Abstract Number: Esoc2026a1446 Long-Term Outcomes of Carotid Endarterectomy Versus Carotid Artery Stenting in Patients With Carotid Stenosis: A Real-World Analysis

Abstract Background and aims In patients with asymptomatic moderate carotid stenosis, guidelines recommend intensive medical therapy with surveillance, reserving carotid revascularization for selected high-risk individuals. However, the optimal interventional strategy remains uncertain, and long-term real-world comparative data between carotid endarterectomy (CEA) and carotid artery stenting (CAS) are limited. We evaluated the long-term effectiveness and safety of CEA versus CAS. Methods Using real-world data from the TriNetX network, we conducted a retrospective observational study comparing long-term outcomes in patients with carotid stenosis treated with CEA or CAS. Subgroup analyses included patients with prior ischemic stroke. Cohorts were balanced using 1:1 propensity score matching. Outcomes were assessed over 6 months and up to 4 years. The primary endpoint was a composite of all-cause mortality, stroke, and acute myocardial infarction. Secondary endpoints included individual components and angina. Kaplan–Meier estimates and Cox proportional hazards models were used. Results After propensity score matching, 1884 patients were included. CEA was associated with a significantly lower incidence of the primary composite outcome at 4 years compared with CAS (hazard ratio HR 0.79, 95% confidence interval CI 0.69–0.90). Stroke risk was also significantly lower with CEA (HR 0.80, 95%CI 0.70–0.91). Mortality tended to be lower after CEA, but was not statistically significant (HR 0.75, 95% CI 0.55–1.02). Similar patterns were observed across subgroups defined by prior ischemic stroke. Conclusions In this large real-world analysis, CEA was associated with better long-term outcomes than CAS in patients with carotid stenosis, supporting careful patient selection in contemporary practice. Conflict of interest Leandra Serio : nothing to disclose Table 1 - belongs to Background and aims Table 2 - belongs to Methods Table 3 - belongs to Results Figure 1 - belongs to Conclusions