TY - JOUR

T1 - Comparative Analysis of Carotid Artery Stenting and Carotid Endarterectomy in Clinical Practice

AU - Karpenko, Andrey

AU - Starodubtsev, Vladimir

AU - Ignatenko, Pavel

AU - Dixon, Frances

AU - Bugurov, Savr

AU - Bochkov, Igor

AU - Rabtsun, Artem

AU - Gostev, Alexander

AU - Ruzankin, Pavel

AU - Brusaynskaya, Anna

N1 - Publisher Copyright: © 2020 Elsevier Inc. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020/5

Y1 - 2020/5

N2 - 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.

AB - 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.

KW - Brachiocephalic arteries

KW - carotid artery

KW - carotid endarterectomy

KW - carotid stenting

KW - TRIAL

KW - STENOSIS

KW - ANGIOPLASTY

KW - RISK

KW - ISCHEMIC-STROKE

UR - http://www.scopus.com/inward/record.url?scp=85081197534&partnerID=8YFLogxK

U2 - 10.1016/j.jstrokecerebrovasdis.2020.104751

DO - 10.1016/j.jstrokecerebrovasdis.2020.104751

M3 - Article

C2 - 32160955

AN - SCOPUS:85081197534

VL - 29

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

SN - 1052-3057

IS - 5

M1 - 104751

ER -