Jon S Matsumura1, Bret M Hanlon2, Kenneth Rosenfield3, Jenifer H Voeks4, George Howard5, Gary S Roubin6, Thomas G Brott7. 1. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc. Electronic address: matsumura@surgery.wisc.edu. 2. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc. 3. Massachusetts General Hospital, Boston, Mass. 4. Department of Neurology, Medical University of South Carolina, Charleston, SC. 5. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Ala. 6. Cardiovascular Associates of the Southeast, Birmingham, Ala. 7. Mayo Clinic, Jacksonville, Fla.
Abstract
OBJECTIVE: Asymptomatic carotid stenosis is the most frequent indication for carotid endarterectomy (CEA) in the United States. Published trials and guidelines support CEA indications in selected patients with longer projected survival and when periprocedural complications are low. Transfemoral carotid artery stenting with embolic protection (CAS) is a newer treatment option. The objective of this study was to compare outcomes in asymptomatic, nonoctogenarian patients treated with CAS vs CEA. METHODS: Patient-level data was analyzed from 2544 subjects with ≥70% asymptomatic carotid stenosis who were randomized to CAS or CEA in addition to standard medical therapy. One trial enrolled 1091 (548 CAS, 543 CEA) and another enrolled 1453 (1089 CAS, 364 CEA) asymptomatic patients less than 80 years old (upper age eligibility). Independent neurologic assessment and routine cardiac enzyme screening were performed. The prespecified, primary composite endpoint was any stroke, myocardial infarction, or death during the periprocedural period or ipsilateral stroke within 4 years after randomization. RESULTS: There was no significant difference in the primary endpoint between CAS and CEA (5.3% vs 5.1%; hazard ratio, 1.02; 95% confidence interval, 0.7-1.5; P = .91). Periprocedural rates for the components are (CAS vs CEA): any stroke (2.7% vs 1.5%; P = .07), myocardial infarction (0.6% vs 1.7%; P = .01), death (0.1% vs 0.2%; P = .62), and any stroke or death (2.7% vs 1.6%; P = .07). After this period, the rates of ipsilateral stroke were similar (2.3% vs 2.2%; P = .97). CONCLUSIONS: In a pooled analysis of two large randomized trials of CAS and CEA in asymptomatic, nonoctogenarian patients, CAS achieves comparable short- and long-term results to CEA.
OBJECTIVE: Asymptomatic carotid stenosis is the most frequent indication for carotid endarterectomy (CEA) in the United States. Published trials and guidelines support CEA indications in selected patients with longer projected survival and when periprocedural complications are low. Transfemoral carotid artery stenting with embolic protection (CAS) is a newer treatment option. The objective of this study was to compare outcomes in asymptomatic, nonoctogenarian patients treated with CAS vs CEA. METHODS: Patient-level data was analyzed from 2544 subjects with ≥70% asymptomatic carotid stenosis who were randomized to CAS or CEA in addition to standard medical therapy. One trial enrolled 1091 (548 CAS, 543 CEA) and another enrolled 1453 (1089 CAS, 364 CEA) asymptomatic patients less than 80 years old (upper age eligibility). Independent neurologic assessment and routine cardiac enzyme screening were performed. The prespecified, primary composite endpoint was any stroke, myocardial infarction, or death during the periprocedural period or ipsilateral stroke within 4 years after randomization. RESULTS: There was no significant difference in the primary endpoint between CAS and CEA (5.3% vs 5.1%; hazard ratio, 1.02; 95% confidence interval, 0.7-1.5; P = .91). Periprocedural rates for the components are (CAS vs CEA): any stroke (2.7% vs 1.5%; P = .07), myocardial infarction (0.6% vs 1.7%; P = .01), death (0.1% vs 0.2%; P = .62), and any stroke or death (2.7% vs 1.6%; P = .07). After this period, the rates of ipsilateral stroke were similar (2.3% vs 2.2%; P = .97). CONCLUSIONS: In a pooled analysis of two large randomized trials of CAS and CEA in asymptomatic, nonoctogenarian patients, CAS achieves comparable short- and long-term results to CEA.
Authors: Hans-Henning Eckstein; Peter Ringleb; Jens-Rainer Allenberg; Jürgen Berger; Gustav Fraedrich; Werner Hacke; Michael Hennerici; Robert Stingele; Jens Fiehler; Hermann Zeumer; Olav Jansen Journal: Lancet Neurol Date: 2008-09-05 Impact factor: 44.182
Authors: Giampaolo Greco; Natalia Nickolayevna Egorova; Alan Jay Moskowitz; Annetine Christine Gelijns; K Craig Kent; Andrew Joseph Manganaro; Robert Matthew Zwolak; Thomas Stewart Riles Journal: Ann Surg Date: 2013-06 Impact factor: 12.969
Authors: A R Naylor; J-B Ricco; G J de Borst; S Debus; J de Haro; A Halliday; G Hamilton; J Kakisis; S Kakkos; S Lepidi; H S Markus; D J McCabe; J Roy; H Sillesen; J C van den Berg; F Vermassen; P Kolh; N Chakfe; R J Hinchliffe; I Koncar; J S Lindholt; M Vega de Ceniga; F Verzini; J Archie; S Bellmunt; A Chaudhuri; M Koelemay; A-K Lindahl; F Padberg; M Venermo Journal: Eur J Vasc Endovasc Surg Date: 2017-08-26 Impact factor: 7.069
Authors: Joseph L Blackshear; Donald E Cutlip; Gary S Roubin; Michael D Hill; Pierre P Leimgruber; Richard J Begg; David J Cohen; John F Eidt; Craig R Narins; Ronald J Prineas; Stephen P Glasser; Jenifer H Voeks; Thomas G Brott Journal: Circulation Date: 2011-05-23 Impact factor: 29.690
Authors: Kristina A Giles; Allen D Hamdan; Frank B Pomposelli; Mark C Wyers; Marc L Schermerhorn Journal: J Vasc Surg Date: 2010-09-22 Impact factor: 4.268
Authors: Jörg Ederle; Joanna Dobson; Roland L Featherstone; Leo H Bonati; H Bart van der Worp; Gert J de Borst; T Hauw Lo; Peter Gaines; Paul J Dorman; Sumaira Macdonald; Philippe A Lyrer; Johanna M Hendriks; Charles McCollum; Paul J Nederkoorn; Martin M Brown Journal: Lancet Date: 2010-02-25 Impact factor: 79.321