Study Finds Long-Term Outcomes of CAS With Appropriate Patient Selection Comparable to CEA

February 1, 2011—In the Journal of the American College of Cardiology, Paola De Rango, MD, et al published findings from a study that sought to evaluate long-term outcomes of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) based on physician-guided indications (2011; 57:664-671). The investigators concluded that when physicians use their clinical judgment to select the appropriate technique for carotid revascularization, CAS can offer efficacy and durability comparable to CEA with benefits persisting at 5 years.

In the study, the investigators reviewed consecutive patients (71% men, mean age 71.3 years) treated by CEA (n = 1,118) or CAS (n = 1,084) after a training phase. Selection of treatment was based on better-suitability characteristics (morphology and clinical). Data were adjusted with propensity score analysis and stratified by symptoms, age, and sex. As detailed by the investigators, 30-day stroke/death rates were similar (2%, CEA vs 2.8%, CAS; P = .27).

The risk was higher in symptomatic versus asymptomatic patients (3.5% vs 2%; P = .04) but without significant difference between CAS and CEA groups. Five-year survival rates were 87.7% in CEA and 82% in CAS (P = .05). Kaplan-Meier estimates of the composite of any periprocedural stroke/death and ipsilateral stroke at 5 years after the procedure were similar in all patients (4.7% vs 3.7%; P = .4) and the subgroups of symptomatic (8.7% vs 4.9%; P = .7) and asymptomatic (2.5% vs 3.3%; P = .2) patients in CEA versus CAS, respectively. Cox analysis, adjusted by propensity score, identified statin treatment (P = .016) and symptomatic disease (P = .003) as being associated with the composite endpoint. There were no sex- or age-related significant outcome differences, the investigators reported.