Key result
Carotid artery stenting with protection devices was associated with 17% 8-year mortality, compared to 30% for stenting without protection and 11% for carotid endarterectomy (P=0.02).
Why the study?
Does carotid artery stenting with or without distal protection devices improve immediate and long-term clinical outcomes compared to carotid endarterectomy in patients with symptomatic carotid stenosis?
Cohort (n=253)
No
Does carotid artery stenting with or without distal protection devices improve immediate and long-term clinical outcomes compared to carotid endarterectomy in patients with symptomatic carotid stenosis?
Carotid artery stenting with a distal protection device is associated with lower rates of vascular complications and mortality compared to stenting without protection, though carotid endarterectomy demonstrated the lowest absolute long-term mortality.
Protection devices may favor stenting over unprotected approaches; leaves open endarterectomy superiority pending randomized data.
OBJECTIVE: To evaluate the immediate and long-term clinical outcomes after carotid artery stenting (CAS) with and without protection devices (PDs), compared with carotid endarterectomy (CEA). METHODS: A total of 116 patients with symptomatic carotid stenosis underwent CAS; 56 patients (48.3%) underwent CAS-PD; and 137 patients underwent CEA. RESULTS: There were more ipsilateral transient ischemic attacks (TIAs) in the CEA group than in CAS-PD and CAS + PD (4 [3%] vs 1 [1.6%] and 0 respectively, P = 0.02). In the CAS-PD group there were more vertebrobasilar TIAs, ipsi- and contralateral strokes, myocardial infarctions, and death rates in the 30-day postprocedural period. After 8-year follow-up, there were 18 (30%) death cases in the CAS-PD group, 10 death cases (17%) in the CAS + PD patients, and 15 death cases (11%) in the CEA group of patients (P = .02). CONCLUSION: Our data show that CAS + PD was associated with lower rate of vascular complications and mortality compared with CAS-PD and CEA.
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Kimiagar et al. (2012) conducted a cohort in Symptomatic carotid stenosis (n=253). Carotid artery stenting with protection devices (CAS + PD) vs. Carotid artery stenting without protection devices (CAS-PD) and carotid endarterectomy (CEA) was evaluated on 8-year mortality (p=0.02). Carotid artery stenting with protection devices was associated with 17% 8-year mortality, compared to 30% for stenting without protection and 11% for carotid endarterectomy (P=0.02).
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