Background Carotid endarterectomy is more effective than medical management in the prevention of stroke in patients with severe symptomatic or asymptomatic atherosclerotic carotidartery stenosis. Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, ICSS trial has established equivalent safety and efficacy. Many hospitals have developed CEA and CAS in mainland China, but the data of safty and efficacy is rare.
Methods The revascularization of extracranial carotid artery stenosis (RECAS) study is a multicentre, prospective cohort trial. Patients with symptomatic carotid artery stenosis in 36 centers were continuously assigned to receive carotid artery stenting or carotid endarterectomy. Patients were followed up by independent clinicians not directly involved in the treatment. The primary end point of the study was the cumulative incidence of a major cardiovascular event at 1 year — a composite of death, stroke, or myocardial infarction within 30 days after the intervention or death or ipsilateral stroke between 31 days and 1 year. This study is registered, number NCT01994187.
Results The trial enrolled 2762 patients (CAS group, n=1543; CEA group, n=1176; CEA+CAS group, n=43). The primary end point was achieved in 4.47% (69/1543) in patients treated with carotid artery stents, and 4.93% (58/1176) in patients treated with carotid endarterectomy, an absolute difference of 0.46%. Risks of any stroke (3.50% vs 3.32%) was higher in the stenting group than in the endarterectomy group, but the risks of any death (0.39% vs 0.51%) was lower in the stenting group than in the endarterectomy group. Nine procedural myocardial infarctions were recorded in the stenting group, compared with thirteen in the endarterectomy group.
Interpretation Completion of long-term follow-up is needed to establish the efficacy of carotid artery stenting compared with endarterectomy.
Disclosures Y. Bin: None. C. Yanfei: None. W. Yabing: None. G. Peng: None. M. Yan: None. J. Liqun: None.
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