Carotid Endarterectomy Yields Better Short-Term Results Compared to Stenting

A new study has found that both symptomatic and asymptomatic carotid artery stenting (CAS) patients had significantly higher 30-days post-procedure incidence of death, stroke, or myocardial infarction (MI), when compared to Carotid Endarterectomy (CEA) patients.

Researchers at the Veterans Affair Medical Center (VAMC, Washington, DC, USA), Washington University (St. Louis, MI, USA), New England Research Institutes (Watertown, MA, USA), and other members of the Outcomes Committee of the Society for Vascular Surgery Vascular Registry (SVS-VR) reviewed data on 6,403 procedures performed by 287 providers at 56 centers across the United States. An additional 1,450 CAS patients and 1,368 CEA patients with 30-day outcomes were also included in the study. The primary outcomes were combined death, stroke, and myocardial infarction (MI).


The study results showed that after risk-adjustment for age, history of stroke, diabetes, and other factors found to be significant confounders; logistic regression analysis suggested better outcomes following CEA. For CAS, death, stroke, or MI at 30 days was 7.13% for symptomatic patients and 4.60% for asymptomatic patients; for CEA, death, stroke, or MI at 30 days was 3.75% in symptomatic patients and 1.97% in asymptomatic patients. When CAS and CEA were compared in the treatment of atherosclerotic disease only, the difference in outcomes between the two procedures was more pronounced, with death, stroke, or MI at 6.42% after CAS compared to 2.62% following CEA. The study was published in the January 2009 issue of the Journal of Vascular Surgery.

"The majority of patients were treated because of atherosclerotic disease,” said senior author Professor Anton Sidawy, M.D., MPH, chief of vascular surgery at VAMC. "In general, there was a greater proportion of CAS patients with preprocedure lateralizing neurological symptoms, as well as higher prevalence of cardiac comorbidities compared with CEA patients.”

"This initial report from the Vascular Registry provides proof of concept that a specialty society-based vascular registry can succeed in meeting regulatory and scientific goals,” said Professor Gregorio Sicard, M.D., chairman of the SVS Outcomes Committee and chief of vascular surgery at Washington University. "With continued enrollment and follow-up, analysis of SVS Vascular Registry will supplement randomized trials by providing real-world comparisons of CAS and CEA with sufficient numbers to serve as an outcome assessment tool of important patient subsets and across the spectrum of peripheral vascular procedures.”

The SVS Vascular Registry for Carotid Procedures currently has 77 participating clinical facilities and over 9,700 patients. The SVS-VR provides semi-annual institutional benchmarking reports to participating facilities on outcomes by procedure. The New England Research Institutes serves as the independent data coordinating center, maintaining the database, and performing statistical analysis. The SVS designed the Vascular Registry with potential for expansion to procedures involving other vascular beds.

Related Links:
Veterans Affair Medical Center
Washington University
New England Research Institutes