Outcomes of Stenting versus Endarterectomy for Symptomatic Extracranial Carotid Stenosis: A Retrospective Multicenter Study in Korea

Jayoun Lee, Ji Hye You, Sung Hee Oh, Sangjin Shin, Byung Moon Kim, Tae Sun Kim, Yong Pil Cho, Pyoung Jeon, Hyeonseon Park

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3 Citations (Scopus)

Abstract

Background: The present multicenter retrospective study aimed to compare the outcome of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) among Korean patients with symptomatic extracranial carotid stenosis. Methods: Between January 2008 and December 2011, 677 patients underwent either CAS (346, 51.1%) or CEA (331, 48.9%). The primary end point included the occurrence of major adverse cardiovascular events (MACEs), defined as fatal or nonfatal stroke and myocardial infarction, and all-cause mortality during the periprocedural period and within 4 years after CAS or CEA. Results: Although patients undergoing CAS and CEA did not differ significantly in MACE incidence within 4 years (15.3% vs. 11.5%, P = 0.14), CEA showed lower periprocedural MACE incidence than CAS with clinical significance (6.1% vs. 3.0%, P = 0.06). During the periprocedural period, the incidence of any stroke was significantly higher in patients undergoing CAS (5.5% vs. 2.4%, P = 0.04) but not the incidence of myocardial infarction (0.6% vs. 0.3%, P > 0.99). Kaplan–Meier survival analysis showed similar MACE-free (P = 0.16), stroke-free (P = 0.24), and overall survival (P = 0.25) rates in both groups. On subgroup analysis, patients older than 70 years undergoing CAS had a significantly higher incidence of MACE at 4 years (22.7% vs. 13.7%, P = 0.03). Conclusions: Although the risk of MACE did not differ significantly within 4 years in this Korean population undergoing CAS and CEA, there was a higher risk of stroke with CAS during the periprocedural period.

Original languageEnglish
Pages (from-to)185-192.e1
JournalAnnals of Vascular Surgery
Volume54
DOIs
Publication statusPublished - 2019 Jan

Fingerprint

Endarterectomy
Carotid Stenosis
Korea
Carotid Arteries
Multicenter Studies
Retrospective Studies
Carotid Endarterectomy
Stroke
Incidence
Myocardial Infarction
Survival Analysis
Survival
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Lee, Jayoun ; You, Ji Hye ; Oh, Sung Hee ; Shin, Sangjin ; Kim, Byung Moon ; Kim, Tae Sun ; Cho, Yong Pil ; Jeon, Pyoung ; Park, Hyeonseon. / Outcomes of Stenting versus Endarterectomy for Symptomatic Extracranial Carotid Stenosis : A Retrospective Multicenter Study in Korea. In: Annals of Vascular Surgery. 2019 ; Vol. 54. pp. 185-192.e1.
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title = "Outcomes of Stenting versus Endarterectomy for Symptomatic Extracranial Carotid Stenosis: A Retrospective Multicenter Study in Korea",
abstract = "Background: The present multicenter retrospective study aimed to compare the outcome of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) among Korean patients with symptomatic extracranial carotid stenosis. Methods: Between January 2008 and December 2011, 677 patients underwent either CAS (346, 51.1{\%}) or CEA (331, 48.9{\%}). The primary end point included the occurrence of major adverse cardiovascular events (MACEs), defined as fatal or nonfatal stroke and myocardial infarction, and all-cause mortality during the periprocedural period and within 4 years after CAS or CEA. Results: Although patients undergoing CAS and CEA did not differ significantly in MACE incidence within 4 years (15.3{\%} vs. 11.5{\%}, P = 0.14), CEA showed lower periprocedural MACE incidence than CAS with clinical significance (6.1{\%} vs. 3.0{\%}, P = 0.06). During the periprocedural period, the incidence of any stroke was significantly higher in patients undergoing CAS (5.5{\%} vs. 2.4{\%}, P = 0.04) but not the incidence of myocardial infarction (0.6{\%} vs. 0.3{\%}, P > 0.99). Kaplan–Meier survival analysis showed similar MACE-free (P = 0.16), stroke-free (P = 0.24), and overall survival (P = 0.25) rates in both groups. On subgroup analysis, patients older than 70 years undergoing CAS had a significantly higher incidence of MACE at 4 years (22.7{\%} vs. 13.7{\%}, P = 0.03). Conclusions: Although the risk of MACE did not differ significantly within 4 years in this Korean population undergoing CAS and CEA, there was a higher risk of stroke with CAS during the periprocedural period.",
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Outcomes of Stenting versus Endarterectomy for Symptomatic Extracranial Carotid Stenosis : A Retrospective Multicenter Study in Korea. / Lee, Jayoun; You, Ji Hye; Oh, Sung Hee; Shin, Sangjin; Kim, Byung Moon; Kim, Tae Sun; Cho, Yong Pil; Jeon, Pyoung; Park, Hyeonseon.

