Letter: Early Outcomes After Carotid Endarterectomy and Carotid Artery Stenting: A Propensity-Matched Cohort Analysis

Abstract

To the Editor:We read with great interest the article by Sastry et al 1 regarding periprocedural adverse events after carotid artery stenting (CAS) and carotid endarterectomy (CEA) and congratulate the authors for selecting an important topic for their analysis. Although CAS and CEA have been extensively a Statistical tests performed: Welch two sample t-test; Pearson Chi-square test of independence; bold indicates significance (α = 0.05).

In Reply: Early Outcomes After Carotid Endarterectomy and Carotid Artery Stenting: A Propensity-Matched Cohort Analysis

“…Furthermore, it should be noted that the rates of stroke observed in our own cohort was broadly comparable or even lower than other large prospective and retrospective studies (see Table 4B). 2 As such, we are inclined to suggest that the major difference in result between our own study and that of Ansari et al 1 is a result of included vascular-specific risk factors and, possibly, an altered mix of symptomatic and asymptomatic cases.…”

“…We very much appreciated the letter submitted by Ansari et al 1 in response to our recently published work regarding 30-day outcomes after carotid endarterectomy (CEA) and carotid artery stenting (CAS) using the American College of Surgeons National Surgical Quality Improvement Program database. 2 In brief, motivated by the observation that real-world outcomes do not necessarily parallel findings from prospective, randomized trials, we conducted a retrospective analysis of both procedures in a large, national cohort using a propensity matching method.…”

“…Ansari et al 1 used propensity matching to compare a large sample of patients undergoing CAS and CEA in the vascular procedure-targeted National Surgical Quality Improvement Program database, which contains more specific information regarding patient-level anatomic risk factors and surgical history. In their primary analysis, the authors do not find a statistically significant difference in rates of stroke or transient ischemic attack between the 2 procedures.…”

“…In an effort to standardize patient cohorts, our analysis only considered patients who were admitted from home for elective nonemergent surgery. It is well-known that rates of major complications after CAS and CEA are much higher in patients undergoing (necessarily urgent) intervention for symptomatic carotid stenosis, and it is unclear, based on the reported data, to what extent the patient cohort assessed by Ansari et al 1 reflects a mix of symptomatic and asymptomatic patients. Another important distinction between the 2 analyses was the inclusion of CAS with and without embolic protection devices (EPDs) in our own assessment.…”