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Stroke. 2016 Aug;47(8):2083-9. doi: 10.1161/STROKEAHA.116.013018. Epub 2016 Jul 12.

Long-Term Outcome After Carotid Artery Stenting: A Population-Based Matched Cohort Study.

Author information

1
From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Department of Surgery, Södersjukhuset, Stockholm, Sweden (M.J., P.G., J.M.); Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (D.L.); Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden (D.L.); and Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sweden (A.W.). magnus.jonsson@sodersjukhuset.se.
2
From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Department of Surgery, Södersjukhuset, Stockholm, Sweden (M.J., P.G., J.M.); Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (D.L.); Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden (D.L.); and Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sweden (A.W.).

Abstract

BACKGROUND AND PURPOSE:

Long-term outcome after carotid artery stenting (CAS), a less invasive technique than carotid endarterectomy (CEA), for prevention of stroke, is unclear. The aim was to assess long-term outcomes after CAS, compared with CEA, in a nationwide cohort study.

METHODS:

All patients registered in the national Swedish Vascular Registry (Swedvasc) treated with primary CAS between 2005 and 2012 were identified. For every CAS, 2 CEA controls, matched for sex, age, procedure year, and indication (symtomatic/asymtomatic), were chosen. Postoperative stroke was identified by cross-matching the cohort with the InPatient Registry and charts review. Primary end point was ipsilateral stroke or death >30 days postoperatively.

RESULTS:

A total of 1157 patients were included, 409 CAS and 748 CEA; 73% men with mean age 70 years and 69% were symptomatic. Risk factor profile was similar between the 2 groups. Median follow-up time was 4.1 years. Ipsilateral stroke or death of >30 days postoperatively occurred in 95 of 394 in the CAS group versus 120 of 724 in the CEA group (adjusted hazard ratio, 1.59; 95% confidence interval, 1.15-2.18). The corresponding adjusted rates for death, ipsilateral stroke of >30 days, and any stroke or death of >30 days were 25.7% versus 18.6% (hazard ratio, 1.20; 95% confidence interval, 0.84-1.72), 9.4% versus 2.9% (hazard ratio, 3.40; 95% confidence interval, 1.53-7.53), 34.2% versus 23.6% (hazard ratio, 1.49; 95% confidence interval, 1.10-2.00) for the CAS group versus CEA group, respectively.

CONCLUSIONS:

In this nationwide cohort study, CAS was associated with an increased long-term risk of ipsilateral stroke and death during after the perioperative phase when compared with CEA.

KEYWORDS:

carotid artery, common; cohort studies; endarterectomy, carotid; stenting; stroke

PMID:
27406106
DOI:
10.1161/STROKEAHA.116.013018
[Indexed for MEDLINE]

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