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

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.