Prevention of Stroke: Carotid Artery Stenting or Endarterectomy?

Original Title: Long-Term Outcome after Carotid Artery Stenting. A Population-Based Matched Cohort Study.

Reference: Stroke. 2016 Jul 12. [Epub ahead of print].

 

Carotid Artery Stenting EndarterectomyIn 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.

 

We value your opinion. You are more than welcome to leave your comments, thoughts, questions or suggestions here below.

More articles by this author

RACE Trial: Effect of Balloon Pulmonary Angioplasty and Riociguat on Right Ventricular Afterload and Function in Chronic Thromboembolic Pulmonary Hypertension

Even though pulmonary endarterectomy is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH), up to 40% of patients are not candidates because...

ACC-2025 Congress Second Day Key Studies

BHF PROTECT-TAVI (Kharbanda RK, Kennedy J, Dodd M, et al.)The largest randomized  trial carried out across 33 UK centers between 2020 and 2024, assessing...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Radial Patency in Coronary Procedures: Is Heparin Enough or Should We Aim for Distal Transradial Access?

Transradial access is the preferred route in most coronary procedures due to its proven reduction in mortality compared to transfemoral access. However, one of...

SMART-CHOICE 3 | Efficacy and Safety of Clopidogrel vs Aspirin Monotherapy in High Risk Patients after Percutaneous Coronary Intervention

Courtesy of Dr. Juan Manuel Pérez. After post percutaneous coronary intervention (PCI) standard duration dual antiplatelet therapy (DAPT), the optimal long term monotherapy strategy is...

RACE Trial: Effect of Balloon Pulmonary Angioplasty and Riociguat on Right Ventricular Afterload and Function in Chronic Thromboembolic Pulmonary Hypertension

Even though pulmonary endarterectomy is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH), up to 40% of patients are not candidates because...