Perioperative and follow-up results of Carotid Artery Stenting and Carotid Endarterectomy in Patients with carotid near-occlusion

Background The aim was to compare perioperative and follow-up results of carotid artery stenting (CAS) and carotid endarterectomy (CEA) in patients with carotid near-occlusion (NO). Methods A retrospective analysis was conducted from January 2012 to June 2017 on consecutive patients with NO in our center. Perioperative complications, recurrence rate of ischemic stroke, restenosis rate, and mortality in follow-up were compared between the CAS group and CEA group. Results 92 patients (CAS group, 54 and CEA group, 38) were identified. Perioperative (30-day) results were as follows: the rate of new lesions on diffusion-weighted imaging (DWI) was higher in the CAS group ( n  = 31, 57.4%) than in the CEA group ( n  = 13, 34.2%) ( P  = 0.03); no differences were found in ischemic stroke, transient ischemic attack (TIA), cardiac infarction, and death rate between the two groups. Results from follow-up with a mean period of 28.3 (range from 3 to 60) months were as follows: the restenosis rate was lower in the CAS group ( n  = 1, 1.8%) than the CEA group ( n  = 4, 10.5%) ( P  = 0.04); no differences were found in ischemic stroke, TIA, and the death rate between the two groups. Kaplan–Meier survival curves showed that the five-year survival rate was 85.8% of the CAS group and 82.7% of the CEA group ( P  = 0.61); the five-year rate of freedom from target-lesion restenosis was 93.3% of the CAS group and 80.4% of the CEA group ( P  = 0.02). Conclusions Both CAS and CEA can be used for carotid NO with the same rate of TIA/stroke and long-term survival. The rate of new lesions on DWI after CAS was higher than that in CEA in the perioperative period. CAS had a lower restenosis rate than CEA in follow-up, which might be more beneficial for remodeling of the distal internal carotid artery.