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Original research
Long term durability and outcomes of carotid stenting and carotid endarterectomy
  1. Jin-Man Jung1,
  2. Jeong-Yoon Choi2,
  3. Hyun Jung Kim2,3,
  4. Sang-il Suh4,
  5. Woo-Keun Seo4,5
  1. 1Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
  2. 2Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
  3. 3Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
  4. 4Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
  5. 5Department of Neurology and Stroke Center, Samsung Medical Center, Seoul, Korea
  1. Correspondence to Dr W-K Seo, Department of Neurology and Stroke Center, Samsung Medical Center, 81, Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea; mcastenosis{at}gmail.com

Abstract

Purpose To evaluate the long term durability and outcomes of carotid angioplasty and stenting (CAS) compared with carotid endarterectomy (CEA).

Methods Using multiple comprehensive databases, we searched for randomized controlled trials comparing CAS with CEA for carotid stenosis. Studies were classified according to symptom status: symptomatic, asymptomatic, or all inclusive stenosis. Postprocedural ipsilateral stroke, restenosis/occlusion after revascularization, procedural stroke/death/myocardial infarction (MI), and postprocedural ipsilateral stroke were evaluated. Subgroup analysis was performed according to follow-up duration.

Results 22 studies were included and classified for meta-analyses in relation to specific outcomes. The maximum follow-up duration was 10 years. The risk of postprocedural ipsilateral stroke in CEA was equivalent to that in CAS, irrespective of symptom status or follow-up time points. The CAS group had a greater risk of restenosis/occlusion after revascularization compared with CEA in studies of all inclusive stenosis. A similar tendency was found in studies of symptomatic stenosis, but without statistical significance. However, subgroup analysis showed that the risk of restenosis/occlusion in CAS decreased gradually with time, to the extent that these risks became comparable 1 year after the procedure. Procedural stroke/death/MI and postprocedural ipsilateral stroke occurred more frequently in the CAS group in studies of symptomatic stenosis although not in studies of asymptomatic or all inclusive stenosis. However, this association did not persist when studies were divided according to follow-up time points.

Conclusions Although CAS may be more strongly associated with periprocedural stroke/death compared with CEA, it could be a good alternative to CEA in terms of long term durability and outcomes.

  • Angioplasty
  • Atherosclerosis
  • Intervention

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