Long-Term Outcomes of Carotid Endarterectomy and Carotid Artery Stenting for Carotid Artery Stenosis: Real-World Status in Japan

Introduction: We investigated long-term outcomes of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in our hospital to assess the outcomes of real-world practice in single institute of Japan. Methods: Between August 2006 and July 2014, 236 consecutive carotid revascularizations with either CEA or CAS were performed in our institute. The initial treatment was regarded as the starting point in the cases of the patients who received treatment by bilateral carotid artery stenosis or retreatment. We assessed the long-term outcomes with survival analyses. Results: A total of 210 patients (CEA 128, CAS 82), including 94 symptomatic patients, were enrolled in the current study with mean follow-up period of 45.8 months. The periprocedural stroke/death/myocardial infarction (MI) rate was 3.1% for CEA and 4.9% for CAS groups (p=0.71). Estimates of the 4-year event-free rate from the primary end point (the composite of any stroke, death, or MI within 30 days and any ipsilateral stroke thereafter) using competing risk analysis were 3.1% for CEA and 8.6% for CAS (P=0.041). Kaplan-Meier estimates of the 4-year event-free rate from the secondary end point (the composite of any stroke, death, or MI within 30 days and any stroke or death thereafter) were 12.8% for CEA and 20.1% for CAS (P=0.051). Age (Hazard ratio [HR], 1.14/year [95%CI, 1.03-1.26]; p = 0.012) and CAS (HR, 3.5 [95%CI, 1.05-11.5]; p = 0.04 ) were significant predictors for the primary end point in multivariate analysis. For the secondary end point, age (HR, 2.1/10year [95%CI, 1.27-3.47]; p = 0.004) and CAS (HR, 2.0 [95%CI, 1.04-3.83], p = 0.037) were significant predictors. The inclusion of higher risk patients in the CAS group may have been the reason for CAS being a risk factor. Conclusion: The current study on real-world practices demonstrated perioperative and long-term outcomes that were comparable to previous major studies of large numbers of patients.

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Perioperative and Long-term Outcomes of Carotid Endarterectomy for Japanese Asymptomatic Cervical Carotid Artery Stenosis: A Single Institution Study

Neurologia medico-chirurgica ◽

10.2176/nmc.oa.2014-0398 ◽

2015 ◽

Vol 55 (11) ◽

pp. 830-837 ◽

Cited By ~ 2

Author(s):

Taichi ISHIGURO ◽

Taku YONEYAMA ◽

Tatsuya ISHIKAWA ◽

Koji YAMAGUCHI ◽

Akitsugu KAWASHIMA ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Long Term Outcomes ◽

Single Institution

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Carotid Artery Stenting May Be Losing the Battle against Carotid Endarterectomy for the Management of Symptomatic Carotid Artery Stenosis, But the Jury Is Still Out

Vascular ◽

10.2310/6670.2009.00039 ◽

2009 ◽

Vol 17 (4) ◽

pp. 183-189 ◽

Cited By ~ 7

Author(s):

Kosmas I. Paraskevas ◽

Dimitri P. Mikhailidis ◽

Frank J. Veith

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Artery Stenosis ◽

Long Term Results ◽

Symptomatic Carotid ◽

Symptomatic Carotid Stenosis

Carotid artery stenting (CAS) has emerged as a potential alternative to carotid endarterectomy (CEA) for the management of carotid artery stenosis. The purpose of this article is to provide an evaluation and critical overview of the trials comparing the early and later results of CAS with CEA for symptomatic carotid stenosis. The Cochrane Controlled Trials Register, PubMed/Medline, and EMBASE databases were searched up to February 1, 2009, to identify trials comparing the long-term outcomes of CAS with CEA. The MeSH terms used were “carotid artery stenting,” “carotid endarterectomy,” “symptomatic carotid artery stenosis,” “treatment,” “clinical trial,” “randomized,” and “long-term results,” in various combinations. One single-center and three multicenter randomized studies reporting their long-term results from the comparison of CAS with CEA for symptomatic carotid stenosis were identified. All four studies independently reached the conclusion that CAS may not provide results equivalent to those of CEA for the management of symptomatic carotid stenosis. A higher incidence of recurrent stenosis and peri- and postprocedural events accounted for the inferior results reported for CAS compared with CEA. Current data from randomized studies indicate that CAS provides inferior long-term results compared with CEA for the management of symptomatic carotid artery stenosis. However, it can be argued that all of these trials were performed when both CAS equipment and CAS operators had not evolved to their current status. Given that current equipment and mature experience are required for CAS before comparing it with the current “gold standard” procedure (CEA), the results of soon-to-be reported trials (Carotid Revascularization Endarterectomy vs Stenting Trial [CREST], International Carotid Stenting Study [ICSS], or others) may alter the current impression that CAS is inferior to CEA for the treatment of symptomatic carotid stenosis.

