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Carotid angioplasty with stenting versus endarterectomy: 10-year randomized trial in a community hospital.
JACC Cardiovasc Interv. 2014 Feb; 7(2):163-168.JC

Abstract

OBJECTIVES

This single-center, randomized, clinical trial was designed to determine the 10-year comparative efficacy and durability of carotid angioplasty and stenting (CAS) versus carotid endarterectomy (CEA) in preventing ipsilateral ischemic stroke in symptomatic and asymptomatic patients with high-grade carotid artery stenosis.

BACKGROUND

Modern clinical trials with short-term follow-up indicate CAS and CEA are equivalent in reducing the risk for ipsilateral ischemic stroke secondary to carotid stenosis. A paucity of data exists regarding long-term outcomes.

METHODS

Patients of all surgical risks with symptomatic and asymptomatic carotid stenosis (>70%) were randomly selected for CEA or CAS and followed a minimum of 10 years.

RESULTS

Long-term follow-up was achieved in 173 patients (91%). Eighty-seven (50.2%) died within this period, most commonly of nonvascular causes. No difference in the risk of stroke ipsilateral to the treated artery was noted among treatment groups (p > 0.05). Restenosis determined by sequential ultrasound was assessed only in the CAS group (3.3%) and remained asymptomatic. The combined risk of fatal or nonfatal heart attack over the 10-year period was highest in individuals with symptomatic versus asymptomatic stenosis (27.5% vs. 11.0%; hazard ratio [HR]: 2.32, 95% confidence interval [CI]: 1.298 to 4.146, p = 0.005) and was higher in all patients treated with CEA (HR: 2.27, 95% CI: 1.35 to 3.816, p = 0.002).

CONCLUSIONS

Long-term protection against ipsilateral stroke provided by CAS and CEA did not differ in this trial. The 10-year risk of fatal/nonfatal myocardial infarction was highest in all patients harboring symptomatic carotid stenosis at enrollment. The risk of fatal/nonfatal heart attack was significantly more prevalent in those symptomatic or asymptomatic patients randomized to CEA.

Authors+Show Affiliations

Baptist Health Lexington, Lexington, Kentucky. Electronic address: william.brooks@bhsi.com.Baptist Health Lexington, Lexington, Kentucky.Baptist Health Lexington, Lexington, Kentucky.Department of Cardiology, University of Kentucky, Lexington, Kentucky.Baptist Health Lexington, Lexington, Kentucky.Baptist Health Lexington, Lexington, Kentucky.Baptist Health Lexington, Lexington, Kentucky.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

24556095

Citation

Brooks, William H., et al. "Carotid Angioplasty With Stenting Versus Endarterectomy: 10-year Randomized Trial in a Community Hospital." JACC. Cardiovascular Interventions, vol. 7, no. 2, 2014, pp. 163-168.
Brooks WH, Jones MR, Gisler P, et al. Carotid angioplasty with stenting versus endarterectomy: 10-year randomized trial in a community hospital. JACC Cardiovasc Interv. 2014;7(2):163-168.
Brooks, W. H., Jones, M. R., Gisler, P., McClure, R. R., Coleman, T. C., Breathitt, L., & Spear, C. (2014). Carotid angioplasty with stenting versus endarterectomy: 10-year randomized trial in a community hospital. JACC. Cardiovascular Interventions, 7(2), 163-168. https://doi.org/10.1016/j.jcin.2013.09.010
Brooks WH, et al. Carotid Angioplasty With Stenting Versus Endarterectomy: 10-year Randomized Trial in a Community Hospital. JACC Cardiovasc Interv. 2014;7(2):163-168. PubMed PMID: 24556095.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Carotid angioplasty with stenting versus endarterectomy: 10-year randomized trial in a community hospital. AU - Brooks,William H, AU - Jones,Michael R, AU - Gisler,Paula, AU - McClure,Rick R, AU - Coleman,Timothy C, AU - Breathitt,Linda, AU - Spear,Cheryl, PY - 2013/04/09/received PY - 2013/09/10/revised PY - 2013/09/26/accepted PY - 2014/2/22/entrez PY - 2014/2/22/pubmed PY - 2014/10/22/medline KW - 10-year randomized trial KW - carotid endarterectomy KW - carotid stenting KW - prevention of stroke SP - 163 EP - 168 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 7 IS - 2 N2 - OBJECTIVES: This single-center, randomized, clinical trial was designed to determine the 10-year comparative efficacy and durability of carotid angioplasty and stenting (CAS) versus carotid endarterectomy (CEA) in preventing ipsilateral ischemic stroke in symptomatic and asymptomatic patients with high-grade carotid artery stenosis. BACKGROUND: Modern clinical trials with short-term follow-up indicate CAS and CEA are equivalent in reducing the risk for ipsilateral ischemic stroke secondary to carotid stenosis. A paucity of data exists regarding long-term outcomes. METHODS: Patients of all surgical risks with symptomatic and asymptomatic carotid stenosis (>70%) were randomly selected for CEA or CAS and followed a minimum of 10 years. RESULTS: Long-term follow-up was achieved in 173 patients (91%). Eighty-seven (50.2%) died within this period, most commonly of nonvascular causes. No difference in the risk of stroke ipsilateral to the treated artery was noted among treatment groups (p > 0.05). Restenosis determined by sequential ultrasound was assessed only in the CAS group (3.3%) and remained asymptomatic. The combined risk of fatal or nonfatal heart attack over the 10-year period was highest in individuals with symptomatic versus asymptomatic stenosis (27.5% vs. 11.0%; hazard ratio [HR]: 2.32, 95% confidence interval [CI]: 1.298 to 4.146, p = 0.005) and was higher in all patients treated with CEA (HR: 2.27, 95% CI: 1.35 to 3.816, p = 0.002). CONCLUSIONS: Long-term protection against ipsilateral stroke provided by CAS and CEA did not differ in this trial. The 10-year risk of fatal/nonfatal myocardial infarction was highest in all patients harboring symptomatic carotid stenosis at enrollment. The risk of fatal/nonfatal heart attack was significantly more prevalent in those symptomatic or asymptomatic patients randomized to CEA. SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/24556095/Carotid_angioplasty_with_stenting_versus_endarterectomy:_10_year_randomized_trial_in_a_community_hospital_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-8798(13)01810-4 DB - PRIME DP - Unbound Medicine ER -