Carotid Endarterectomy vs. Carotid Angioplasty in Symptomatic and Asymptomatic Patients: 30-Day Outcomes

Extracranial carotid artery disease represents 15 to 20% of all strokes. Carotid revascularization plays a role in primary and secondary prevention of cerebrovascular events. Outcomes of two common revascularization strategies, Carotid endarterectomy (CAE) and carotid artery stenting (CAS), have been studied and compared. In recent years, complications associated to CAS have dropped thanks to technical advances, more experienced operators and better stent design and intervention strategies.

The aim of this multicenter retrospective study was to compare 30 day outcomes in terms of stroke, acute myocardial infarction (AMI) death and transient ischemic attack (TIA) between CEA and CAS in both asymptomatic and symptomatic patients.

Primary end point was combined risk of ipsilateral stroke, AMI, TIA or death at 30 days, while the secondary end point included technical success and hospital stay length.

From a 1100 patient cohort, 55% underwent CEA and 45% CAS. In both groups, most patients were men, mean age 73. CAS patients tended to have significantly more cardiovascular risk factors, including CAD (p<0,001), hypertension (p=0,02), dyslipidemia (p<0,001), atrial fibrillation (p<0,001) and chronic kidney disease (ERC) (p<0,001), and had lower chances of showing symptoms at presentation (p<0,001), with fewer calcified plaques (p<0,01), but with significantly more severe stenosis (p<0,001) and ulcerated plaque (p<0,001).

Propensity score matching was done for a homogeneous sample, which left 269 patients in the CEA group and 269 in the CAS group. Most patients were asymptomatic (85%). There were 6 minor strokes (2 in CEA and 4 in CAS), all in asymptomatic patients. Among the symptomatic patients, there was 1 AMI in the CEA group and one death in the CAS group. There were no significant differences in the combined end point of stroke AMI and death between the techniques (p=1), neither according to presence of symptoms (p=0,44).

Technical success was 100%. Hospital stay length was significantly shorter in asymptomatic patients treated with CAS vs CEA (p = 0,05). However, there were no differences between symptomatic patients (p=0,32).