Carotid artery stenting vs. carotid endarterectomy: a comparative non-randomized study in two university hospitals

BACKGROUND: Due to the inconclusive evidence on the definitive role of carotid artery stenting (CAS), we aimed to present our results regarding the role and safety of CAS, compared to carotid endarterectomy (CEA), in treating carotid artery atherosclerotic lesions, when carried out by university vascular surgeons. METHODS: The study was conducted during the period 2010-2013, in 2 of Damascus university hospitals. 116 carotid stenosis' patients were treated (71 with CEA and 45 with CAS), in accordance with American Heart Association recommendations. Informed consent was obtained from all patients. A comparative non-randomized study was conducted with 18 months' follow-up period. The composite end point included the sum of all stroke, myocardial infarction (MI) and mortality cases up to 30 days post intervention and any ipsilateral stroke thereafter. The study power was 75%. with a moderate size effect (h=0.5). Chi squared tests were used for all study comparisons with alpha=5%. RESULTS: When comparing the 2 procedures, there was no overall statistical difference between CEA and CAS except for severe hypotension and bradycardia occurring in 22.2% in CAS vs 7% in CEA (P=0.024); this was more obvious when CEA was associated with same day cardiac surgery (17.9%). In addition, the perioperative (up to 30 days) stroke, MI and mortality rate was higher in same day CEA and cardiac surgery procedure (12.8%) than in CAS (2.2%) or CEA alone (0%) (P=0.026). Finally, 7.7% of CEA group (0% of CEA alone and 14.3% of same day CEA and cardiac surgery) vs. 2.3% of CAS group had the composite end point during 18 months' follow-up, without reaching statistically significant difference. CONCLUSIONS: Same day CEA and cardiac procedure or CAS procedure alone had both higher peri intervention stroke, MI and mortality rate than CEA alone; but with no significant difference during follow-up. Further study with longer follow-up and a medical treatment arm is recommended.