Results of carotid artery stenting. Lessons learned in a Belgian ‘real world’ practice

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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Renal Dysfunction is the Strongest Prognostic Factor After Carotid Artery Stenting According to Real-World Data

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2021.106269 ◽

2022 ◽

Vol 31 (3) ◽

pp. 106269

Author(s):

Shigeta Miyake ◽

Ryosuke Suzuki ◽

Taisuke Akimoto ◽

Yu Iida ◽

Wataru Shimohigoshi ◽

...

Keyword(s):

Prognostic Factor ◽

Carotid Artery ◽

Renal Dysfunction ◽

Real World ◽

Carotid Artery Stenting ◽

Real World Data ◽

World Data

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Carotid artery stenting vs. carotid endarterectomy in the management of carotid artery stenosis: Lessons learned from randomized controlled trials

Surgical Neurology International ◽

10.4103/sni.sni_400_17 ◽

2018 ◽

Vol 9 (1) ◽

pp. 85 ◽

Cited By ~ 8

Author(s):

EkkehardM Kasper ◽

MohamedM Salem ◽

AbdulrahmanY Alturki ◽

MatthewR Fusco ◽

AjithJ Thomas ◽

...

Keyword(s):

Carotid Artery ◽

Randomized Controlled Trials ◽

Carotid Endarterectomy ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Lessons Learned ◽

Artery Stenosis ◽

Controlled Trials ◽

Randomized Controlled

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Abstract P489: Differences in Characteristics of Octogenarian Patients Undergoing Carotid Artery Stenting and Carotid Endarterectomy for Carotid Stenosis: Insights From a Real World Surgical Quality Registry

Stroke ◽

10.1161/str.52.suppl_1.p489 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Mohammed Ali Alvi ◽

Yagiz Yolcu ◽

Kenan Rajjoub ◽

Ozan Dikilitas

Keyword(s):

High Risk ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Real World ◽

Carotid Artery Stenting ◽

Real World Data ◽

Surgical Quality ◽

World Data ◽

Quality Registry

Introduction: Several clinical trials evaluating the efficacy of a carotid revascularization procedure excluded patients above age 80. In the current study, we sought to assess the differences in characteristics of octogenarians undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid stenosis using “real-world” data from a national surgical quality registry. Methods: The National Surgical Quality Improvement Program (NSQIP) targeted datasets for CEA and CAS were queried for patients aged ≥80 years between 2012-2018. Results: We identified 5,814 patients undergoing CEA and 189 patients undergoing CAS. Patients in the CAS group were more likely to be ≥90 years (p=0.004), diabetic (p=0.04), had a history of CHF (p=0.012) and a bleeding-disorder (p<0.001). Patients in the CAS group were also more likely to have high risk anatomy (p<0.001), high-risk-physiology (p=0.028). Ninety-nine (52.4%) patients in the CAS group and 2,775 (47.7%) in the CEA group were symptomatic, with most patients in both groups presenting with an ipsilateral stroke. Among asymptomatic patients, 64 (74%) in the CAS group and 2222 (72.7%) in the CEA group had severe/total stenosis (>80%-100%) of the ipsilateral carotid, while 13(14.5%) in the CAS group and 302 (11%) in the CEA group had severe or total stenosis of contralateral carotid. Among symptomatic patients, 58(61.7%) in the CAS group and 1527 (57.5%) in the CEA group were found to have severe/total stenosis of the ipsilateral-carotid, while 12(12.8%) in the CAS group and 208(7.8%) in the CEA group were found to have severe/total occlusion of the contralateral carotid. In the carotid endarterectomy group, 12.2% (n=711) underwent CEA-alone, 44.3% (n=2,575) CEA with angioplasty, 29.9% (n=1,737) CEA with angioplasty and shunt, 2.9% (n=166) CEA with shunt and 10.7%(n=166) eversion CEA. In the CAS group, 52.4%(n=99) underwent CAS with a single tapered stent, 29.1%(n=55) CAS with single tapered stent with CPD, 11.1%(n=21) single straight stent with CPD and 1.6%(n=3) a single straight stent alone. Conclusion: These analyses from real-world data show that there may be some differences in demographic and comorbid characteristics between octogenarians undergoing CAS and CEA.

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