Long-Term Prevention of Stroke

Abstract

When physicians use their clinical judgment to select the appropriate technique for carotid revascularization CAS can offer efficacy and durability comparable to CEA with benefits persisting at 5 years.

Long-Term Outcomes of Carotid Artery Stenting in Clinical Practice

“…Similar to CREST, EVA-3S, and high-volume singlecenter reports, 8,18 in the present analysis, the rate of restenosis after CAS remained relatively low and at the same level as after CEA in randomized trials. Finally, it has to be emphasized that only 2 of the 19 of our patients with restenosis had stroke.…”

“…The overall risk for the primary end point is also comparable with results from other high-volume centers, despite their generally shorter long-term follow-up. 8,[18][19][20] Furthermore, we were able to prevent neurological complications effectively: the observed annual risk for ipsilateral stroke (including the periprocedural period) of 0.6% in the overall cohort compares favorably with the 1.1% of the 10-year CREST data. 5 Our data also support the growing body of evidence that CAS results after the 30-day interval are durable; the flat course of the Kaplan-Meier curves signifying freedom from ipsilateral stroke.…”

“…16 Some high-volume centers report lower event rates in their real-world populations of symptomatic and asymptomatic patients (range from 1.7% to 4.7%). 7,8,[17][18][19][20] However, 3 major issues need to be considered when comparing the current results with older reports. First, a strict, independent neurological assessment before and after the procedure was not mandatory in previous trials and even less so in registries.…”

“…Such registries have already shown comparable results of CAS and CEA. [7][8][9][10] However, most of the previous registry data are limited with respect to the accuracy or completeness of patient surveillance, the length of follow-up, or patient number.…”

Impact of coexisting multivessel coronary artery disease on short-term outcomes and long-term survival of patients treated with carotid stenting

“…Most studies to date have focused on the short-term outcomes of CAS patients, and long-term survival data are not numerous in the literature. In this study, the annual mortality rate was 6.4%, compared to 2.3% in the TARGET-CAS trial (mean age at CAS 65 years, mean follow-up: 23 months) [ 16 ], 3.4% in the multi-center European study (mean age at CAS 72 years, mean follow-up: 32 months) [ 17 ], 3.6% in the Italian study (mean age at CAS 71.5 years, mean follow-up 33 months) [ 18 ], and 5.4% in the Austrian trial (Linz group: mean age at CAS 71 years, median follow-up: 6.5 years) [ 19 ]. These comparisons suggest that the patients included in our study were at high risk for long-term survival.…”