Outcome of Carotid Stenting Versus Endarterectomy

Abstract

Background and Purpose-To compare perioperative and midterm results of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) in similar cohorts of patients, a retrospectively matched case-control study was performed. Methods-Three hundred and one case subjects undergoing CAS with cerebral protection and 301 concurrent matched-controls undergoing CEA were examined. Matching was by sex, age (Ϯ2 years), symptoms and coronary disease. Results-The 30-day disabling stroke/death rate was 2.6% in the CAS group versus 1.3% in the CEA group (odds ratio[OR] 2; 95% CI, 0.54 to 9.35; Pϭ0.4). CAS patients had a significantly higher risk of periprocedural stroke (7.9% versus 2.3%; OR, 5.2; 95% CI, 1.7 to 18; Pϭ0.001) than CEA patients. However, there was a decreasing trend in 30-day neurological event rates for the last 201 CAS matched cases: 5.4% versus 1.9% (OR 2.8; 95% CI, 0.8 to 10.2; Pϭ0.1). Fifty percent of CAS disabling strokes occurred during cannulation of epiaortic vessels before placement of cerebral protection. Conditional multivariate analysis revealed CAS as a predictor of 30-day stroke (hazard ratios [HR] 3.9; 95% CI, 1.6 to 9.4; Pϭ0.002) but not of 30-day disabling stroke/death (HR 3.6; 95% CI, 0.93 to 13.9; Pϭ0.06). Restenosis free intervals at 36 months were 93.6% versus 92.1% for CAS and CEA, respectively, (Pϭ0.6). Conclusions-When comparing CAS with CEA, the risk of any neurological events is still higher, particularly during catheterism and ballooning. The effect of the learning curve related to technical expertise and patient selection may influence the outcome of CAS versus CEA. In the midterm the restenosis rate of CAS compares favorably to CEA.

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary

“…The incidence of restenosis after CAS has been in the range of 3% to 5%. [215][216][217][218][219][220][221][222][223][224][225][226][227][228][229][230][231][232][233] The incidence of TIA has been reported as 1% to 2% in patients undergoing CAS. Intracranial hemorrhage and the hyperperfusion syndrome related to hypertension and anticoagulation have been reported as complications in Ͻ1% of 506 Circulation July 26, 2011 CAS procedures.…”

Cognitive Performance in Elderly Patients Undergoing Carotid Endarterectomy or Carotid Artery Stenting: A Twelve-Month Follow-Up Study

“…Usually, CAS was preferred in the presence of long plaque, severe coronary or pulmonary disease, previous neck surgery or irradiation. CEA was chosen when a fatty component and/or thrombus within the carotid plaque were probable, in addition to the presence of severe carotid tortuosity or calcification [20]. Both types of interventions were performed by highly experienced vascular surgeons (P.D.R., P.C.…”

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

“…The incidence of restenosis after CAS has been in the range of 3% to 5%. [215][216][217][218][219][220][221][222][223][224][225][226][227][228][229][230][231][232][233] The incidence of TIA has been reported as 1% to 2% in patients undergoing CAS. Intracranial hemorrhage and the hyperperfusion syndrome related to hypertension and anticoagulation have been reported as complications in <1% of CAS procedures.…”