compared. The following severity scale has
 been modified from the reporting standards for lower extremity ischemia:Mild (1) refers to a
 complication that resolves spontaneously or with minimal intervention, does not increase the
 hospital length of stay, and does not cause permanent disability. Moderate (2) refers to the
 need for significant intervention, prolongation of hospitalization more than 24 hours, and at
 most, minor permanent disability that does not interfere with normal daily activity. A severe
 complication (3) needs major surgical, endovascular or medical intervention, may be
 associated with prolonged convalescence, is usually accompanied by prolonged or permanent
 disability, and may result in death.
Inclusion Criteria:

 -  Patients with carotid stenosis > 70% who wil be underwent to carotid endarterectomy or
 carotid artery stenting.

 Exclusion Criteria:

 -  Need to concomitant cardiac surgery.