Real-world experience of extracranial carotid artery interventions for atherosclerotic disease during a 10-year period

BACKGROUND: The aim of this study was to assess the long-term outcome of carotid disease treatment with endarterectomy or stenting (CEA or CAS) in a real-world setting during a 10-year period. METHODS: A single center retrospective study with prospectively collected data including patients (symptomatic or asymptomatic) being treated with CEA or CAS. Survival, restenosis, stroke and major adverse cardiac events (MACE) were the outcomes. RESULTS: A total of 413 patients (mean age of 69±3.5 years; 80%, 333/413 males) were treated with CEA (83.7%, 346/413) or CAS (16.3%, 67/413). Most of the patients were asymptomatic (60%, 248/413). The incidence of in-hospital stroke and death was 0.5% (2/413) and 0.7% (3/413), respectively. The survival rate at 1, 3 and 5 years was 98%, 94.7% and 90.6%, respectively. The freedom of re-stenosis at 1, 3 and 5 years was 99%, 98% and 90.5%, respectively. The freedom of any stroke at 1, 3 and 5 years was 99%, 97% and 94.8%, respectively. The freedom of MACE at 1, 3 and 5 years was 97.6%, 91.5% and 86.3%, respectively. Symptomatic presentation was associated with higher rates of restenosis after CEA and higher rate of mortality (P=0.025) and MACE (P=0.022) after CAS. CONCLUSIONS: Carotid interventions remain durable treatment methods of carotid disease. Long-term outcomes regarding mortality, restenosis, and risk of stroke or MACE are similar between CAS and CEA for asymptomatic patients. Symptomatic presentation may be associated with higher rates of restenosis after CEA and higher rate of mortality and MACE after CAS, however larger studies are needed to clarify this issue.