Outcome After 7 Years of Carotid Artery Stenting and Endarterectomy in Sweden – Single Centre and National Results

Abstract

CAS is not as safe as CEA from a national perspective but our results indicate that a single centre can achieve acceptable results with CAS.

Endarterectomy or carotid artery stenting: the quest continues part two

“…The dotted line represents the overall outcome after CEA in those registries, which include a surgical arm (293 events in 8,546 symptomatic patients). [51][52][53] 7,649) (5.1% vs 1.6%; P 5 .001), with predominantly higher stroke rates in CAS (3.8% vs 1.2%, P 5 .004). 52 The SVS has also designed a VR to collect real-world data on the outcome after CAS and CEA.…”

“…However, they do show a reduction in stroke and death rates after CAS (including CAS in asymptomatic patients) from 6.4% in 2004 to 2008 to 3.6% in 2008 to 2011, indicating that increasing experience and improved devices might improve the outcome after CAS. 51 One might argue that these ''real-world'' outcomes after CAS do lie within the 6% perioperative morbidity and mortality boundary maintained in international guidelines for (surgical) treatment of symptomatic patients with severe carotid stenosis (Fig. 1).…”

“…1). 5,11,12,[51][52][53] Another discussion is what type of protection should be used. Three types of protection devices have been developed: distal filters, distal occlusion, and proximal occlusion balloons.…”

“…Other registries are based on data from regional or national vascular databases or databases held by scientific societies, containing either just an endovascular arm or having a surgical arm as well. [51][52][53]63,64 Most of the PMS studies are conducted in ''high risk'' patients because patient selection has to be consistent with the approved device indications for use. Although the 30-day death/stroke rates are promising with only slightly higher outcomes compared with those in ''standard patients'' in ICSS and CREST (Table 2, Fig.…”

“…Symptomatic patients undergoing CAS (n 5 430) showed higher rates of stroke or death than those who had received CEA (n 5 Figure 1 Thirty-day outcome after CAS in symptomatic patients (numbers between the brackets) in recently published registries and observational studies. 9,27,[40][41][42][46][47][48][51][52][53]55,63,64,70 The dashed line represents the maximum of 6% perioperative morbidity and mortality as recommended by various international guidelines. The dotted line represents the overall outcome after CEA in those registries, which include a surgical arm (293 events in 8,546 symptomatic patients).…”