Outcomes of Stenting versus Endarterectomy for Symptomatic Extracranial Carotid Stenosis: A Retrospective Multicenter Study in Korea

Lee, Jayoun; You, Ji Hye; Oh, Sung Hee; Shin, Sue; Kim, Byung Moon; Kim, Tae Sun; Cho, Yong Pil; Jeon, Pyoung; Park, Hyeonseon

doi:10.1016/j.avsg.2018.04.044

Cited by 6 publications

(6 citation statements)

References 25 publications

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“…Although carotid artery stenosis patients undergoing CEA or carotid artery stenting (CAS) had similar 30-day readmission rates [38], Columbo et al [39] recently reported that patients who undergo CEA have a long-term survival advantage over those who undergo CAS in real-world practice, despite no difference in long-term survival in randomized trials. Furthermore, according to a recent multicenter study in Korea, although the risk of major adverse cardiovascular events did not differ significantly within 4 years among Korean CAS and CEA patients, there was a higher risk of stroke with CAS during the periprocedural period [40]. However, the optimal management strategy for DM patients with significant carotid stenosis remains to be defined, because randomized clinical trials have focused on comparing the effectiveness of CEA and CAS for high-risk [41] or standard-risk [29, 42, 43] patients, with minimal specific focus on patients with DM [4, 9].…”

Section: Discussionmentioning

confidence: 99%

Comparison of outcomes after carotid endarterectomy between type 2 diabetic and non-diabetic patients with significant carotid stenosis

Jeong

Kwon

Jung

et al. 2019

Cardiovasc Diabetol

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Background: We aimed to compare early and late outcomes after carotid endarterectomy (CEA) between Korean type 2 diabetic and non-diabetic patients and to investigate the impact of diabetes on the overall incidence of cardiovascular events after CEA. Methods: We retrospectively analyzed 675 CEAs, which were performed on 613 patients with significant carotid stenosis between January 2007 and December 2014. The CEAs were divided into a type 2 diabetes mellitus (DM) group (n = 265, 39.3%) and a non-DM group (n = 410, 60.7%). The study outcomes included the incidence of major adverse events (MAEs), defined as fatal or nonfatal stroke or myocardial infarction or all-cause mortality, during the perioperative period and within 4 years after CEA. Results: Patients in the DM and non-DM groups did not differ significantly in the incidence of MAEs or any of the individual MAE manifestations during the perioperative period. However, within 4 years after CEA, the difference in the MAE incidence was significantly greater in the DM group (P = 0.040). Analysis of the individual MAE manifestations indicated a significantly higher risk of stroke in the DM group (P = 0.006). Multivariate analysis indicated that diabetes was not associated with MAEs or individual MAE manifestations during the perioperative period, whereas within 4 years after CEA, diabetes was an independent risk factor for MAEs overall (hazard ratio [HR], 1.62; 95% confidence interval [CI] 1.06-2.48; P = 0.026) and stroke (HR, 2.55; 95% CI 1.20-5.41; P = 0.015) in particular. Conclusions: Diabetic patients were not at greater risk of perioperative MAEs after CEA; however, the risk of late MAE occurrence was significantly greater in these patients. Within 4 years after CEA, DM was an independent risk factor for the occurrence of MAEs overall and stroke in particular.

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Section: Discussionmentioning

confidence: 99%

Comparison of outcomes after carotid endarterectomy between type 2 diabetic and non-diabetic patients with significant carotid stenosis

Jeong

Kwon

Jung

et al. 2019

Cardiovasc Diabetol

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“…In our facility, the choice between CEA and CAS is not based on age. Elderly patients are more likely to have vascular tortuosity and severe vascular calcification, which may explain the higher risk of CAS in these patients [ 32 , 33 ]. Even if a patient is older than 70 years, if accessibility and feasibility are confirmed in diagnostic angiography, we select CAS that is less invasive.…”

Section: Discussionmentioning

confidence: 99%

Outcomes Following Carotid Endarterectomy and Carotid Artery Stenting in Patients with Carotid Artery Stenosis: A Retrospective Study from a Single Center in South Korea

