Single-Center Analysis Compares Early Outcomes and Restenosis Rates Between CEA and CAS

November 28, 2017—Investigators from Sungkyunkwan University School of Medicine in Seoul, South Korea, conducted a study comparing early outcomes and restenosis rates between carotid endarterectomy (CEA) and carotid artery stenting (CAS) in unselected patients using propensity score matching (PSM) analysis. Seon-Hee Heo, MD, et al published the findings as an "Editor's Choice" article in European Journal of Vascular and Endovascular Surgery (EJVES; 2017;54:573–578).

The investigators concluded that in this PSM-based observation, CEA showed lower 30-day major adverse clinical events (MACEs) and midterm restenosis rates than CAS, reconfirming previous trial results in both asymptomatic and symptomatic patients with CAS in routine clinical practice.

As summarized in EJVES, the study enrolled unselected patients undergoing CEA or CAS between January 2002 and December 2015 at the single institution. The investigators compared 30-day incidence of MACEs (defined as stroke, transient ischemic attack, myocardial infarction, or death) and procedure-related complications, as well as restenosis rates during follow-up.

PSM was used to balance the following factors between the CEA and CAS cohorts: age, sex, hypertension, diabetes, dyslipidemia, smoking, atrial fibrillation, previous percutaneous coronary intervention or coronary artery bypass grafting, valvular heart disease, contralateral carotid occlusion, degree of carotid stenosis, and symptomatic status. Statistical comparisons of outcomes were based on logistic regression analysis and log-rank test.

Of 1,184 patients (CEA, 654; CAS, 530), 452 PSM pairs of CEA and CAS patients were created.

The investigators found that the CAS group showed a relatively higher 30-day incidence of MACEs (7.5% vs 2.4%; odds ratio [OR], 3.261, 95% confidence interval [CI], 1.634–6.509; P = .001), but a lower incidence of procedure-related complications (1.5% vs 5.3%; OR, 0.199; 95% CI, 0.075–0.528; P = .001). During a mean follow-up of 49.1 months (range, 1–180 months), restenosis rates were higher after CAS than after CEA (1.5% vs 1% at 12 months and 5.4% vs 1.2% at 24 months, respectively; P = .008), reported the investigators in EJVES.