Carotid revascularization therapies: carotid angioplasty and stenting linked to higher risk of perioperative mortality, stroke, and unfavorable discharges than carotid endarterectomy


Clinical equipoise of carotid revascularization therapies remains controversial. Researchers sought to determine whether adverse outcomes after carotid endarterectomy ( CEA ) or carotid angioplasty and stenting ( CAS ) were similar using propensity score–matched analysis of retrospective data from a large hospital discharge database.

All CEA and CAS cases were identified from the 2006 to 2011 Premier Perspective Database and subjected to 1:1 propensity score matching using 33 clinical covariates associated with carotid revascularization.

A primary composite end point of peri- or postoperative mortality, stroke, or acute myocardial infarction and a modified composite end point excluding acute myocardial infarction were used to compare the findings with recent prospective controlled trials.

Multivariate regression and Cox-proportional hazard ratio survival analysis were performed to compare revascularization therapy outcomes.

After 1:1 propensity score matching, 24 004 ( 12 002 CEA and CAS ) asymptomatic and 3506 ( 1753 CEA and CAS ) symptomatic procedures were included.

The risk of the primary composite end point was significantly higher after CAS than CEA in both asymptomatic ( odds ratio, OR=1.40 [ 1.19–1.65 ]; P less than 0.0001 ) and symptomatic ( OR=2.31 [ 1.78–3.00 ]; P less than 0.0001 ) presentations, irrespective of age ( P=0.28 ) or sex ( P=0.35 ).

Similar findings were observed using the modified composite end point for both asymptomatic ( OR=1.49 [1.25–1.78]; P less than 0.0001 ) and symptomatic ( OR=3.02 [ 2.25–4.07 ]; P less than 0.0001 ) presentations.

Acute myocardial infarction risk was not significantly different between revascularization therapies, regardless of clinical presentation ( P=0.71 and 0.24 ).

In conclusion, among individuals undergoing carotid artery revascularization from a large sample of US hospitals, carotid angioplasty and stenting was associated with higher risk of perioperative mortality, stroke, and unfavorable discharges compared with carotid endarterectomy for all ages and clinical presentations. ( Xagena )

McDonald RJ et al, Stroke 2014; 45: 3311-3319

XagenaMedicine_2014



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