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Outcomes for Carotid Stenting, Endarterectomy Similar in Patients With Prior Carotid Stenting
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In a cohort of patients who previously had ipsilateral carotid artery stenting, there was no difference in outcomes between those who underwent repeat carotid stenting and those who underwent endarterectomy, researchers reported.
The researchers analyzed 474 patients from the Vascular Quality Initiative database who underwent carotid endarterectomy or stenting between January 2003 and April 2015 after previous carotid stenting. Isibor Arhuidese, MD, from Johns Hopkins Hospital, presented the findings at the Society of Vascular Surgery 2016 Vascular Annual Meeting.
According to the researchers, 20% of the cohort underwent endarterectomy and 80% underwent repeat carotid stenting. There were no significant differences between the groups in age, sex, race, symptomatic status, hypertension prevalence, diabetes prevalence, CAD, congestive HF or current smoking (P > .05 for all).
At 30 days, the rate of stroke or death in asymptomatic patients was 4.8% in the endarterectomy group and 0.4% in the stenting group (P = .01), whereas in symptomatic patients, the rates were 0% in the endarterectomy group and 4.7% in the stenting group (P = .21), according to the researchers.
Perioperative MI was 3.2% in the endarterectomy group and 1.1% in the stenting group (P = .13), Arhuidese and colleagues found.
In the overall cohort, after adjustment for symptomatic status and medical characteristics, there were no significant differences between the groups in stroke or death at 30 days (OR = 0.74; 95% CI, 0.11-5.05) or at 1 year (OR = 0.92; 95% CI, 0.38-2.23), according to the researchers.
Arhuidese and colleagues determined the following characteristics were independent predictors of stroke or death: older age (HR = 1.09; 95% CI, 1.05-1.14), diabetes (OR = 2.2; 95% CI, 1.2-4.1) and active smoking (HR = 2.3; 95% CI, 1.1-4.7).
“Tight management of diabetes and smoking cessation remain potent targets for improving overall outcomes in these patients,” Arhuidese and colleagues wrote in an abstract. – by Erik Swain
Reference:
Arhuidese I, et al. Plenary Session 5: SS22. Presented at: Society of Vascular Surgery 2016 Vascular Annual Meeting; June 8-11, 2016; National Harbor, Md.
Disclosure: Arhuidese reports no relevant financial disclosures.
Perspective
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Christopher J. Kwolek, MD
This is a unique and important study, but we have to be careful about drawing conclusions from it. In asymptomatic patients with prior carotid stenting, the rate of 30-day stroke or death was 4.8% in the endarterectomy group vs. 0.4% in the stenting group, which suggests that if we focus on stroke or death, repeat carotid angioplasty may be safer. In the symptomatic cohort, the results were reversed and endarterectomy was safer. However, the sample size, particularly in the symptomatic patient cohort, is small, and there is a lot of information we don’t have, including the equipment used and whether there was cranial nerve injury. We need more people to publish and present their data on this topic.
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