Outcome differences between carotid artery stenting (CAS) and carotid endarterectomy (CEA) in postoperative ventricular arrhythmia, neurological complications, and in-hospital mortality

Introduction and objectives Which is the best carotid stenosis treatment remains a controversial issue. To present day, no study has compared the results of carotid artery stenting versus carotid endarterectomy in Portugal. We aim to provide real life numbers regarding the outcomes of both procedures in Portuguese public hospitals. Methods Every patient registered between 2005 and 2015 with the main diagnosis of carotid stenosis and submitted to carotid endarterectomy or carotid artery stenting was included. The information was obtained through the Central National Healthcare Administrative database, a mandatory registry for hospital refunding. Primary outcomes were hospital mortality and stroke. Patient demographics, comorbidities and hospital length of stay were also evaluated. Results The study included 6094 patients: 1399 were symptomatic (mention of prior stroke) and 4695 asymptomatic. Carotid artery stenting was performed on 22% of the symptomatic and 18% of the asymptomatic patients. In the symptomatic patients, the in-hospital mortality was significantly higher in those submitted to stenting (3.6% vs. 1.6% in carotid endarterectomy, p = 0.025). No significant differences in outcomes were observed in the asymptomatic group (mortality 0.9% vs. 0.8%, p = 0.852; stroke rate of 2.6% vs. 2.3%, p = 0.652 – carotid artery stenting vs. carotid endarterectomy). In both groups, there was an important increase in the proportion of stenting between 2005 and 2012, followed by a gradual decline until 2015. Conclusion Despite its increasing frequency, a higher early mortality was documented for CAS in symptomatic patients. No worse outcome was observed in asymptomatic patients.

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Abstract 16911: Socioeconomic Status as a Predictor of Post-Operative Mortality and Outcomes in Carotid Artery Stenting vs Carotid Endarterectomy

Circulation ◽

10.1161/circ.142.suppl_3.16911 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jigesh Baxi ◽

Xiaoyan Deng ◽

Fady K Soliman ◽

Alexis K Okoh ◽

Joshua C Chao ◽

...

Keyword(s):

Socioeconomic Status ◽

Carotid Artery ◽

Hospital Mortality ◽

Carotid Endarterectomy ◽

Carotid Artery Stenting ◽

Independent Predictor ◽

Low Ses ◽

Median Income ◽

Significant Independent Predictor ◽

Secondary Outcomes

Introduction: The association between socioeconomic status (SES) and adverse surgical outcomes represents an emerging area of concern. Furthermore, with regard to carotid stenosis, Carotid Artery Stenting (CAS) has been demonstrated to pose a greater risk of postoperative complications, such as stroke, than Carotid Endarterectomy (CEA). This study aims to compare the impact of low SES on patients undergoing Carotid Artery Stenting (CAS) versus Carotid Endarterectomy (CEA). Methods: The National Inpatient Sample (NIS) was queried from 2010 to 2015. Patients who underwent CAS and CEA were identified. Patients of the highest and lowest median income quartiles by zip code were selected and compared based on demographics, hospital characteristics, and comorbidities (Charleston Comorbidity Index: CCI). Primary and secondary outcomes were in-hospital mortality and postoperative stroke, respectively. Multivariable analysis was used to determine the effect of SES on in-hospital mortality. Results: 3,516 and 1,909 underwent CAS; 22,852 and 15,547 patients underwent CEA in the low and high SES groups, respectively. Low SES was a significant independent predictor of mortality (OR = 2.07 [1.25-3.53], p = 0.005) for patients who underwent a CEA, but not for those undergoing CAS. CCI and age were strong predictors of mortality for both procedures (CAS odds ratio (OR)(age) 1.05[1.00-1.10] p = 0.05, OR(CCI) 1.45[1.17-1.80] p < 0.001; CEA: OR(age) 1.03[1.01-1.06] p = 0.01, OR(CCI) 1.60[1.45-1.77] p < 0.001). Of secondary outcomes, stroke was strongly associated with CEA, while bleeding was with CAS. [Figure 1]. Conclusions: Low SES is a significant independent predictor of postoperative mortality in patients who underwent CEA, but not CAS. CEA is also associated with a higher incidence of stroke in these patients. These findings suggest that there may be a benefit to a minimally invasive approach (CAS) rather than the present standard of care (CEA), in selected low SES patients.