In: Annals of Vascular Surgery, Vol. 54, 01.2019, p. 185-192.e1.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes of Stenting versus Endarterectomy for Symptomatic Extracranial Carotid Stenosis

T2 - A Retrospective Multicenter Study in Korea

AU - Lee, Jayoun

AU - You, Ji Hye

AU - Oh, Sung Hee

AU - Shin, Sangjin

AU - Kim, Byung Moon

AU - Kim, Tae Sun

AU - Cho, Yong Pil

AU - Jeon, Pyoung

AU - Park, Hyeonseon

PY - 2019/1

Y1 - 2019/1

N2 - Background: The present multicenter retrospective study aimed to compare the outcome of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) among Korean patients with symptomatic extracranial carotid stenosis. Methods: Between January 2008 and December 2011, 677 patients underwent either CAS (346, 51.1%) or CEA (331, 48.9%). The primary end point included the occurrence of major adverse cardiovascular events (MACEs), defined as fatal or nonfatal stroke and myocardial infarction, and all-cause mortality during the periprocedural period and within 4 years after CAS or CEA. Results: Although patients undergoing CAS and CEA did not differ significantly in MACE incidence within 4 years (15.3% vs. 11.5%, P = 0.14), CEA showed lower periprocedural MACE incidence than CAS with clinical significance (6.1% vs. 3.0%, P = 0.06). During the periprocedural period, the incidence of any stroke was significantly higher in patients undergoing CAS (5.5% vs. 2.4%, P = 0.04) but not the incidence of myocardial infarction (0.6% vs. 0.3%, P > 0.99). Kaplan–Meier survival analysis showed similar MACE-free (P = 0.16), stroke-free (P = 0.24), and overall survival (P = 0.25) rates in both groups. On subgroup analysis, patients older than 70 years undergoing CAS had a significantly higher incidence of MACE at 4 years (22.7% vs. 13.7%, P = 0.03). Conclusions: Although the risk of MACE did not differ significantly within 4 years in this Korean population undergoing CAS and CEA, there was a higher risk of stroke with CAS during the periprocedural period.

AB - Background: The present multicenter retrospective study aimed to compare the outcome of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) among Korean patients with symptomatic extracranial carotid stenosis. Methods: Between January 2008 and December 2011, 677 patients underwent either CAS (346, 51.1%) or CEA (331, 48.9%). The primary end point included the occurrence of major adverse cardiovascular events (MACEs), defined as fatal or nonfatal stroke and myocardial infarction, and all-cause mortality during the periprocedural period and within 4 years after CAS or CEA. Results: Although patients undergoing CAS and CEA did not differ significantly in MACE incidence within 4 years (15.3% vs. 11.5%, P = 0.14), CEA showed lower periprocedural MACE incidence than CAS with clinical significance (6.1% vs. 3.0%, P = 0.06). During the periprocedural period, the incidence of any stroke was significantly higher in patients undergoing CAS (5.5% vs. 2.4%, P = 0.04) but not the incidence of myocardial infarction (0.6% vs. 0.3%, P > 0.99). Kaplan–Meier survival analysis showed similar MACE-free (P = 0.16), stroke-free (P = 0.24), and overall survival (P = 0.25) rates in both groups. On subgroup analysis, patients older than 70 years undergoing CAS had a significantly higher incidence of MACE at 4 years (22.7% vs. 13.7%, P = 0.03). Conclusions: Although the risk of MACE did not differ significantly within 4 years in this Korean population undergoing CAS and CEA, there was a higher risk of stroke with CAS during the periprocedural period.

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