Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis

Mas, Jean‐Louis; Châtellier, Gilles; Beyssen, B.; Branchereau, A; Moulin, Thierry; Becquemin, Jean‐Pierre; Larrue, Vincent; Lièvre, Michel; Leys, Didier; Bonneville, Jean‐François; Watelet, J; Pruvo, Jean‐Pierre; Albucher, Jean‐François; Viguier, Alain; Piquet, Philippe; Garnier, P.; Viader, Fausto; Touzé, Emmanuel; Giroud, Maurice; Hammoud, Hassan; Pillet, J; Favrole, Pascal; Neau, Jean‐Philippe; Ducrocq, Xavier; Investigators, Stroke Oxygen Study; Act, Abstr

doi:10.1056/nejmoa061752

Cited by 1,414 publications

(672 citation statements)

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“…From what has been described, it appears clear that the biggest limitations of the study are the scarce endovascular technique experience of the operators (12 carotid artery stentings or 35 procedures performed on supra-aortic trunks, of which five were carotid) and the preprocedural anti-platelet therapy which was only recommended and not always homogeneously administered. Double anti-platelet therapy was administered to 82.9% of the patients and only 85.4% were administered anti-platelet therapy after the intervention [16].…”

Section: Discussionmentioning

confidence: 99%

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Carotid artery stenting: a single-centre experience with up to 8 years’ follow-up

et al. 2008

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Carotid artery stenting (CAS) may be an alternative to surgical endoarterectomy not only in highrisk patients. We report results in the endovascular treatment of carotid artery disease with up to 8 years' follow-up. In this retrospective study, we analysed data from 853 consecutive patients (946 arteries) treated for carotid artery stenosis between April 1999 and March 2007; 491 (52%) arteries were symptomatic and 455 (48%) were asymptomatic. Preprocedural evaluation of the patients was performed with echo Doppler, magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) and a neurological examination. A cerebral protection device was used in 879 (92.9%) procedures. Anti-platelet therapy was administered before and after the procedure. All patients were included in a followup of up to 8 years. Technical success was achieved in 943 (99.6%) lesions. At 30 days, there was a 0.21% (n=2) death rate, a 0.42% major stroke rate, a 1.69% minor stroke/transient ischaemic attack (TIA) rate and a combined 2.32% TIA/stroke and death rate. During follow-up, echo Doppler evidenced restenosis in 39 (4.85%) cases; of these, only five, presenting restenosis >80%, were treated with an endovascular reintervention. At the long-term follow-up, two strokes (0.23%) were reported, which both occurred within the first 2 years. In our experience, carotid artery stenting seems to be a safe and effective treatment, providing satisfactory long-term clinical results.

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Section: Discussionmentioning

confidence: 99%

“…While in the CAVATAS and SAPPHIRE studies the periprocedural complication rate (stroke and death) of CEA and CAS are comparable with a greater risk/benefit ratio in patients at high risk for surgery; EVA-3S reported a higher complication rate in CAS [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Carotid artery stenting: a single-centre experience with up to 8 years’ follow-up

et al. 2008

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“…Nevertheless, few data exist on the utilization of statin therapy among patients with carotid artery disease. In the multicenter randomized controlled EVA‐3S (Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis) and SPACE (Stent‐Supported Percutaneous Angioplasty of the Carotid Artery Versus Endarterectomy) trials, only 49% of patients were on lipid‐lowering therapy at the time of carotid revascularization 10, 11. This is particularly concerning, given data from the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial that showed carotid stenosis patients derive the greatest benefit from intense statin therapy with respect to adverse cerebro‐ and cardiovascular events 12…”

Section: Introductionmentioning

confidence: 99%

Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization

Hussain

Saposnik

Raju

et al. 2018

JAHA

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BackgroundStatins are commonly used for the prevention of cardiovascular events; however, statins are underutilized in patients with noncoronary atherosclerosis. We sought to establish the rates of statin use in patients with carotid artery disease and to examine the association between statin therapy and outcomes after carotid revascularization.Methods and ResultsIn this population‐level retrospective cohort study, we identified all individuals aged ≥66 years who underwent carotid endarterectomy or stenting in Ontario, Canada (2002–2014). The primary outcome was a composite of 1‐year stroke, myocardial infarction, or death (major adverse cardiac and cerebrovascular events). Five‐year risks were also examined. Adjusted hazard ratios were computed using inverse probability of treatment weighting based on propensity scores. A total of 7893 of 10 723 patients (73.6%) who underwent carotid revascularization were on preprocedural statin therapy; moderate‐ or high‐dose therapy was utilized by 7384 patients (68.9%). The composite rate of 1‐year major adverse cardiac and cerebrovascular events was lower among statin users (adjusted hazard ratio: 0.76; 95% confidence interval, 0.70–0.83). Patients who were on persistent long‐term statin therapy after the carotid procedure continued to experience significantly lower risk of major adverse cardiac and cerebrovascular events at 5 years (adjusted hazard ratio: 0.75, 95% confidence interval, 0.71–0.80). The beneficial associations with statin use were observed regardless of type of carotid revascularization procedure, carotid artery symptom status, or statin dose.ConclusionsContinuous statin therapy was associated with a 25% lower risk of long‐term adverse cardiovascular events in patients with significant carotid disease. Along with other supportive evidence, statins should be considered in patients undergoing carotid revascularization, and efforts are required to increase statin use in this undertreated population.

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“…CREST (Carotid Revascularization Endarterectomy versus Stenting Trial)10 reported the shortest median interval; this was still 22 days for CEA and 18 days for CAS. In all except two RCTs, the mean delay from the index event to revascularization was greater than 1 month9, 12, 14. Even in studies that mostly revascularized sooner after the index event, the mean delay was above the 2‐week threshold3, 10.…”

mentioning

confidence: 88%

“…Of the 12 RCTs3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 that have compared carotid endarterectomy (CEA) with carotid artery stenting (CAS) in patients with significant carotid stenosis, only five3, 9, 10, 12, 14 provided information on the time from the index event to revascularization. CREST (Carotid Revascularization Endarterectomy versus Stenting Trial)10 reported the shortest median interval; this was still 22 days for CEA and 18 days for CAS.…”

mentioning

confidence: 99%

Timing of carotid intervention

Meershoek

Borst

2018

British Journal of Surgery

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Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis

Abstract: In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting. (ClinicalTrials.gov number, NCT00190398 [ClinicalTrials.gov].).

Cited by 1,414 publications

References 22 publications

Carotid artery stenting: a single-centre experience with up to 8 years’ follow-up

Carotid artery stenting: a single-centre experience with up to 8 years’ follow-up

Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization

Timing of carotid intervention

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