Procedural and mid-term outcomes of carotid artery stenting and carotid endarterectomy in asymptomatıc patients: A single center experience

Aim: Atherosclerotic carotid artery stenosis (CS) is responsible for ~20% of strokes. The management of CS in an asymptomatic patient has been less clear. In situations were carotid endarterectomy (CEA) is thought to be more risky, surgeons must also have enough experience and capability to perform carotid artery stenting (CAS) to provide suitable, patient-tailored treatment. In this study, the same investigator performed all interventions (CAS and CEA), and one type of stenting device and EPD was used. In addition, periprocedural monitoring was carried out for at least 24 h. The objective of this study was to compare procedural results and 12-month follow-up outcomes of patients who were treated by the same operator- either CAS or CEA- in one year. Material and Methods: A retrospective single-center review involving asymptomatic patients with severe stenosis of the ICA caused by atherosclerotic disease who was treated with either stenting with embolic protection (Group 1, n=17) or carotid endarterectomy (group 2, n=18) according to their clinical and anatomical risk profile between 1 January 2018 and 31 December 2018 at Numune Research and Training Hospital, Department of Cardiovascular Surgery, Ankara-Turkey was conducted. A duplex ultrasound (DUS) and neurological assessment was obtained prior to hospital discharge as a baseline, 30-days, 6 months, and 1 year thereafter. Patients’ demographic and clinical characteristics, angiographic variables, primary endpoints including the composite of death, stroke and myocardial infarction during the 30 days after the procedure or ipsilateral stroke during the 365 days after the procedure was compared. Primary endpoints also including primary technical success, periprocedural clinical success, primary patency, clinical failure, periprocedural adjunctive maneuvers and secondary endpoints including complications, freedom from clinically driven target-lesion revascularization at 12 months, freedom from death, freedom from all stroke and freedom from restenosis rates were assessed and compared between the groups. Results: High-risk anatomical criteria were present in 8 (47.0%) patients, high-risk clinical criteria were present in 11 (64.7%) patients. Group 2 patients were older (67.7±7.4 vs 71.2± 6.9, p0.05), but hyperlipidemia (58.8% vs 44.4%, p0.05), chronic renal insufficiency requiring hemodialysis (11.7% vs 0.0%, p0.05) and left ventricular dysfuntion (17.6% vs 0.0%, p0.05) were significantly more frequent in Group 1. CCDS of group 1 was significantly lower than group 2 (4.7 ± 1.3 vs 7.3 ± 1.2; p0.05, respectively). The lesions of the patients undergoing CEA were significantly longer (12.7 ± 2.6 vs 18.5 ± 4.2 mm.; p0.05) and more calcified (11.7% vs 50.0%, p0.05) than the patients in group 1. Likewise, the degree of stenosis in group 2 was significantly more than that of group 1 (81.4 ± 4.2 vs 88.3±6.4 %; p0.05, respectively). Primary technical success was 100% for both groups. Periprocedural clinical success was 100% for Group 1, and 94.4% for group 2. Primary patency rates at 1/6/12 months were 100%/ 94.1%/94.1% for group 1, and 100%/100%/94.4% for group 2. Freedom from restenosis and freedom from CD-TLR at 12 months was 94.1% and 94.4% for group 1 and group 2. No death, major strokes, miyocardial infarction and systemic complications occured. Conclusion: This study showed similar short and mid-term results for CEA and CAS in asymptomatic patients with significant carotid disease. Although we have shown good results for both CEA and CAS, CAS should be limited to those cases that are not suitable for open surgery and treatment of asymptomatic carotid artery disease with CEA should be considered for patients with few risk factors and long life expectancy. Both CEA and CAS reduce the long-term stroke risk in asymptomatic patients. The appropiate treatment strategy should be selected according to the patient’s individual risk factors and imaging data.