Internal carotid artery stenosis – angioplasty with stenting or endarterectomy? A restrospective, single-center, observational study

Abstract

Introduction: This study aimed to investigate the impact of carotid artery stenting(CAS) vs carotid artery endarterectomy(CEA) on outcomes in patients treated for unilateral internal carotid artery(ICA) stenosis.Methods: Between January-2021 and December-2021, 131-patients with stenosed unilateral internal carotid artery undergoing primary isolated internal carotid artery intervention were retrospectively analyzed. Patients were divided into two groups, those who underwent carotid endarterectomy(CEA) (n=87) and those who underwent carotid artery stenting(CAS)(n=44). Propensity score matching (PSM) selected 35 pairs and both groups were comparable for all baseline characteristics and well balanced.Results: In the unmatched cohort, CEA and CAS had comparable long-term outcomes in terms of mortality. Survival at 12, 24 and 36 months was 95.4% vs 95.5%, 92.0% vs 95.5% and 92.0% vs 95.5%, respectively(P Log-rank=0.47). However, CEA was associated with reduced incidence of stroke at follow-up. Freedom from stroke at 12, 24 and 36 months was 98.9% vs 90.9%, 97.6% vs 86.2% and 97.6% vs 86.2%, respectively(P Log-rank=0.011). In the matched cohort, CEA and CAS had comparable long-term outcomes in terms of mortality. Survival at 12, 24 and 36 months was 94.3% vs 94.3%, 91.4% vs 94.3% and 91.4% vs 94.3%, respectively(P Log-rank=0.65). However, CEA was associated with reduced incidence of stroke at follow-up. Freedom from stroke at 12, 24 and 36 months was 100% vs 91.4%, 100% vs 85.5% and 100% vs 85.5%, respectively(P Log-rank =0.024).Conclusions: The present PSM study showed that, in patients with isolated unilateral ICA stenosis, CEA was associated with reduced incidence of stroke compared to CAS.