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- Title
Long-Term Outcomes of Carotid Endarterectomy and Carotid Artery Stenting When Performed by a Single Vascular Surgeon.
- Authors
Rizwan, Muhammad; Aridi, Hanaa Dakour; Dang, Tru; Alshwaily, Widian; Nejim, Besma; Malas, Mahmoud B.
- Abstract
Objectives: Carotid artery endarterectomy (CEA) and carotid artery stenting (CAS) are 2 effective treatment options for carotid revascularization and stroke prevention. The long-term outcomes of Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) reported similar stroke and death rate between the 2 procedures. This study presents the short- and long-term outcomes of CEA and CAS of all risk patients performed by a single vascular surgeon in a real-world setting. Methods: We retrospectively reviewed all patients who underwent CEA and CAS from September 2005 to June 2017 at our institute. Student t test, χ2, and Fisher exact tests were used to compare patient's characteristics. Multivariate logistic, cox regression models and survival analysis were used to compare postoperative and long-term outcomes between the 2 groups. Results: Over 2000 patients were evaluated for carotid artery stenosis during the study period, and 313 revascularization procedures were performed (CEA: 47%, CAS: 53%). Patients' age (Mean [95% confidence interval, CI] 68.8 [67.2-70.4] vs 69.7 [68.2-71.3], P = .40) was similar between CEA and CAS. Patients who underwent CAS had significantly higher comorbidities (chronic obstructive pulmonary disease [COPD], chronic heart failure [CHF], hyperlipidemia, and prior ipsilateral intervention, all P < .05). No difference was found in 30-day complications after CEA versus CAS including stroke (2.0% vs 1.2%), myocardial infarction (MI; 0.7% vs 1.2%), death (0% vs 1.2%) as well as combined major adverse events (stroke/death/MI; 2.7% vs 3.0%; all P > .05). Overall 7-year survival, stroke-free survival and restenosis-free survival were similar between the 2 groups (P > .5). Significant predictors of mortality were diabetes (hazard ratio, HR [95% CI]: 2.41 [1.15-5.08]), chronic kidney disease (HR [95% CI]: 4.89 [1.97-12.13]), and COPD (HR [95% CI]: 3.31 [1.43-7.71]; all P values <.05). Statin use was protective with 71% reduction in risk of mortality (HR [95% CI]: 0.29 [0.12-0.67], P = .004). Conclusion: Our experience showed comparable short- and long-term outcomes of CAS and CEA performed for carotid artery stenosis by vascular surgeon. There was no difference between single institutional long-term outcomes and CREST outcomes following CEA and CAS.
- Subjects
CAROTID artery surgery; MORTALITY risk factors; STROKE prognosis; CHI-squared test; CHRONIC kidney failure; CONFIDENCE intervals; FISHER exact test; HEART failure; HYPERLIPIDEMIA; OBSTRUCTIVE lung diseases; MULTIVARIATE analysis; POSTOPERATIVE period; PROBABILITY theory; SURGICAL stents; SURGEONS; SURVIVAL analysis (Biometry); T-test (Statistics); COMORBIDITY; DISEASE relapse; STATINS (Cardiovascular agents); LOGISTIC regression analysis; CAROTID artery stenosis; TREATMENT effectiveness; PROPORTIONAL hazards models; RETROSPECTIVE studies; REVASCULARIZATION (Surgery); CAROTID endarterectomy; ODDS ratio
- Publication
Vascular & Endovascular Surgery, 2019, Vol 53, Issue 3, p216
- ISSN
1538-5744
- Publication type
Article
- DOI
10.1177/1538574418823379