Original Title: Long-Term Outcome after Carotid Artery Stenting. A Population-Based Matched Cohort Study.
Reference: Stroke. 2016 Jul 12. [Epub ahead of print].
In the prevention of stroke, carotid artery stenting (CAS) is far less invasive than endarterectomy, but its long term outcomes remain unclear.
This large cohort study compared the long term outcomes of CAS vs. endarterectomy.
All patients included in the Swedvasc registry (National Swedish Vascular Registry) treated with CAS between 2005 and 2012 were identified. For every CAS procedure, 2 control endarterectomy procedures were included, matched by:
- sex
- age
- year of procedure
- indication (symptomatic/asymptomatic).
Primary end point was ipsilateral stroke, or death 30 days after procedure.
A total 1157 patients were included (409 CAS and 748 endarterectomy). Median age was 70 and 69% were symptomatic.
Risk factors were similar in both groups and the population was followed up at mean 4.1 years.
Death or stroke rates beyond the 30 days perioperative period occurred in:
- 95 of 394 CAS patients (25.7%)
- 120 of 724 endarterectomy patients (18.6%)
[Adjusted risk 1.59; CI 95% 1.15–2.18]
Death rate was:
- 25.7% with CAS
- 18.6% with endarterectomy
[HR 1.20; CI 95% 0.84–1.72]
Ipsilateral stroke rate was:
- 9.4% with CAS
- 2.9% with endarterectomy
[HR 3.40; CI 95% 1.53–7.53]
Any stroke + death after 30 days was:
- 34.2% with CAS
- 23.6% with endarterectomy
[HR 1.49; CI 95% 1.10–2.00]
Conclusion
In this cohort study, CAS was associated with a long term increased risk of ipsilateral stroke and death after perioperative period compared to endarterectomy.
Editorial Comment
Even though population was matched, some characteristics may be misleading in this kind of studies. Higher mortality in the CAS group cannot be explained by excessive ipsilateral stroke and may be due to higher global risk, which may have favored CAS indication, being less invasive.
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