A prospective registry on carotid artery revascularisation selected by consensus of a cardiovascular team
Fabrizio Tomai1, Leonardo De Luca, Luca Weltert
1Adress.
Insights
Carotid artery revascularization using stenting (CAS) or endarterectomy (CEA) showed similar early and long-term clinical event rates in patients with carotid obstructive disease (COD). Both procedures met established clinical outcome standards.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Carotid obstructive disease (COD) poses a significant risk for stroke.
- Carotid artery revascularization, including carotid endarterectomy (CEA) and carotid artery stenting (CAS), are established treatment options.
- Patient selection for revascularization is often guided by cardiovascular team consensus.
Purpose of the Study:
- To evaluate the early and long-term incidence of clinical events in patients with carotid obstructive disease (COD) undergoing carotid artery revascularization.
- To compare outcomes between CEA and CAS when selected by a cardiovascular team consensus.
- To assess the safety and efficacy of carotid revascularization procedures.
Main Methods:
- Prospective registry including 403 consecutive patients with COD.
- Patients underwent either CEA (130) or CAS (273).
- Propensity score matching was used to balance baseline covariates; major adverse cardiac and cerebrovascular events (MACCE) were assessed at 30 days and long-term follow-up.
Main Results:
- The 30-day MACCE incidence was 4.0% (95% CI: 2.1 to 6.0) with no significant difference between CAS and CEA groups in unmatched or matched cohorts.
- Two-year freedom from MACCE was 80.5%±0.94%, with no statistically significant differences between the CAS and CEA groups.
- These outcomes indicate that both revascularization methods are performing within expected standards.
Conclusions:
- Carotid artery revascularization, selected by cardiovascular team consensus, demonstrates acceptable early and long-term clinical event rates.
- Both carotid endarterectomy (CEA) and carotid artery stenting (CAS) appear to be safe and effective options for patients with carotid obstructive disease.
- The study supports current clinical practice guidelines for managing carotid obstructive disease.
Aims:
This prospective registry was designed to evaluate the early and long-term incidence of clinical events in patients with carotid obstructive disease (COD), after carotid artery revascularisation selected by consensus of a cardiovascular team.
Methods And Results:
403 consecutive patients with COD scheduled for carotid revascularisation were included: 130 were treated with carotid endarterectomy (CEA) and 273 with carotid artery stenting (CAS). Propensity score matching was performed to assemble a cohort of patients in whom all baseline covariates would be well balanced. The occurrence of major adverse cardiac and cerebrovascular events (MACCE), including any death, non-fatal myocardial infarction or stroke, was assessed at 30 days and at long-term follow-up. The incidence of MACCE at 30 days was 4.0% (95% confidence interval: 2.1 to 6.0), without any significant difference between the CAS and CEA groups in unmatched and matched populations. The cumulative freedom from MACCE at two-year follow-up was 80.5%±0.94%, with no statistically significant differences between the CAS and CEA groups, both in the total population and in the matched cohort.
Conclusions:
In this registry of patients undergoing carotid artery revascularisation selected by consensus of a cardiovascular team, the early and long-term incidence of clinical events is up to standard.
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