CAS confers higher long-term risk for ipsilateral stroke than CEA
Patients in the Swedish Vascular Registry who underwent carotid artery stenting had increased long-term risk for ipsilateral stroke and death compared with those who underwent carotid endarterectomy.
Researchers analyzed data on 409 patients enrolled in the national cohort registry who were treated with primary carotid artery stenting (CAS) or symptomatic or asymptomatic carotid artery stenosis from 2005 to 2012. Also included in the analysis were 748 patients (control group) who underwent carotid endarterectomy (CEA); for each CAS patient, the researchers aimed to include two CEA controls, matched for sex, age (± 2 years), procedure year and indication (categorized as transient ischemic attack, amaurosis fugax, minor stroke or asymptomatic).
Three-quarters of the overall population was male, the mean age was 70 years and 69% of patients were asymptomatic. Although the two groups had comparable risk factor profiles at baseline, the CAS group had a higher prevalence of diabetes and a trend toward more cardiac and pulmonary disease.
The primary endpoint was ipsilateral stroke and death from 31 days after index date until Dec. 31, 2012 (end of follow-up); the index date was defined as the date of the carotid procedure. The median follow-up time for the primary endpoint was 4.1 years (interquartile range, 2.4-5.8), the equivalent of 3,994 person-years.
After the perioperative phase, 95 patients in the CAS group had a new ipsilateral stroke or died vs. 120 in the CEA group; this corresponded to a 5-year cumulative incidence of 30.8% (95% CI, 25.3-37.1) in the CAS group vs. 20.7% (95% CI, 17.2-24.7) in CEA patients, according to the data published in Stroke.
Ischemic stroke accounted for the majority of strokes; the CEA group demonstrated a higher rate of hemorrhagic strokes vs. the CAS group (CEA group, 10%; 95% CI, 3-21 vs. CAS group, 4%; 95% CI, 1-14).
Crude analysis revealed that the CAS group had an overall higher risk (HR = 1.71; 95% CI, 1.26-2.31) for ipsilateral stroke or death after 30 days vs. the CEA group. An adjusted risk analysis revealed similar findings (HR = 1.59; 95% CI, 1.15-2.18).
Thirty data after CAS or CEA, a new ipsilateral stroke occurred in 9.4% of the group vs. 2.9% of the CEA group (adjusted HR = 3.4; 95% CI, 1.53-7.53). The CAS group also had a higher prevalence of the combined endpoint of any stroke or death after 30 days vs. the CEA group (34.2% CAS vs. 23.6% CEA; 95% CI, 1.1-2)
“This nationwide cohort study shows that CAS confers an increased long-term risk of stroke and death when compared to CEA,” the researchers wrote. “This increased risk is mainly explained by an increased rate of ipsilateral stroke after the periprocedural period, indicating that CAS is not as durable as CEA for treatment of carotid artery stenosis.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.