Carotid Artery Stenting Versus Carotid Endarterectomy for Symptomatic or Asymptomatic Extracranial Carotid Stenosis: A National Cohort Study

Authors

Chayakrit Krittanawong
Song Peng Ang
Jonathan A Tangsrivimol
Yusuf Qadeer, Henry Ford HealthFollow
Zhen Wang
Hafeez Ul Hassan Virk
Umair Khalid
Samin K Sharma
Alan Dardik

Recommended Citation

Krittanawong C, Ang SP, Tangsrivimol JA, Qadeer YK, Wang Z, Virk HUH, Khalid U, Sharma SK, and Dardik A. Carotid artery stenting versus carotid endarterectomy for symptomatic or asymptomatic extracranial carotid stenosis: A national cohort study. J Stroke Cerebrovasc Dis 2024; 33(12):108094.

Document Type

Article

Publication Date

12-1-2024

Publication Title

J Stroke Cerebrovasc Dis

Abstract

INTRODUCTION: Stroke is now the 5th leading cause of death in the United States, and carotid artery stenosis is the cause of about 20% to 25% of strokes. We hypothesized that CAS may be an alternative to CEA in both symptomatic and asymptomatic patients with carotid artery stenosis.

METHODS: We evaluated the clinical characteristics, adverse events and mortality of patients with carotid artery stenosis comparing CEA vs. CAS using data from a national population-based cohort study from January 1, 2016, to December 30, 2020.

RESULTS: We evaluated 374,875 patients with carotid stenosis, of whom 344,020 had asymptomatic carotid stenosis and 30,855 had symptomatic carotid stenosis. CAS was associated with higher mortality in both symptomatic and asymptomatic carotid stenosis, compared to CEA, with the trend slightly decreasing for both interventions from the years 2018-2020. CEA was associated with lower adverse events in both symptomatic and asymptomatic carotid stenosis, compared to CAS.

CONCLUSIONS: Our current data suggest a benefit of CEA over CAS for both symptomatic and asymptomatic carotid stenosis with lower complications, lower mortality and a higher rate of discharge. However, this is not a head-to-head comparison as it becomes selection bias for this procedure; therefore, further prospective head-to-head comparison between 2 groups in the same patient population is needed.

Medical Subject Headings

Humans; Carotid Stenosis; Endarterectomy, Carotid; Female; Male; Stents; Aged; Treatment Outcome; Asymptomatic Diseases; Middle Aged; United States; Risk Factors; Time Factors; Risk Assessment; Endovascular Procedures; Databases, Factual; Aged, 80 and over; Stroke; Retrospective Studies

PubMed ID

39424210

Volume

33

Issue

12

First Page

108094

Last Page

108094