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Long-Term Outcomes of Carotid Endarterectomy and Carotid Artery Stenting When Performed by a Single Vascular Surgeon

Vascular and Endovascular Surgery ◽

10.1177/1538574418823379 ◽

2019 ◽

Vol 53 (3) ◽

pp. 216-223 ◽

Cited By ~ 3

Author(s):

Muhammad Rizwan ◽

Hanaa Dakour Aridi ◽

Tru Dang ◽

Widian Alshwaily ◽

Besma Nejim ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Artery Stenosis ◽

Long Term Outcomes ◽

Vascular Surgeon ◽

Free Survival ◽

Carotid Revascularization ◽

Short And Long Term

Objectives: Carotid artery endarterectomy (CEA) and carotid artery stenting (CAS) are 2 effective treatment options for carotid revascularization and stroke prevention. The long-term outcomes of Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) reported similar stroke and death rate between the 2 procedures. This study presents the short- and long-term outcomes of CEA and CAS of all risk patients performed by a single vascular surgeon in a real-world setting. Methods: We retrospectively reviewed all patients who underwent CEA and CAS from September 2005 to June 2017 at our institute. Student t test, χ2, and Fisher exact tests were used to compare patient’s characteristics. Multivariate logistic, cox regression models and survival analysis were used to compare postoperative and long-term outcomes between the 2 groups. Results: Over 2000 patients were evaluated for carotid artery stenosis during the study period, and 313 revascularization procedures were performed (CEA: 47%, CAS: 53%). Patients’ age (Mean [95% confidence interval, CI] 68.8 [67.2-70.4] vs 69.7 [68.2-71.3], P = .40) was similar between CEA and CAS. Patients who underwent CAS had significantly higher comorbidities (chronic obstructive pulmonary disease [COPD], chronic heart failure [CHF], hyperlipidemia, and prior ipsilateral intervention, all P < .05). No difference was found in 30-day complications after CEA versus CAS including stroke (2.0% vs 1.2%), myocardial infarction (MI; 0.7% vs 1.2%), death (0% vs 1.2%) as well as combined major adverse events (stroke/death/MI; 2.7% vs 3.0%; all P > .05). Overall 7-year survival, stroke-free survival and restenosis-free survival were similar between the 2 groups ( P > .5). Significant predictors of mortality were diabetes (hazard ratio, HR [95% CI]: 2.41 [1.15-5.08]), chronic kidney disease (HR [95% CI]: 4.89 [1.97-12.13]), and COPD (HR [95% CI]: 3.31 [1.43-7.71]; all P values <.05). Statin use was protective with 71% reduction in risk of mortality (HR [95% CI]: 0.29 [0.12-0.67], P = .004). Conclusion: Our experience showed comparable short- and long-term outcomes of CAS and CEA performed for carotid artery stenosis by vascular surgeon. There was no difference between single institutional long-term outcomes and CREST outcomes following CEA and CAS.

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Transcarotid Artery Revascularization and Advances in Vascular Surgery for Carotid Artery Disease

Surgical Technology Online ◽

10.52198/21.sti.39.cv1484 ◽

2021 ◽

Author(s):

James Hu ◽

◽

Andy Sohn ◽

Justin George ◽

Rajesh Malik ◽

...

Keyword(s):

Carotid Artery ◽

Vascular Surgery ◽

Carotid Endarterectomy ◽

Surgical Management ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Carotid Artery Disease ◽

Artery Stenosis ◽

Cerebrovascular Accidents ◽

Artery Disease

Carotid artery atherosclerotic disease impacts over 2 million Americans annually. Since the advent of the carotid endarterectomy by Debakey in 1953, the surgical management of carotid artery stenosis has prevented cerebrovascular accidents. The technology utilized to manage carotid artery stenosis continued to evolve with the utilization of carotid artery stenting in 1989 and more recently transcarotid artery revascularization (TCAR). This review discusses the modern management of carotid artery stenosis with an emphasis on transcarotid artery revascularization (TCAR) and reversal of flow for reversal of flow for embolic protection.

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Carotid Endarterectomy Versus Stenting: A Meta-Analysis of Randomized Trials

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100011380 ◽

2011 ◽

Vol 38 (2) ◽

pp. 230-235 ◽

Cited By ~ 29

Author(s):

Daniel Yavin ◽

Derek J. Roberts ◽

Michael Tso ◽

Garnette R. Sutherland ◽

Misha Eliasziw ◽

...

Keyword(s):

Myocardial Infarction ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Meta Analysis ◽

Artery Stenosis ◽

Cranial Neuropathy ◽

Cardiac Complications ◽

Lower Odds

Background:A meta-analysis of randomized controlled trials (RCTs) was conducted to update the available evidence on the safety and efficacy of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) in the treatment of carotid artery stenosis.Methods:A comprehensive search was performed of MEDLINE, EMBASE, CENTRAL, bibliographies of included articles and past systematic reviews, and abstract lists of recent scientific conferences. For each reported outcome, a Mantel-Haenszel random-effects model was used to calculate odds ratios (ORs) and 95% confidence intervals (CI). The I2 statistic was used as a measure of heterogeneity.Results:Twelve RCTs enrolling 6,973 patients were included in the meta-analysis. Carotid artery stenting was associated with a significantly greater odds of periprocedural stroke (OR 1.72, 95% CI 1.20 to 2.47) and a significantly lower odds of periprocedural myocardial infarction (OR 0.47, 95% CI 0.29 to 0.78) and cranial neuropathy (OR 0.08, 95% CI, 0.04 to 0.16). The odds of periprocedural death (OR 1.11, 95% CI 0.56 to 2.18), target vessel restenosis (OR 1.95, 95% CI 0.63 to 6.06), and access-related hematoma were similar following either intervention (OR 0.60, 95% CI 0.30 to 1.21).Conclusions:In comparison with CEA, CAS is associated with a greater odds of stroke and a lower odds of myocardial infarction. While the results our meta-analysis support the continued use of CEA as the standard of care in the treatment of carotid artery stenosis, CAS is a viable alternative in patients at elevated risk of cardiac complications.

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