Author + information
- Received March 25, 2010
- Revision received September 16, 2010
- Accepted September 16, 2010
- Published online February 8, 2011.
- Paola De Rango, MD⁎,⁎ (, )
- Gianbattista Parlani, MD⁎,
- Fabio Verzini, MD, PhD⁎,
- Giuseppe Giordano, MD⁎,
- Giuseppe Panuccio, MD⁎,
- Matteo Barbante, MD⁎ and
- Piergiorgio Cao, MD†
- ↵⁎Reprint requests and correspondence:
Dr. Paola De Rango, Unit of Vascular and Endovascular Surgery, University of Perugia, Hospital S. M. Misericordia, Piazza Menghini 1, 06134 Perugia, Italy
Objectives This study sought to evaluate long-term outcomes of carotid stenting (CAS) versus carotid endarterectomy (CEA) based on physician-guided indications.
Background The issue regarding long-term outcome of CAS versus CEA in patients with carotid stenosis is clinically relevant but remains unsettled.
Methods Consecutive patients (71% men, mean age 71.3 years) treated by CEA (n = 1,118) or CAS (n = 1,084) after a training phase were reviewed. Selection of treatment was based on better-suitability characteristics (morphology and clinical). Data were adjusted with propensity score analysis and stratified by symptoms, age, and sex.
Results Thirty-day stroke/death rates were similar: 2.8% in CAS and 2.0% in CEA (p = 0.27). The risk was higher in symptomatic (3.5%) versus asymptomatic (2.0%) patients (p = 0.04) but without significant difference between CAS and CEA groups. Five-year survival rates were 82.0% in CAS and 87.7% in CEA (p = 0.05). Kaplan-Meier estimates of the composite of any periprocedural stroke/death and ipsilateral stroke at 5 years after the procedure were similar in all patients (4.7% vs. 3.7%; p = 0.4) and the subgroups of symptomatic (8.7% vs. 4.9%; p = 0.7) and asymptomatic (2.5% vs. 3.3%; p = 0.2) patients in CEA versus CAS, respectively. Cox analysis, adjusted by propensity score, identified statin treatment (p = 0.016) and symptomatic disease (p = 0.003) associated with the composite end point. There were no sex- or age-related significant outcome differences.
Conclusions When physicians use their clinical judgment to select the appropriate technique for carotid revascularization CAS can offer efficacy and durability comparable to CEA with benefits persisting at 5 years.
The authors have reported that they have no relationships to disclose.
- Received March 25, 2010.
- Revision received September 16, 2010.
- Accepted September 16, 2010.
- American College of Cardiology Foundation