Kim

2023

Med Sci Monit

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Background:Previous randomized controlled trials and meta-analyses comparing carotid endarterectomy (CEA) and carotid artery stenting (CAS) included a large number of patients, but the diagnosis, treatment selection, and performance were heterogeneous. This retrospective study from a single center in South Korea aimed to evaluate outcomes following CEA and CAS in patients with carotid artery stenosis. Material/Methods:A retrospective analysis was performed using the data of patients who underwent carotid revascularization between September 2016 and June 2021 at a single institution. The primary outcomes were stroke, myocardial infarction (MI), and death during the periprocedural period. Results:We enrolled a total of 61 (44 symptomatic and 17 asymptomatic) patients who underwent CEA or CAS. Among them, 36 (59%) underwent CEA and 25 (41%) underwent CAS. Statistically significant differences were found between the groups in degree of carotid stenosis (CEA: 87.0±9.1, CAS: 80.5±9.3, P=0.007). All patients with confirmed plaque ulceration before carotid revascularization underwent CEA. Two (3.3%) periprocedural strokes occurred, 1 in each group, on the ipsilateral side. There were no significant differences between CEA and CAS in the event-free survival rate for stroke during the follow-up (log-rank test=0.806). Conclusions:Favorable outcomes in terms of periprocedural stroke were observed. We found no significant difference between the 2 carotid revascularization techniques in the incidence of periprocedural stroke in symptomatic and asymptomatic patients. To confirm our findings, further studies involving a larger number of patients and continuous follow-up are necessary.

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“…This study was conducted at a tertiary referral center that performs more than 90 elective CEAs annually, and skilled surgeons with postoperative management experience were associated with substantially lower perioperative stroke/death in patients undergoing CEA. 14 In the distribution of high-risk factors, CEA was frequently performed in patients with severe comorbidities but was rarely performed in patients with anatomical factors such as dissection, surgically inaccessible high lesion, and postendarterectomy restenosis. 17,18 For such patients, there is a demand for a new treatment modality with better outcomes than CAS, and a new technology of trans carotid artery revascularization (TCAR) is showing excellent early outcomes in clinical trials.…”

Section: Discussionmentioning

confidence: 99%

The Impact of age and outcomes of high-risk patients on carotid revascularization

et al. 2023

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Objectives To validate the accuracy of high-risk criteria for carotid endarterectomy (CEA) and analyze the correlation between age and outcome of CEA and carotid artery stenting (CAS) in risk groups. Methods We reviewed a prospectively managed vascular surgery database in a single tertiary referral center, and 2482 internal carotid arteries (ICAs) had undergone carotid revascularization from November 1994 to December 2021. To validate high-risk criteria for CEA, patients were classified as high risk (Hr) and normal risk (Nr). Subgroup analysis was performed with patients older or younger than 75 years to investigate the relationship between age and outcome in each group. Primary endpoints were 30-day outcomes including stroke, death, stroke/death, myocardial infraction (MI), and major adverse cardiovascular events (MACEs). Results A total of 2345 ICAs in 2256 patients were enrolled. The number of patients in the Hr group was 543 (24%) and the number in the Nr group was 1713 (76%). CEA and CAS were performed on 1384 (61%) and 872 (39%) patients, respectively. The 30-day stroke/death rate was higher with CAS than CEA in both the Hr (1.1% vs. 3.9%, p = 0.032) and Nr (1.2% vs. 6.9%, p < 0.001) groups. In unmatched logistic regression analysis of the Nr group ( n = 1778), the rate of 30-day stroke/death (OR, 5.575; 95% CI, 2.922–10.636; p < 0.001) was higher for CAS than CEA. In propensity score matching of the Nr group, the rate of 30-day stroke/death (OR, 5.165; 95% CI, 2.391–11.155; p < 0.001) was also higher for CAS than CEA. In the age <75 subgroup of the Hr group ( n = 428), CAS was associated with higher 30-day stroke/death (OR, 14.089; 95% CI, 1.314–151.036; p = 0.029). In the age ≥75 subgroup of the Hr ( n = 139), there was no difference in 30-day stroke/death between CEA and CAS. In the age <75 subgroup of the Nr group ( n = 1318), 30-day stroke/death (OR, 6.300; 95% CI, 2.797–14.193; p < 0.001) was higher in CAS. In the age ≥75 subgroup of the Nr group ( n = 460), 30-day stroke/death (OR, 6.468; 95% CI, 1.862–22.471; p = 0.003) was higher in CAS. Conclusions In patients older than 75 years in the Hr group, there were relatively poor 30-day treatment outcomes in both CEA and CAS. Alternative treatment is needed that can expect better outcomes in older high-risk patients. In the Nr group, CEA has a significant benefit compared with CAS, and CEA should be recommended more to these patients.

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Outcomes of Stenting versus Endarterectomy for Symptomatic Extracranial Carotid Stenosis: A Retrospective Multicenter Study in Korea

Cited by 6 publications

References 25 publications

Comparison of outcomes after carotid endarterectomy between type 2 diabetic and non-diabetic patients with significant carotid stenosis

Comparison of outcomes after carotid endarterectomy between type 2 diabetic and non-diabetic patients with significant carotid stenosis

Outcomes Following Carotid Endarterectomy and Carotid Artery Stenting in Patients with Carotid Artery Stenosis: A Retrospective Study from a Single Center in South Korea

The Impact of age and outcomes of high-risk patients on carotid revascularization

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