Carotid revascularization in patients with ongoing oral anticoagulant therapy: the advantages of stent placement.

To assess the influence of oral anticoagulant therapy conversion to heparin (OAT-CH) on carotid endarterectomy (CEA) outcomes and the influence of unmodified oral anticoagulant therapy (OAT) on carotid artery stenting (CAS) and to compare the outcomes of CEA in OAT-CH with CAS in ongoing OAT.The 30-day results from all patients who underwent CEA and CAS in a 6-year period were analyzed for stroke, death, myocardial infarction (MI), and hematoma of the access site requiring surgical evacuation. We evaluated the influence of OAT-CH in CEA and the influence of OAT in CAS and compared CEA and CAS outcomes in patients receiving OAT-CH and OAT.Among 1,222 carotid revascularizations, there were 711 CEAs (58.1\%) and 511 CAS procedures (41.9\%). In the CEA group, 31 (4.4\%) patients were treated with OAT-CH, and these patients had a significantly higher complication rate compared with patients not receiving OAT, including death (1 [3.2\%] vs 4 [0.6\%]; P = .04), stroke (4 [12.9\%] vs 10 [1.4\%]; P = .001), and hematoma (3 [9.6\%] vs 11 [1.6\%]; P = .02). In CAS, the results were similar in patients receiving OAT (30 [5.8\%]) and patients not receiving OAT. Patients receiving OAT who underwent CAS had better outcomes than patients receiving OAT-CH who underwent CEA, including stroke, death, MI, and hematoma combined (0 [0.0\%] vs 7 [22.5\%]; P =.01).OAT management significantly influences the results of carotid revascularization. Because CAS with unmodified OAT had a significantly better outcome than CEA with OAT-CH, carotid revascularization strategies should favor CAS rather than CEA in this setting.