Comparative Analysis of Carotid Artery Stenting and Carotid Endarterectomy in Clinical Practice
Andrey Karpenko1, Vladimir Starodubtsev1, Pavel Ignatenko1
1Siberian Federal Biomedical Research Center, Ministry for Public Health Care of Russian Federation, Novosibirsk, Russia.
Insights
Carotid endarterectomy (CEA) showed a lower 30-day stroke risk than carotid stenting (CAS) in symptomatic patients. For asymptomatic patients, both procedures had similar long-term stroke and survival rates.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Severe carotid artery stenosis poses a significant risk of stroke.
- Carotid endarterectomy (CEA) and carotid stenting (CAS) are primary interventions for managing this condition.
- Evaluating the comparative effectiveness of CEA and CAS in real-world clinical practice is crucial.
Purpose of the Study:
- To compare the immediate and long-term outcomes of CEA versus CAS with embolic protection in patients with severe carotid artery stenosis.
- To assess stroke rates and survival in asymptomatic and symptomatic patient subgroups.
Main Methods:
- Retrospective cohort study (2009-2017) including 1791 patients (1728 cases) after propensity score matching.
- Comparison of 615 CEA cases (eversion and "classic" with patch) against 615 CAS cases.
- Analysis of 30-day and 5-year outcomes, including stroke rates and survival.
Main Results:
- In asymptomatic patients, 30-day stroke rates were similar (1.5% CEA vs. 2.4% CAS; P=.48) and 5-year stroke rates did not differ significantly (3.3% CEA vs. 4.6% CAS; P=.3).
- In symptomatic patients, the 30-day stroke rate was significantly higher for CAS (7.5%) compared to CEA (2.5%; P=.04).
- Five-year stroke rates for symptomatic patients were 8.7% for CEA and 13% for CAS (P=.2).
Conclusions:
- Carotid stenting (CAS) should be used cautiously in symptomatic patients due to a higher 30-day stroke risk compared to carotid endarterectomy (CEA).
- For patients aged 80 or younger with asymptomatic or symptomatic severe carotid stenosis, CEA and CAS demonstrated comparable 5-year stroke and survival rates in routine practice.
Abstract:
The objective of the study was to describe immediate and long-term results of carotid endarterectomy (CEA) versus carotid stenting (CAS) with embolic protection in patients with severe carotid artery stenosis in clinical practice.
Materials And Methods:
This is a retrospective cohort study, conducted between 2009 and 2017. During the analyzed period, 2132 operations (2006 patients) were performed: 1215 (57%) CEA and 917 (43%) CAS. 278 patients (13.8% of 2006) were not contactable during the follow-up period (>30 days) leaving 1791 cases (1728 patients) for inclusion in the analysis. Propensity score matching was used to compare the treatment results of groups (561 cases were matched out of 1791). The results of 615 CEA (316 eversion, 299 "classic" with patch) and 615 CAS (using a variety of carotid stents) were compared.
Results:
In the asymptomatic subgroup (n = 455), the 30-day rate of stroke was not significantly different between the CEA group and the CAS group (1.5% versus 2.4%, P = .48). The 5-year rate of stroke was not significantly higher for CAS than for CEA (4.6% versus 3.3%, P = .3). In the symptomatic subgroup (n = 160), the 30-day rate of stroke was significantly higher in the CAS group than in the CEA group (7.5% versus 2.5%, P = .04). The 5-year rate of stroke was 13% for CAS and 8.7% for CEA (P = .2).
Conclusions:
In the symptomatic subgroup, the 30-day rate of stroke was significantly higher in the CAS group than in the CEA group, therefore the use of CAS for symptomatic patients in routine practice should be limited. Our study demonstrates that the rates of stroke and survival after CEA and CAS in patients aged 80 years or younger with asymptomatic or symptomatic severe carotid stenosis did not differ significantly over a period of 5 years.