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Differential Effects of Carotid Artery Stenting Versus Carotid Endarterectomy on External Carotid Artery Patency

Journal of Endovascular Therapy ◽

10.1583/1545-1550(2007)14[208:deocas]2.0.co;2 ◽

2007 ◽

Vol 14 (2) ◽

pp. 208-213 ◽

Cited By ~ 1

Author(s):

Edward Y. Woo ◽

Jagajan Karmacharya ◽

Omaida C. Velazquez ◽

Jeffrey P. Carpenter ◽

Christopher L. Skelly ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenting ◽

External Carotid Artery ◽

External Carotid ◽

Differential Effects

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Faculty Opinions recommendation of Late outcomes after carotid artery stenting versus carotid endarterectomy: insights from a propensity-matched analysis of the Reduction of Atherothrombosis for Continued Health (REACH) Registry.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.5152956.5134054 ◽

2010 ◽

Author(s):

Bruce Biccard ◽

Reitze Rodseth

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenting

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Comparison of results between carotid endarterectomy versus carotid artery stenting using propensity score matching analysis

Journal of Vascular and Endovascular Surgery ◽

10.21767/2573-4482-c1-001 ◽

2018 ◽

Vol 03 ◽

Author(s):

Dong Ik Kim

Keyword(s):

Carotid Artery ◽

Propensity Score ◽

Carotid Endarterectomy ◽

Propensity Score Matching ◽

Carotid Artery Stenting ◽

Propensity Score Matching Analysis ◽

Comparison Of Results

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Distribution of Care and Hospital Incidence of Carotid Endarterectomy and Carotid Artery Stenting: A Secondary Analysis of German Hospital Episode Data

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2021.03.021 ◽

2021 ◽

Author(s):

Christoph Knappich ◽

Pavlos Tsantilas ◽

Michael Salvermoser ◽

Sofie Schmid ◽

Michael Kallmayer ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenting ◽

Secondary Analysis ◽

German Hospital ◽

Hospital Episode

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Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study

BMJ ◽

10.1136/bmj.n49 ◽

2021 ◽

pp. n49

Author(s):

Jeffrey J Perry ◽

Marco L A Sivilotti ◽

Marcel Émond ◽

Ian G Stiell ◽

Grant Stotts ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Carotid Artery ◽

Confidence Interval ◽

Carotid Endarterectomy ◽

Likelihood Ratio ◽

Transient Ischaemic Attack ◽

Carotid Artery Stenting ◽

Stroke Risk ◽

Ischaemic Attack

Abstract Objective To validate the previously derived Canadian TIA Score to stratify subsequent stroke risk in a new cohort of emergency department patients with transient ischaemic attack. Design Prospective cohort study. Setting 13 Canadian emergency departments over five years. Participants 7607 consecutively enrolled adult patients attending the emergency department with transient ischaemic attack or minor stroke. Main outcome measures The primary outcome was subsequent stroke or carotid endarterectomy/carotid artery stenting within seven days. The secondary outcome was subsequent stroke within seven days (with or without carotid endarterectomy/carotid artery stenting). Telephone follow-up used the validated Questionnaire for Verifying Stroke Free Status at seven and 90 days. All outcomes were adjudicated by panels of three stroke experts, blinded to the index emergency department visit. Results Of the 7607 patients, 108 (1.4%) had a subsequent stroke within seven days, 83 (1.1%) had carotid endarterectomy/carotid artery stenting within seven days, and nine had both. The Canadian TIA Score stratified the risk of stroke, carotid endarterectomy/carotid artery stenting, or both within seven days as low (risk ≤0.5%; interval likelihood ratio 0.20, 95% confidence interval 0.09 to 0.44), medium (risk 2.3%; interval likelihood ratio 0.94, 0.85 to 1.04), and high (risk 5.9% interval likelihood ratio 2.56, 2.02 to 3.25) more accurately (area under the curve 0.70, 95% confidence interval 0.66 to 0.73) than did the ABCD2 (0.60, 0.55 to 0.64) or ABCD2i (0.64, 0.59 to 0.68). Results were similar for subsequent stroke regardless of carotid endarterectomy/carotid artery stenting within seven days. Conclusion The Canadian TIA Score stratifies patients’ seven day risk for stroke, with or without carotid endarterectomy/carotid artery stenting, and is now ready for clinical use. Incorporating this validated risk estimate into management plans should improve early decision making at the index emergency visit regarding benefits of hospital admission, timing of investigations, and prioritisation of specialist referral.

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