Carotid stenting versus carotid surgery: a prospective cohort study

It was already known that carotid artery disease poses a significant risk for stroke. Prior research has shown that both carotid endarterectomy and carotid stenting are used to reduce this risk. However, no prior work had resolved the comparative effectiveness of these two approaches in a long-term setting. That uncertainty drove this study to examine outcomes in a real-world patient population. The gap in understanding included how neurological and cardiac events differ between the two procedures. Researchers wanted to clarify whether stenting could match the safety and efficacy of surgery. They also aimed to assess the rate of restenosis in each group. This study sought to provide evidence to guide clinical decision-making in this area.

This study aimed to compare the outcomes of carotid stenting and carotid surgery in a consecutive patient cohort. The specific problem was the lack of long-term data on the comparative safety and effectiveness of these two procedures. Researchers wanted to determine whether stenting could achieve similar neurological and cardiac outcomes as surgery. They also sought to evaluate the incidence of restenosis in both groups. The motivation was to inform clinical practice with real-world evidence. The study focused on short-term and midterm follow-up data. It included patients treated between 1995 and 2002. The goal was to assess whether stenting could be a viable alternative to surgery.

The study followed a prospective cohort design with 455 patients and 482 lesions. Patients were divided into two groups: 107 received carotid stenting and 348 had carotid surgery. A cerebral protection device was used in the last 46 stent cases. All patients underwent duplex ultrasound at 1 and 6 months post-procedure and yearly thereafter. The study compared baseline characteristics such as age, sex, and symptoms between the groups. Researchers tracked neurological events, cardiac morbidity, and death rates. They also monitored the rate of restenosis during follow-up. The study used statistical analysis to compare outcomes between the two groups.

At 1 month post-procedure, the stent group had 7 minor strokes and 1 major stroke, while the surgery group had 1 minor stroke. The overall neurological event rate, including TIA, was 10.5% in the stent group and 1.9% in the surgery group (p=0.0002). Cardiac morbidity was 3.5% in the stent group and 1.6% in the surgery group (p=NS). The death rate was 0% in the stent group and 0.8% in the surgery group (p=NS). The combined permanent stroke/death rate was 2.6% in the stent group and 1.1% in the surgery group (p=NS). During follow-up, the cumulative all-stroke rate was 8.8% in the stent group and 1.9% in the surgery group (p=0.001). The 3-year survival rate free from major neurological events was 95.2% in the stent group and 96.9% in the surgery group (p=NS). Restenosis occurred in 7.5% of stented arteries versus 1.4% in the surgery group (p=0.001).

The authors reported that carotid stenting and carotid surgery had comparable major stroke and death rates in this study. They noted that the neurological event rate was significantly higher in the stent group at 1 month. The cumulative all-stroke rate remained higher in the stent group during follow-up. However, the 3-year survival rate free from major neurological events was similar between the two groups. The authors observed a significantly higher rate of restenosis in the stent group. They suggested that this finding may affect long-term outcomes. The study did not find a significant difference in cardiac morbidity or death rates. The authors concluded that stenting may be a viable option in selected patients but requires careful monitoring for restenosis.