open access
Predictors of outcome events and 6-year mortality after carotid endarterectomy and carotid stenting in patients with carotid artery stenosis
Affiliations- Department of Neurology Pavol Jozef Safarik University and L. Pasteur University Hospital, Trieda SNP 1, 04011 Košice, Slovakia
- Clinic of Vascular Surgery, Eastern Slovak Cardiovascular Institute and P. J. Safarik University, Kosice, Slovak Republic, Trieda SNP 1, 04011 Košice, Slovakia
open access
Abstract
Aim. The aim of our study was to evaluate the results of CEA and CAS in patients with carotid artery stenosis, and their effect on long-term mortality and morbidity, as well as to identify predictors of long-term mortality in a single-centre observational study.
Clinical rationale. While data on short-term morbidity and mortality after carotid endarterectomy (CEA) and carotid stenting (CAS) is robust, there is only a limited amount of literature on long-term mortality and its predictors five years-plus post these procedures.
Material and methods. Consecutive patients with symptomatic and asymptomatic internal carotid artery stenosis treated with CEA or CAS in a single centre in eastern Slovakia between 2012 and 2014 were included. We recorded basic sociodemographic data, the presence of co-morbidities and periprocedural complications. Clinical and sonographic follow-up was performed three and 12 months after the procedures. Patient survival data and any stroke data was obtained at the end of a six-year follow-up.
Results. We included 259 patients after CEA (mean age 67.4 ± 8.5, 64.5% men) and 321 after CAS (mean age 66.9 ± 8.4, 73.5% men). We did not identify a statistically significant difference in short-term or long-term mortality, survival times, or the presence of short-term or long-term complications between the CEA and CAS groups. Predictors of long-term mortality included age and diabetes mellitus in both cohorts. Repeated interventions were related to increased mortality only in the CAS cohort. Conclusions. The results of our study show that long-term mortality does not differ between CEA and CAS.
Abstract
Aim. The aim of our study was to evaluate the results of CEA and CAS in patients with carotid artery stenosis, and their effect on long-term mortality and morbidity, as well as to identify predictors of long-term mortality in a single-centre observational study.
Clinical rationale. While data on short-term morbidity and mortality after carotid endarterectomy (CEA) and carotid stenting (CAS) is robust, there is only a limited amount of literature on long-term mortality and its predictors five years-plus post these procedures.
Material and methods. Consecutive patients with symptomatic and asymptomatic internal carotid artery stenosis treated with CEA or CAS in a single centre in eastern Slovakia between 2012 and 2014 were included. We recorded basic sociodemographic data, the presence of co-morbidities and periprocedural complications. Clinical and sonographic follow-up was performed three and 12 months after the procedures. Patient survival data and any stroke data was obtained at the end of a six-year follow-up.
Results. We included 259 patients after CEA (mean age 67.4 ± 8.5, 64.5% men) and 321 after CAS (mean age 66.9 ± 8.4, 73.5% men). We did not identify a statistically significant difference in short-term or long-term mortality, survival times, or the presence of short-term or long-term complications between the CEA and CAS groups. Predictors of long-term mortality included age and diabetes mellitus in both cohorts. Repeated interventions were related to increased mortality only in the CAS cohort. Conclusions. The results of our study show that long-term mortality does not differ between CEA and CAS.
Keywords
carotid stenting, carotid endarterectomy, mortality, predictors
About this articleTitle
Predictors of outcome events and 6-year mortality after carotid endarterectomy and carotid stenting in patients with carotid artery stenosis
Journal
Neurologia i Neurochirurgia Polska
Issue
Article type
Research Paper
Pages
67-73
Published online
2020-11-26
Page views
1208
Article views/downloads
529
DOI
Pubmed
Bibliographic record
Neurol Neurochir Pol 2021;55(1):67-73.
Keywords
carotid stenting
carotid endarterectomy
mortality
predictors
Authors
Norbert Leško
Milan Maretta
Matej Škorvánek
Mária Frankovičová
Vladimír Sihotský
Ľubomír Špak
Zuzana Gdovinová
References (15)- Grau AJ, Weimar C, Buggle F, et al. Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke. 2001; 32(11): 2559–2566.
- Aboyans V, Ricco JB, Bartelink MLEL, et al. ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018; 39(9): 763–816.
- Mas JL, Trinquart L, Leys D, et al. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. The Lancet Neurology. 2008; 7(10): 885–892.
- Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. The Lancet. 2010; 375(9719): 985–997.
- Economopoulos KP, Sergentanis TN, Tsivgoulis G, et al. Carotid artery stenting versus carotid endarterectomy: a comprehensive meta-analysis of short-term and long-term outcomes. Stroke. 2011; 42(3): 687–692.
- Meier P, Knapp G, Tamhane U, et al. Short term and intermediate term comparison of endarterectomy versus stenting for carotid artery stenosis: systematic review and meta-analysis of randomised controlled clinical trials. BMJ. 2010; 340: c467.
- Eckstein HH, Ringleb P, Allenberg JR, et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol. 2008; 7(10): 893–902.
- Brown MM, Rogers J, Bland JM. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. The Lancet. 2001; 357 (9270): 1729–1737. https://doi org/10 1016/S1474. 4422; 09: 70228–5.
- Gurm HS, Yadav JS, Fayad P, et al. SAPPHIRE Investigators. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. 2008; 358(15): 1572–1579.
- Brott TG, Hobson RW, Howard G, et al. CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010; 363(1): 11–23.
- Brott TG, Howard G, Roubin GS, et al. CREST Investigators. Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis. N Engl J Med. 2016; 374(11): 1021–1031.
- Brott TG, Calvet D, Howard G, et al. Long-term outcomes of stenting and endarterectomy for symptomatic carotid stenosis: a preplanned pooled analysis of individual patient data. Lancet Neurol. 2019; 18 (4): 348–356. https://doi org/10 1016/S1474. 4422; 19: 30028–6.
- Parlani G, De Rango P, Cieri E, et al. Diabetes is not a predictor of outcome for carotid revascularization with stenting as it may be for carotid endarterectomy. J Vasc Surg. 2012; 55(1): 79–89; discussion 88.
- Arquizan C, Trinquart L, Touboul PJ, et al. EVA-3S Investigators. Restenosis is more frequent after carotid stenting than after endarterectomy: the EVA-3S study. Stroke. 2011; 42(4): 1015–1020.
- Brott TG, Halperin JL, Abbara S, et al. ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/ SCAI/SIR/SNIS/SVM/SVS guideline on themanagement of patients with extracranial carotid and vertebral artery disease: executive summary. Vasc Med. 2011; 124(4): 489–532.
